Monday, November 28, 2011

ADHD Medication and Federal Law: Why Is It Such A Hassle To Get My Medications?

A few weeks ago, Mo over at Milligrams asked me to write a post on ADHD.  I realized that responding to his comment on my post actually required a series of several more posts.

Today's post addresses is actually one in a sub-series, concerning the legal issues that pertain to ADD medication.   This post United States covers federal drug laws, which operate under the United States Federal Controlled Substances Act.  When you're having trouble finding treatment for your adult ADHD, it pretty much comes down to the Controlled Substances Act.  That's why I'm beginning my series with this topic, even though it's rather dry.

*** Today's post concerns federal law and how it affects the simple act of filling your prescription.  I will begin with a brief overview of the classification of ADD medications under the federal Controlled Substances Act.  I will define the term"Schedule II medication".  I will go on to describe what that classification means when it comes to filling prescriptions ADHD meds.

As always, this long and complicated post is broken up into sections which are named in bold.  I will recap the main points of my post at the end.

And because it makes me feel better to write it, even though I'm sure you know better, I want to make it clear that I am not a lawyer, and this post should in now way be construed as legal advice. ***

The United States Controlled Substances Act: Schedule II

By and large, medications for ADHD are psychostimulants, and they generally fall into one of two categories: amphetamines and methylphenidate.  Under the US Controlled Substances Act of 1970, these drugs were designated as Schedule II controlled substances.  Schedule II includes any medication that has a high potential for abuse and addiction.  To put this in some context, other meds in this category include cocaine and opium.  

(To put it in even more context, the only class of medications that is more restrictive is Schedule I.  Schedule I drugs have no recognized medicinal purpose in the US and can only be used for research.  An example of a Schedule I drug is heroin.)

Notice the bold font I used up there, in the section on Schedule II? I wanted to make the point that this is some serious sh*t. 

As you might imagine, Schedule II drugs are tightly regulated by the feds.  But that's not the only set of laws that regulates these meds.  The Controlled Substances Act permits states to enact whatever regulations they want to regarding a controlled substance -- as long as those state regulations are even more stringent than federal law. I'll get into that in a later post.

What Does the Schedule II Classification Mean for Filling Prescriptions of ADD Medications?

Obviously, any prescription medication needs a prescription from a practitioner order to be dispensed -- otherwise, it wouldn't be a prescription med.  Where Schedule II medications differ from other meds is how the scrip can be transmitted to the pharmacy, and how many refills are allowed.  Unlike other, less regulated medications, Schedule II drugs are subject to the following rules.  And these are just the rules that pertain to pharmacists:
  • Schedule II drugs cannot be dispensed without a written prescription from a medical practitioner.  There are two exceptions to this:
    • The prescribing doctor is the one giving you the meds, and is you're the end user.  In other words, your pdoc can give you free samples of Medication X  -- if you are the person who will be taking the medication -- to make sure the medication is effective, you can tolerate it, etc, before you pay for a whole month's prescription.  Basically this means that you have to be an adult patient.  Your child's pdoc can't give you free samples on behalf of your kid, because you're not the end user.  And you can't just go giving drug samples to kids.
    • It is a medical emergency, in which case oral permission from a practitioner is sufficient.
  • There can be no refills of a Schedule II medication.
In short: None of the conveniences available for other prescriptions are available in the case of a Schedule II.  You have to have a written scrip -- your doctor cannot phone it or fax it in.  And when it comes time to refill?  You have to bring in a whole, brand-new, written prescription.

(The section of the Controlled Substances Act that governs the dispensation of Schedule II drugs is
Title 21 > Chapter 13 > Subchapter I > Part C > Section 829.  It can be found at on the website at the Cornell University Law School.  Go on, click on it.  It's exciting!  Besides, all the cool kids are doing it.)

What Do Schedule II Dispensation Rules Mean For Patients With ADHD?
Reading the last paragraph, it might sound like federal law requires people with ADD to see their psychiatrists once a month just to keep taking their prescribed medication.  Sounds like a major inconvenience, doesn't it? Is this really the case? Well, that depends.

Prescribing Schedule II Drugs Under California State Law:

In California, the answer  -- from a legal perpective at least -- is NO.  Granted, some pdocs might prefer to check in with their patients on a monthly basis, sometimes for good reasons, and sometimes for bad ones (more on that later).  But as far as the law in concerned, psychiatrists can write multiple prescriptions for a Schedule II medication and post-date them.

This is what my pdoc does.  By this point he knows me and trusts me, so I see him once every three months for a med check/depression check, and he then he writes three scrips with an "OK to fill after [this date]" notation.  That being said, he saw me once a month at the beginning; partly this was to check in with the meds, and (though he didn't say this outright) to make sure I wasn't tweaking. 

Other doctors like to see their patients once a month regardless.  It's not their legal obligation; they just feel more comfortable checking in more often.  Or, in some cases, they might prefer to bill the insurance company a monthly fee, and make more money than they would by seeing the patient every three months.

Again, this is the case in California, and if you live in another state the situation might be completely different.  Even so, when it comes to prescribing Schedule II's, doctors can impose all kinds of restrictions on their patients.  But that's a topic for another post.

To recap for my ADHD readers who just skimmed this post (and if I hadn't written it, believe me that's what I would have done):
  • ADD meds are placed in Schedule II under the Controlled Substances Act, along with drugs like opium and cocaine.
  • Schedule II substances require a written prescription, with a few exceptions (such as emergencies)
  • Schedule II substances cannot be refilled
  • Some doctors require monthly visits from their ADHD patients in order to give them the written scrip
  • In some states, this is the law; in others, it's the doctor's personal preference
The next post in this series discusses drug laws and the impact they have on prescribing doctors.  The third post is about what it's like to live under these laws.


  1. May I have the name of the doctor you use? Ive been on the same adhd medication at the same dose since I was 17 (I turned 30 this month). I was diagnosed at 9 by qualified professionals at a children's hospital. Im tired of being treated suspiciously or disresptfullu by doctors just because I have adhd and take adhd medicine ( of course safely, responsibly as directed for the past decade+).

    I'm trying to find more compassionate, reasonable doctors, and your doctor sounds like that. Do you have an email I could write you at?

  2. Nice post....ADHD is a psychiatric disorder usually diagnosed during childhood. Children with ADHD are often hyperactive (overactive) and have difficulty paying attention and staying focused on tasks.ADHD Medicine

  3. I was put threw a non-medication intervention program which caused me to be constantly bullied threw elementary, middle and high school, their best method to help me focus on tasks at hand was by simply saying very loudly, Pay Attention which I believe may have caused me to develop timid or shy like behavior at times. along with other negative behavioral development issues which I have been for the most part have been able to overcome with minor impulsive flare ups I seem to do alright however other people who do not understand phycology and what its like to have this condition and how it can effect other people in different ways. however I'm 27 years old now I was just recently started on adhd medication about 3 months ago, they started me on 10 mgs of methylphenidate for a month and a half after 2 or 3 weeks I made an appointment to see the doctor do to still having serious problems focusing on my work duties and my driving to and from work. my most recent visit to the urgent care room today after complaining that my medication wasn't working very well and after being in fear that I may potentially unintentionally harm myself or someone else at work I still received no treatment and was only told too go to work tomorrow only wait until after I got to work at 7 or 7:30 and span my medication out to make it last the whole day when I could potentially walk out in front of a forklift at work or see a interesting look cloud in the sky on my drive home and stare at it for a little while. and accidently wreck my vehicle or kill myself at work I don't know I ve been to 4 different medical facilities complaining about my medication complications and they all said I would not be able to receive proper dosing for adhd medication until I see a psychiatrist next week when I have been complaining about this issue and my attention span needs for basically my whole life I cannot even get a work excuse to miss work until I see a psychiatrist. I was injured last year and I believe that maybe hitting my head may have increased my conditions also I was diagnosed with nothing wrong with me after being struck in the back as a child by an older school bully during recess hours at school. having severe back pain my whole life with adhd and no supervision and doing nothing but hard dangerous manual labor for barely any money my whole life I began self medicating my self for all the anxiety and pain and stress hyper tension issues as a teen after receiving no help from health care providers my whole life and still not receiving the proper medication dosing, I come to think and wonder what may be the underlying reason why our youth today may be having mixed feelings about joining organizations with ill intents. after observing youths behavior and understanding how youth may be easily influenced to do things especially ones with underlying mental health issues I do believe may be a serious factor in economical collapse and downfall of todays societies. I believe fear generating fear do too significant multi media news spans and messaging systems may be causing physicians to develop abnormal psychological paranoid tendencies. I believe some of these doctors may be suffering from underlying mental behavioral tendencies preventing them from being able to make proper decisions as far as being able to trust there patients for fear of being sued or fired or the basic fear of rejection may cause them to make impulsive rash hyper paranoid decisions based of possibly the way a person looks as far as physical traits or body language movements. physicians seem to forget that psychiatric diagnosis of behavioral health in people can only be done by observing a persons behavior for a long period of time there is a difference between having a reason to being paranoid and being paranoid for no reason.


What are your thoughts? Talk amongst yourselves!