How do you respond to early refill requests for stimulants in stable patients who report lost or stolen medication?
How do you balance preserving the therapeutic alliance while ensuring appropriate risk mitigation?
Answer from: at Academic Institution
I do not refill stimulants when they are reported lost or stolen.
When starting a treatment course of stimulants with a patient, I review a brief list of instructions and expectations. For stimulants, this includes that it is their responsibility to store and protect their medication from the...
Comments
at Steven A. Fayer MD PC Agree there is much abuse of stimulants, and they ...
at R Michael Prudent LLC I agree with all of the above. That said, I am awa...
at DHCS I wish all psychiatrists followed the same practic...
at Donna Lohmann, MD, PLLC It very much depends upon the patient. Most of my ...
at Private Practice In residency, I had a mother say that she had lost...
at Central Michigan University Totally agree with what Dr. @RachBeisel has writte...
For me, the key is at the onset of forming an alliance. The doctor and patient agree that stimulants are powerful tools in our armamentarium to manage the core ADHD symptoms. Emphasis on special features of this treatment modality is made at the first visit, which includes special precautions for co...
Definitely a case-by-case thing for me. In our clinic, patients sign a controlled substance agreement, and I review these parameters with them. I will often refill enough medication to get a patient to their next appointment and schedule them to come into the clinic as soon as possible. We discuss t...
I tell the patient they are entitled to "one lost stimulant prescription per lifetime." This communicates a firm boundary and a bit of helpful humor. It has served well.
Vacation early-refills are infrequent in my practice, and I simply type the rationale in the e-prescription. If it requires inter...
Agree with the comments, though I believe the approach should be both cautious and individualized. A thorough initial discussion and/or controlled substances contract, and more caution is often very helpful, especially with the younger adult demographic, where diversion is more common. I typically a...
Comments
at Thapar Renu K Office An initial evaluation of the patient to know the p...
I explain to patients when they start treatment with stimulants that they are responsible for their medications. I will not do a refill for “lost or stolen” medications under any circumstances. That results in a few requests for an exception. The occasional request is denied.
Depends upon the severity of ADHD and comorbidities. My usual answer is to wait until next due, but I can refill if in rare, genuine non-repeat cases without active family members with addiction.
Comments
at Hammerbeck Behavorial Medicine After treating adults with ADHD for over 30 years,...
Agree there is much abuse of stimulants, and they ...
I agree with all of the above. That said, I am awa...
I wish all psychiatrists followed the same practic...
It very much depends upon the patient. Most of my ...
In residency, I had a mother say that she had lost...
Totally agree with what Dr. @RachBeisel has writte...