Here are the five primary challenges associated with stimulant medications, along with some potential strategies for addressing them.
Stimulant medications for ADHD, such as Adderall and Ritalin, are classified as controlled substances. This classification, overseen by the Drug Enforcement Agency (DEA) and state licensing bodies, aims to curb illegal sales and misuse. These regulatory measures are designed to prevent unethical prescribing practices and excessive use of these drugs. However, drawing from my personal experiences with pharmacies and ADHD prescribers, I can attest to the complexities these regulations add to the treatment process.
Even my long-standing ADHD patients, who are on effective and finely-tuned treatment plans, frequently cite the top issues they face as the erratic availability of medication and logistical problems with pharmacies. These challenges have become increasingly intricate in the past year due to ongoing shortages of stimulant medications.
Ironically (and frustratingly), the standard treatment for this condition that impairs planning, organization, and perception of time is a highly regulated Schedule 2 controlled substance. This situation often feels like we are penalized for having ADHD and the minor errors or lapses in memory that come with having ADHD. After extensive research into these prevalent issues, we are committed to finding and implementing practical solutions to make these challenges more manageable.
Schedule II controlled substances, which include many ADHD medications, cannot be refilled. Instead, prescribers must write 2 or 3 separate “post-dated” prescriptions in order for you to receive a 2-month or 3-month supply of your medication. Post-dated means your first 30-day prescription will be available immediately (as long as it has been at least 28 days from the date you last picked up the exact dosage from your pharmacy). The second and/or third prescriptions will not be able to be filled right away because they will have an “earliest fill date” label on them that is post-dated to 28 days from the day you last received that same prescription.
According to DEA rules, stimulant prescriptions cannot have refills. So, even when your doctor sends several months' worth of prescriptions, each bottle will say "no refills."
This also means:
A prescription for a Schedule II controlled substance can't be filled more than 90 days after it's issued. This means that your doctor cannot prescribe a six month supply, as they can with your blood pressure medication. Patients will often meet with us every 2-4 weeks during medication trials, then every month until stable, and then we transition into the “maintenance phase,” where we meet every 3 months (4 times a year). This is the longest we are legally able to go without a visit to check in on how you are doing with your psychiatrist.
If you don't use your medication daily, you might want to pick up your second prescription after 28 days anyway, even if you’re not out of pills yet. This is because controlled substance prescriptions can expire after 90 days, meaning you won't be able to fill it and will need to set up another appointment to receive new prescriptions, possibly before your next visit was scheduled. This can create problems when our schedule is booked out for weeks because these situations are typically unexpected.