Frequency of follow up visits for controlled meds

[SpongeBob DoctorPants]

I've tried searching for any specific laws regarding the frequency of follow up visits which may be required for someone to receive a prescription for a controlled substance, but couldn't find anything. Is it just up to the individual prescriber to set their own policy on this? In particular, I am wondering about stimulants since I work mostly with kids.

In training I had been taught that a follow up was required every 3 months for someone on a stimulant, but later I had learned of stimulants being prescribed to patients with a visit only every 6 months. (Because stimulants can only legally be prescribed for up to 90 days, patients would get three 30-day scripts, and then get three more scripts when those run out.)

The AACAP practice parameter for ADHD does not set forth any firm requirements, but states that "significant contact with the clinician should typically occur two to four times per year in cases of uncomplicated ADHD". It further states, "Nothing in this parameter should be construed as justification for ... regarding more limited contact by the clinician as substandard when clinical evidence documents that the patient is functioning well." To me, this suggests that there is no requirement to see a patient within a specified time frame in order for them to receive a prescription, even if it has been more than 6 months since their last visit.

Is my understanding of this correct? Or is there actually some law out there requiring a minimum office visit frequency, which I just haven't been able to find?

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[TexasPhysician]

The DEA does not practice medicine by specifying exactly how to practice. To stay out of their vision though, I would consider the fact that they specify 90 days of controlled meds at max as a big hint.

 

[Bartelby]

I no longer work in outpatient, but when I did three months was our limit for stimulants. Of course, think beforehand about whether you will renew beyond that when they miss their three month followup, and whether you need to space appointments more closely if that happens often.

 

[SpongeBob DoctorPants]

Thank you for the excellent replies. This is very helpful, as it gives me an idea of what others are doing, or what might possibly be considered standard of care. In training, I do recall many of our stable patients on stimulants coming in every 3 months for the most part, but this subject was never formally discussed.

When I first learned that six month follow ups might be appropriate, this was actually involving the case of my own child who was being treated for ADHD, and the doctor said 3 months was no longer necessary and instead suggested every 6 months. I wonder if this might have been simply because I was a psychiatry resident/fellow and the doctor felt we were more reliable than most. Whatever the reasoning might have been, this led me to think that 6 months would be appropriate for other stable patients as well.

For what it's worth, the AACAP practice parameter I quoted above does state that seeing patients twice a year is acceptable for uncomplicated ADHD, but after rereading it, I realize this statement makes no reference to the use of stimulants (and of course, ADHD can be managed without stimulants).

 

[futuredo32]

In residency we were taught 3 months for any meds minimum. I follow that.

 

[NickNaylor]

For stable patients for which I have little to no concern for misuse/abuse, I will go up to 2 months. For most other patients, I will only provide 30-day fills of controlled substances. This isn't based on anything and is probably overly conservative, but nevertheless is how I've done things with my clinic patients.

 

[SpongeBob DoctorPants]

Thanks for the input. It is nice to know what others are doing. I suppose my tendency toward longer intervals between visits stems from my fellowship training experience, where we had a very busy child & adolescent clinic and it was often difficult to get a follow up scheduled within 3 months, just because the clinic schedule was too full. When I saw adult patients in residency, we would also increase the time between visits as patients got better, and once we were seeing someone every 6 months, they were considered stable enough for discharge.