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.
(The section of the Controlled Substances Act that governs the dispensation of Schedule II drugs is
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