Honestly, why do some many Psychiatrists not like CAP

[PikminOC]

In prisons, seroquel, trazodone, Wellbutrin, Benadryl, and many other meds have value and are floating around.

In high schools, cough medicine and cleaning solvents are abused.

Should we ban all of those?

Pill counts? That is a waste of time. Do you do this with lisinopril to ensure compliance? If the patient abused lisinopril and replaced the pills with a different pill altogether, are you familiar enough with all generic sizes and colors of lisinopril to ensure they weren’t all switched?

There is no indication to drug screen the average patient much like there is no reason to do full body MRI’s. You won’t find out how many the patient took via drug screen and if anything, you’ll discover a lack of abuse when patients forget to take it.

We have tons of data that we are under-treating ADHD and that stims reduce the risk of substance abuse overall.

Are there some clinics that make it too easy to get them? Sure. Just like there are too many urgent cares giving out abx for viral issues. We will never achieve med perfection, but the overall benefit with stims far outweighs negatives.

Not all the things you are referring to are traced back to a physician license.

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[PikminOC]

You have been asking for research on this thread to back up claims and other posters have provided it.

Please provide data demonstrating that pill counts and drug screens should be utilized on every C2 patient including how they reduce risk of illicit drug use and diversion.

I drug screen patients when concerns arise.

I've attached the Texas pain society recommendation on a previous post

 

[PikminOC]

So how many other stimulants used in other countries where Adderall is banned? Enlighten me

Know Before You Go: International Travel with ADHD Medications - CHADD

Do you plan to travel out of the United States, either for business or on vacation? Before you go, you need to reach out to both the US Department of State and the embassy of the country you plan to visit if you intend to take your ADHD medication with you. “Travelers should not assume…

chadd.org

Still waiting for more info on this as I was called illiterate

 

[TexasPhysician]

I've attached the Texas pain society recommendation on a previous post

Your link is related to chronic opioid management. That is a different subject altogether. Where is the evidence related to stimulants, ADHD best practices, or all C2’s as you specified?

 

[PikminOC]

Your link is related to chronic opioid management. That is a different subject altogether. Where is the evidence related to stimulants, ADHD best practices, or all C2’s as you specified?

My states are not differentiating this. Neither is the DEA as they are the same class with the same risk of diversion and abuse.

 

[TexasPhysician]

My states are not differentiating this. Neither is the DEA as they are the same class with the same risk of diversion and abuse.

There is no data to back up your claims beyond a DEA classification?

My state says I can’t Rx Tramadol a few times to a patient without registering as a chronic pain clinic. Tramadol is schedule IV, but the barriers for me are 1000% higher than stimulants. My state doesn’t seem to agree that class 2 is higher risk than class 4 then. It views all opioids and opioid like meds to be higher risk than all non-opioid meds regardless of federal class.

By your argument of made-up rules and classifications are above actual data, stimulants are not even at the same level of risk as Tramadol (class 4). Pill counts for meds with fewer barriers than Tramadol is a waste of physician time and resources.

 

[VA Hopeful Dr]

If they're building up a supply they don't need it for true ADHD. And people find any ways to abuse stimulants too

Horse hockey.

One of my kids is on stimulants. We can get "refills" every 28 days. That's an extra 2 pills per 30 days. Doing this for the 10 months (minus a several day delay at one point due to supply issues) has built up around an extra 10ish pills.

 

[Stagg737]

Do patients lie? I thought benzos were schedule 4.
They are both dea classified and the same steps should be taken with each, starting with the drug screen prior to starting and during treatment
Why do you need a drug test for ADHD meds?


Such screenings are designed to check if ADHD patients are safely taking their pills, such as Adderall, and not selling them, taking too many, or using other drugs.Mar 25, 2023

It's incredibly easy to manipulate a UDS, especially for meds/substances with short half lives like stimulants and some benzos. I don't have anything against people getting a UDS on patients when warranted, I just find the utility to be exaggerated in many cases and some guidelines to be unnecessarily restrictive. Also, you have no way to know if they're really abusing them or not if the screen is positive unless you get a quantitative screen, which I've never seen at any of the places I've worked.

 

[calvnandhobbs68]

If they're building up a supply they don't need it for true ADHD. And people find any ways to abuse stimulants too

I really don't think you even know what you're arguing for or against at this point. The point of a pill count would be to try to "catch" people who are overusing or selling their medication because they wouldn't be able to come up with the amount of pills expected. However, it is extremely easy to beat a pill count using the various methods I outlined....so whether "building up a supply" has anything to do with having "true ADHD" or not doesn't even matter.

Based on your various responses I don't know if you have a great grasp of what various "schedules" of medications truly mean either in relation to actual abuse potential or what actual abuse patterns look like for various drugs at risk of abuse or diversion.

 

[aquatic ape]

Haven’t read the whole thread, surprised it generated so much discussion. My 2 cents is that under the bio psycho social model, kids can lean very heavily social and bio, and their social elements aren’t fixable through any agency of their own.

If you are split between peds and CAP then 100% go CAP. You can make 2-3x the salary. Money isn’t everything, but pediatricians are so poorly paid

 

[PikminOC]

All I know is that many doctors in my state were brought up controlled sub prescriptions, and this included stims. The outcomes were that these meds were treated the same.

And I don't let people fill every 28 days.

We will have to agree to disagree. And since this is going on circles it's better to get back on track of this original thread topic.

 

[ObsequiousAplomb]

Still waiting for more info on this as I was called illiterate

Your response continues to demonstrate poor literacy. Re-read what I said and then come back with a real question. I already told you several other drugs that are prescribed in other countries. Believe it or not, a doctor in the US doesn't know all the dozens of psychiatric drugs that exist solely in Russia. Does the fact they are available in Russia and not the US automatically mean they are just as bad as Adderall? Someone with your literacy probably also doesn't think this rationally when there's an opportunity to harm a patient by withholding treatment from a suffering patient.


Also, just fyi, ALL prescription medications are "scheduled by the DEA." So if in your mind a C4 and a C2n require the same monitoring, does a C5 or C6 also have this bizarre, idiosyncratic "sameness" ?

 

[PikminOC]

I rarely give out c2 stims or c4 benzos or zdrugs. I do the same monitoring for both of them.

I do not know of DEA class 6 meds. Sertraline is not DEA classified. Drug Scheduling

 

[PikminOC]

Prescription Stimulant Addiction Statistics

About 5 million people (2.1% of adults) in the U.S. misuse prescription stimulants. These stimulants are only intended to be used by doctor’s instruction to treat ADHD (attention deficit hyperactivity disorder), narcolepsy, and occasionally depression. Prescription stimulants usually come in...

www.addictionhelp.com

 

[Psychiater]

I rarely give out c2 stims or c4 benzos or zdrugs. I do the same monitoring for both of them.

I do not know of DEA class 6 meds. Sertraline is not DEA classified. Drug Scheduling

DEA schedules are I-V, though some states have a separate “schedule VI” for all other non-DEA-scheduled but prescription only medications (Massachusetts comes to mind) or “other substances of abuse” (North Carolina and Virginia come to mind.)

 

[PikminOC]

DEA schedules are I-V, though some states have a separate “schedule VI” for all other non-DEA-scheduled but prescription only medications (Massachusetts comes to mind) or “other substances of abuse” (North Carolina and Virginia come to mind.)

So for schedule 2 to 4. I am strict. I don't prescribe the other ones. And my state doesn't have a 6