Lost prescription for ADHD medication and psychiatrist won't replace
May 1, 2015 10:59 PM Subscribe
Help!! My psychiatrist won't replace the Vyvanse prescription she just wrote me two days ago, which I accidentally threw out yesterday, and had not filled yet. Pharmacies will only accept a written prescription. Please help me solve this by next Friday when I run out of meds. I'm in Tennessee and this has the potential to destroy my performance at work for the next 2 months.
I've only been taking it for a few weeks and it has helped me SO much at my extremely stressful job. Now I'm facing not having it for two months (since she wrote 2 months worth of prescriptions) and am literally in my office crying with the door closed about having things go back to the way they were before. I was so stressed all the time because it was so hard to stay organized. I had not been treating my ADHD for a while because I disliked the meds I had tried before.
Important details:
-I live in Nashville, TN
-Pharmacies only accept a written prescription
-I don't have a primary care or any other physician--moved here 9 months ago and hadn't gotten around to it
-I'm bipolar and have ADHD, in my experience I've had PCP's refuse to touch those issues
Questions:
-How do I get a new doctor to write it? I know I'm going to look like a drug seeker who's doctor shopping. I have NEVER had a drug or alcohol problem, I don't even drink AT ALL, but they're not going to know me or believe me.
-Should I ask on the phone if they do prescribe it? Or would that just make it worse?
-Do they have a way to know if there is a prescription out there? If they do, I don't want to hide it because that will really look bad.
-Do they have a way to know if I've FILLED a prescription recently or not? I would think that would help me since I could verify that I'm not in fact filling multiple prescriptions from different doctors.
-My dad is a doctor, and in emergency situations, he has written me prescriptions before. But he's out of state and I'm 99% sure Tennessee pharmacies won't fill an out of state prescription for a controlled substance. If I'm wrong, though, please let me know!
I've only been taking it for a few weeks and it has helped me SO much at my extremely stressful job. Now I'm facing not having it for two months (since she wrote 2 months worth of prescriptions) and am literally in my office crying with the door closed about having things go back to the way they were before. I was so stressed all the time because it was so hard to stay organized. I had not been treating my ADHD for a while because I disliked the meds I had tried before.
Important details:
-I live in Nashville, TN
-Pharmacies only accept a written prescription
-I don't have a primary care or any other physician--moved here 9 months ago and hadn't gotten around to it
-I'm bipolar and have ADHD, in my experience I've had PCP's refuse to touch those issues
Questions:
-How do I get a new doctor to write it? I know I'm going to look like a drug seeker who's doctor shopping. I have NEVER had a drug or alcohol problem, I don't even drink AT ALL, but they're not going to know me or believe me.
-Should I ask on the phone if they do prescribe it? Or would that just make it worse?
-Do they have a way to know if there is a prescription out there? If they do, I don't want to hide it because that will really look bad.
-Do they have a way to know if I've FILLED a prescription recently or not? I would think that would help me since I could verify that I'm not in fact filling multiple prescriptions from different doctors.
-My dad is a doctor, and in emergency situations, he has written me prescriptions before. But he's out of state and I'm 99% sure Tennessee pharmacies won't fill an out of state prescription for a controlled substance. If I'm wrong, though, please let me know!
You need to go back to your doctor. You lost the prescription. You didn't fill it, sell it, or give it to anyone else. Your doctor should write you another prescription. If she's concerned, have her call it in to a pharmacy herself and you'll go pick it up.
I am a little concerned that you're bipolar and currently having world-destroying meltdowns of the thought of being without Vyvanse after only two weeks on it. You may want to bring this up with your doctor.
Go back to your doctor and calmly explain the entire situation as best you can.
posted by erst at 11:40 PM on May 1, 2015 [28 favorites]
I am a little concerned that you're bipolar and currently having world-destroying meltdowns of the thought of being without Vyvanse after only two weeks on it. You may want to bring this up with your doctor.
Go back to your doctor and calmly explain the entire situation as best you can.
posted by erst at 11:40 PM on May 1, 2015 [28 favorites]
I used to take Adderall, and I had to get it filled when living with family in Virginia for a while (I usually live in Wisconsin). I had the paper prescriptions and was able to fill it there at CVS, no problem. It's worth calling the pharmacies and asking.
posted by mermaidcafe at 11:42 PM on May 1, 2015
posted by mermaidcafe at 11:42 PM on May 1, 2015
Also, I agree that the doctor should replace it. However, I had problems once when I just somehow lost a partial bottle of clonazepam. The mental health center that is my only option for meds because of healthcare has a flat policy against replacing lost meds, likely because they work with so many addicts. (I was told that it'd be different if it had been stolen, but that would have required a police report.) So even if the doctor is understanding, her hands may be tied. If absolutely all else fails, cal her back and ask what other options you have. My experience here has taught me that a lot of mental health providers love to label clients addicts at the smallest opportunity, and that could damage your relationship with your doctor down the road.
posted by mermaidcafe at 11:47 PM on May 1, 2015 [1 favorite]
posted by mermaidcafe at 11:47 PM on May 1, 2015 [1 favorite]
I get my ADHD meds from a neurologist for exactly this reason. The first month I was on adderall I changed the dosage 2-3 times and ended up with a ton of extra adderall as a result and was at no time treated like anything other than an adult making cautious and informed medical decisions. If you can find an ADHD/ADD specific neuro to see you I would recommend that 1 billion times more than seeing someone who will ascribe the worst possible sinister reasons to your behavior by default, aka the unfortunate majority of mental health providers.
For now I think you should explain the situation to your dad and ask him to help, either with filling it locally and sending it to you, or sending you new prescriptions.
posted by poffin boffin at 11:57 PM on May 1, 2015 [8 favorites]
For now I think you should explain the situation to your dad and ask him to help, either with filling it locally and sending it to you, or sending you new prescriptions.
posted by poffin boffin at 11:57 PM on May 1, 2015 [8 favorites]
I'm on both clonazepam and Dexedrine, which are both prescriptions that turn doctors into complete assholes because their license is on the line.
Beg, plead, go to a drop in clinic every two weeks if that doesn't work. Beg and plead at the clinics.
Your doctor is beyond the normal prickitude that ADHD meds come with FYI. Once the crisis is over, DTFM unless they're the best psychiatrist on the planet.
posted by Yowser at 1:17 AM on May 2, 2015 [5 favorites]
Beg, plead, go to a drop in clinic every two weeks if that doesn't work. Beg and plead at the clinics.
Your doctor is beyond the normal prickitude that ADHD meds come with FYI. Once the crisis is over, DTFM unless they're the best psychiatrist on the planet.
posted by Yowser at 1:17 AM on May 2, 2015 [5 favorites]
Oh, and thank your lucky stars that your dad is a doctor. He's also an option obviously!
posted by Yowser at 1:19 AM on May 2, 2015
posted by Yowser at 1:19 AM on May 2, 2015
Go back to your doctor and calmly explain the entire situation as best you can.
And if this doesn't work, calmly explain that you are unsatisfied with the quality of your care and either need the script re-written, or need a referral to another doctor or doctors who won't treat you like a criminal because you have ADD and lose things. And that you expect your records transferred IMMEDIATELY upon request to avoid any further delay from reevaluation and so work repercussions.
FWIW, Google turns up a host of clinics and docs in Nashville who treat ADD if your current doc won't give a referral (although that's not the best way to find a new doc).
posted by snuffleupagus at 4:40 AM on May 2, 2015 [7 favorites]
And if this doesn't work, calmly explain that you are unsatisfied with the quality of your care and either need the script re-written, or need a referral to another doctor or doctors who won't treat you like a criminal because you have ADD and lose things. And that you expect your records transferred IMMEDIATELY upon request to avoid any further delay from reevaluation and so work repercussions.
FWIW, Google turns up a host of clinics and docs in Nashville who treat ADD if your current doc won't give a referral (although that's not the best way to find a new doc).
posted by snuffleupagus at 4:40 AM on May 2, 2015 [7 favorites]
Also there's a database in TN for monitoring scheduled drugs. Your doc should be able to check this site to see if your prescription was filled (at least, in TN). The worry may be that you could stash the duplicate prescription and fill it later, rather than that you've already filled it.
posted by snuffleupagus at 5:18 AM on May 2, 2015 [3 favorites]
posted by snuffleupagus at 5:18 AM on May 2, 2015 [3 favorites]
Your father precribing you a controlled substance is insane and could get him in a lot of trouble. Don't even ask.
Declining to replace lost prescriptions for controlled substances is pretty standard and doesn't mean you have an Evil Psychiatrist. However, usually some leeway is possible if you make a good case. As someone said above, if it can be shown that you haven't filled the script, that should help.
posted by kevinsp8 at 6:10 AM on May 2, 2015 [17 favorites]
Declining to replace lost prescriptions for controlled substances is pretty standard and doesn't mean you have an Evil Psychiatrist. However, usually some leeway is possible if you make a good case. As someone said above, if it can be shown that you haven't filled the script, that should help.
posted by kevinsp8 at 6:10 AM on May 2, 2015 [17 favorites]
The worry may be that you could stash the duplicate prescription and fill it later, rather than that you've already filled it.
This. Your doc is sort of between a rock and a hard place on this one. He/she knows they could be in a pack of trouble if suddenly two scripts enter the system. That said, I can't believe there isn't some mechanism available to providers for just this sort of situation.
posted by Thorzdad at 6:32 AM on May 2, 2015 [4 favorites]
This. Your doc is sort of between a rock and a hard place on this one. He/she knows they could be in a pack of trouble if suddenly two scripts enter the system. That said, I can't believe there isn't some mechanism available to providers for just this sort of situation.
posted by Thorzdad at 6:32 AM on May 2, 2015 [4 favorites]
Mod note: From the OP:
Thank you all for your thoughtful replies. Snuffleupagus, that sounds like what I was worried about...do you know if, before prescribing something, doctors check whether that person has recently gotten a prescription for the same thing? Or is it not searchable like that and just something the state reviews?posted by taz (staff) at 6:35 AM on May 2, 2015 [35 favorites]
After the initial anxiety of hearing the doctor wouldn't replace it, I was able to do two things: first, got an appointment with a new psychiatrist, which I'm hoping to be able to cancel because he doesn't accept insurance. Second, got an appointment with mine for a few days earlier. I only talked to the receptionist yesterday and she told me of the blanket policy when I explained the situation--and to be fair, it was a reminder, because I signed a form acknowledging it when I first started going there, but I forgot. Receptionist refused to put me through to doctor then but I just called and made the appointment later. Upon reflection I think it might be ok--she may not have a way around the policy but I think it's likely she'd agree to prescribe something else. (She was encouraging, not weird, about my starting ADHD meds again.) Now if when I explain the situation she won't even try to work around their policy, I'm going to complain about being treated like a criminal and find a new doctor.
Erst wrote: "I am a little concerned that you're bipolar and currently having world-destroying meltdowns of the thought of being without Vyvanse after only two weeks on it. You may want to bring this up with your doctor."
I know this is not supposed to be for back-and-forth, and that you were just trying to help. But to the world of people out there...I find this kind of comment hurtful and dismissive. It's like saying my feelings aren't legitimate because, after all, I have a mood disorder so whatever's going on with my mood is just a symptom of that. Like I can't just be upset about something that normal people would be upset about. If I cry a little it's a "meltdown." If you had been struggling at work both because the job is incredibly difficult for even non-disabled people, and you had a medical condition that adds to that struggle, and you FINALLY got treatment and started feeling like maybe you could handle your job, and then got news that means it would be either really challenging or even impossible to get treatment for that condition for two whole months...who the hell would NOT be upset and freak out a little after they got that news?
I work with a mental healthcare team that includes a psychiatrist, and we call pharmacies all the time to check if clients have picked up their meds (normally because the clients are high risk and we're worried they've gone off their meds). So yes, that information is easily available to your doctor's office.
Granted, just because you have not yet picked up medication does not mean that you won't, but I think your psychiatrist is being overly rigid, whether that's a personal policy or an agency policy, and if it were me, I'd consider finding a new prescribing provider regardless of whether you can get this prescription rewritten.
posted by jaguar at 6:38 AM on May 2, 2015
Granted, just because you have not yet picked up medication does not mean that you won't, but I think your psychiatrist is being overly rigid, whether that's a personal policy or an agency policy, and if it were me, I'd consider finding a new prescribing provider regardless of whether you can get this prescription rewritten.
posted by jaguar at 6:38 AM on May 2, 2015
Mod note: Just as a quick note: Despite the last question in OP's update, this is not the place to debate if it's okay to be upset or not, and really, folks need to stick to the question of how to replace a lost prescription under these circumstances rather than making judgments. Thanks.
posted by taz (staff) at 6:43 AM on May 2, 2015 [4 favorites]
posted by taz (staff) at 6:43 AM on May 2, 2015 [4 favorites]
I work with a mental healthcare team that includes a psychiatrist, and we call pharmacies all the time to check if clients have picked up their meds (normally because the clients are high risk and we're worried they've gone off their meds). So yes, that information is easily available to your doctor's office.
It occurs to me that that's because we use electronic prescriptions, so we know where the prescription was sent in, which would not be the case with a paper prescription. They should still be able to check the controlled substances monitoring database now and going forward.
posted by jaguar at 6:54 AM on May 2, 2015
It occurs to me that that's because we use electronic prescriptions, so we know where the prescription was sent in, which would not be the case with a paper prescription. They should still be able to check the controlled substances monitoring database now and going forward.
posted by jaguar at 6:54 AM on May 2, 2015
FWIW, a former colleague was in distress at work after she went to a friend's house and had her handbag liberated of her supply of Xanax. Her regular doctor refused to write her a new script but she went to a walk-in clinic and the doctor gave her a lecture but gave her a new script. This is not the same as your situation (withdrawing suddenly from Xanax can cause death) and we are in a different country but I wouldn't rule out another doctor being willing to help you.
posted by Cheese Monster at 6:58 AM on May 2, 2015
posted by Cheese Monster at 6:58 AM on May 2, 2015
Where did you throw it out? Dumpster diving/sifting through nasty trash is quite honestly the best option.
DO NOT GET A NEW DOCTOR TO WRITE IT. They will report it to the database, and then you have had three, maybe four prescriptions wrtten in the span of a week. HUGE red flag. Do you want no Vyvanse for two months or none ever again? I personally don't think it's worth the risk. Don't bring your father into this, please. As for your own doctor, s/he is not likely to replace the prescription. Obviously they can check the database to see if it was filled, but they have no way of knowing if you have them squirreled away in your sock drawer. I fill my prescriptions a few days/a week ahead of time and it would be really easy for me to sneak a few old prescriptions in there and have enough Adderall for a pretty intense binge without raising flags in the database.
I have no idea how "I threw out prescriptions" = bipolar. I have bipolar and ADHD. Bipolar is intense mood fluctuations. ADHD is all-consuming shame. I have accidentally shredded bills before reading the amount on the bill, I have forgotten to turn in assignments/missed appointments/missed deadlines/done a million stupid things. The "world-destroying meltdown" I would have in this instance is: "Oh my god I am the stupidest dumb fuck in the world. Even on my medication I am too stupid to actually keep a prescription in my hands, this was the one thing that has actually helped me and now I have fucked myself for two fucking months because I am seriously the dumbest living fuck on the face of the entire planet." ADHD causes some pretty intense shame, and I totally understand.
I'm sorry, OP. Go garbage spelunking and then go to your doctor and hope for the best. Ultimately, two months is not all that long in the scheme of things. I would be crushed without having my Adderall for two months, but work on creating some new coping skills (a thing you need to do even with meds). I'm so sorry.
posted by good lorneing at 7:04 AM on May 2, 2015 [7 favorites]
DO NOT GET A NEW DOCTOR TO WRITE IT. They will report it to the database, and then you have had three, maybe four prescriptions wrtten in the span of a week. HUGE red flag. Do you want no Vyvanse for two months or none ever again? I personally don't think it's worth the risk. Don't bring your father into this, please. As for your own doctor, s/he is not likely to replace the prescription. Obviously they can check the database to see if it was filled, but they have no way of knowing if you have them squirreled away in your sock drawer. I fill my prescriptions a few days/a week ahead of time and it would be really easy for me to sneak a few old prescriptions in there and have enough Adderall for a pretty intense binge without raising flags in the database.
I have no idea how "I threw out prescriptions" = bipolar. I have bipolar and ADHD. Bipolar is intense mood fluctuations. ADHD is all-consuming shame. I have accidentally shredded bills before reading the amount on the bill, I have forgotten to turn in assignments/missed appointments/missed deadlines/done a million stupid things. The "world-destroying meltdown" I would have in this instance is: "Oh my god I am the stupidest dumb fuck in the world. Even on my medication I am too stupid to actually keep a prescription in my hands, this was the one thing that has actually helped me and now I have fucked myself for two fucking months because I am seriously the dumbest living fuck on the face of the entire planet." ADHD causes some pretty intense shame, and I totally understand.
I'm sorry, OP. Go garbage spelunking and then go to your doctor and hope for the best. Ultimately, two months is not all that long in the scheme of things. I would be crushed without having my Adderall for two months, but work on creating some new coping skills (a thing you need to do even with meds). I'm so sorry.
posted by good lorneing at 7:04 AM on May 2, 2015 [7 favorites]
Your doctor is beyond the normal prickitude that ADHD meds come with FYI. Once the crisis is over, DTFM unless they're the best psychiatrist on the planet.
No, this is 100% standard nationwide. My doctor has a sign in the waiting room to this effect, even. Especially for a controlled substance, this is the policy of every doctor that gives a shit about staying a doctor. Doesn't mean OP's doctor won't help, but this is hardly prickish, not even a little prickish.
posted by good lorneing at 7:09 AM on May 2, 2015 [6 favorites]
No, this is 100% standard nationwide. My doctor has a sign in the waiting room to this effect, even. Especially for a controlled substance, this is the policy of every doctor that gives a shit about staying a doctor. Doesn't mean OP's doctor won't help, but this is hardly prickish, not even a little prickish.
posted by good lorneing at 7:09 AM on May 2, 2015 [6 favorites]
Snuffleupagus, that sounds like what I was worried about...do you know if, before prescribing something, doctors check whether that person has recently gotten a prescription for the same thing? Or is it not searchable like that and just something the state reviews?
The information online suggests that any health care provider in the state can register for it, and use it. I couldn't tell you what your own doctor's practice is, or what the prevailing practice is in TN w/r/t use of this database, for that matter.
I used to take dexedrine, which is plain old amphetamine, back when it was written on triplicate forms. I lost a script once. It wasn't the end of the world, and that was before monitoring. I've lost meds too. It happens. It's an attention disorder, for crying out loud. And this is Vynase. Not dexedrine.
I understand the doc's concern, but this seems like a pretty alarmist reaction and I question the sufficiency of a unilateral policy when it comes to making sure patients receive their needed medication. You should remind them that you also have a mood/depressive disorder and presumably the medication you take for that, if any, was prescribed in expectation that you would also be on Vynase. Being on antidepressants or antipsychotics etc. along with stimulants is different than being on those drugs without stimulants.
posted by snuffleupagus at 7:11 AM on May 2, 2015
The information online suggests that any health care provider in the state can register for it, and use it. I couldn't tell you what your own doctor's practice is, or what the prevailing practice is in TN w/r/t use of this database, for that matter.
I used to take dexedrine, which is plain old amphetamine, back when it was written on triplicate forms. I lost a script once. It wasn't the end of the world, and that was before monitoring. I've lost meds too. It happens. It's an attention disorder, for crying out loud. And this is Vynase. Not dexedrine.
I understand the doc's concern, but this seems like a pretty alarmist reaction and I question the sufficiency of a unilateral policy when it comes to making sure patients receive their needed medication. You should remind them that you also have a mood/depressive disorder and presumably the medication you take for that, if any, was prescribed in expectation that you would also be on Vynase. Being on antidepressants or antipsychotics etc. along with stimulants is different than being on those drugs without stimulants.
posted by snuffleupagus at 7:11 AM on May 2, 2015
No, this is 100% standard nationwide.
This is not my experience.
On the other hand, I'm not that enthusiastic of a patient when it comes to ADD meds, and at least a couple of the times I had a lost script or meds replaced it was because the doc noticed I seemed unmedicated and asked why. I was also adolescent or college-aged. Which was a little while ago, now.
posted by snuffleupagus at 7:17 AM on May 2, 2015
This is not my experience.
On the other hand, I'm not that enthusiastic of a patient when it comes to ADD meds, and at least a couple of the times I had a lost script or meds replaced it was because the doc noticed I seemed unmedicated and asked why. I was also adolescent or college-aged. Which was a little while ago, now.
posted by snuffleupagus at 7:17 AM on May 2, 2015
I don't mean that a doctor will refuse to provide a new prescription, I mean that it's a doctor's out-of-the-box policy and that refusing to do so is 100% legit/not prickish, especially if OP is new to the med and the doctor doesn't have a record with them about taking it responsibly yet.
posted by good lorneing at 7:20 AM on May 2, 2015
posted by good lorneing at 7:20 AM on May 2, 2015
DO NOT GET A NEW DOCTOR TO WRITE IT. They will report it to the database, and then you have had three, maybe four prescriptions wrtten in the span of a week. HUGE red flag.
The admittedly limited information on this info page suggests that prescription information is uploaded when the prescription is filled. By the pharmacist. So all that will show up there are actually filled scripts.
If the state and providers were tracking the prescriptions from origination, they could presumably be invalidated and re-isussed without these problems, and prescribers wouldn't have to worry about what Rx slips people have 'lost' in their nightstands and sock drawers. That doesn't seem to be the case.
Also not sure how there are 'three or four' prescriptions here, filled or unfilled. It sounds like the OP has received one prescription from this doctor, filled probably close to a month ago now since it's soon to run out.
posted by snuffleupagus at 7:28 AM on May 2, 2015 [2 favorites]
The admittedly limited information on this info page suggests that prescription information is uploaded when the prescription is filled. By the pharmacist. So all that will show up there are actually filled scripts.
If the state and providers were tracking the prescriptions from origination, they could presumably be invalidated and re-isussed without these problems, and prescribers wouldn't have to worry about what Rx slips people have 'lost' in their nightstands and sock drawers. That doesn't seem to be the case.
Also not sure how there are 'three or four' prescriptions here, filled or unfilled. It sounds like the OP has received one prescription from this doctor, filled probably close to a month ago now since it's soon to run out.
posted by snuffleupagus at 7:28 AM on May 2, 2015 [2 favorites]
I don't know why people here are saying the doctor is unprofessional for refusing to replace a prescription for a controlled substance with high street value, for a patient who's only been taking it for a few weeks, when the patient in question agreed to the doctor's no-replacement policy up front. I truly sympathize with you, OP, but that is like seventeen red flags right there, and I'm a physician who prescribes a fair amount of controlled substances and generally has a forgiving attitude toward stuff like this for patients I know well. This scenario seems unique and devastating to you, but I--and any physician who prescribes controlled substances-- probably see it 3 times a week. Complaining about this through official channels is seriously not going to get you anywhere, especially if you were given a copy of her refill policy up front.
I think your best bet is to go to your appointment, throw yourself on the mercy of your regular psychiatrist, ask them to confirm in the Tennessee Prescription Drug Monitoring Database that you haven't filled it, and ask for a replacement. This isn't foolproof, though, because uploading of prescriptions from pharmacies often lags by a few days to a week, and your physician does not have months worth of regular refills to reassure her that this is an aberrancy. One of the big drawbacks of the current prescription system is that once you've written a prescription, there's no way to cancel it (except for calling the pharmacy where it's held and speaking personally with the pharmacist. There is no way to cancel a prescription that hasn't been filed with a pharmacy. It seems stupid and drives me crazy in all kinds of ways (lots of patients continuing to get auto-refills on things like blood pressure medication that have been changed, for example).
I would NOT go to a different psychiatrist unless you are actually going to change permanently, because if your regular psychiatrist sees that you got a prescription from someone else, that is considered "doctor shopping" and would also likely constitute a breach of your medication agreement, and my guess is that your original doctor would refuse to prescribe any more medication, period. I would definitely not ask your father to prescribe for you, which could endanger his license for real.
posted by The Elusive Architeuthis at 8:02 AM on May 2, 2015 [9 favorites]
I think your best bet is to go to your appointment, throw yourself on the mercy of your regular psychiatrist, ask them to confirm in the Tennessee Prescription Drug Monitoring Database that you haven't filled it, and ask for a replacement. This isn't foolproof, though, because uploading of prescriptions from pharmacies often lags by a few days to a week, and your physician does not have months worth of regular refills to reassure her that this is an aberrancy. One of the big drawbacks of the current prescription system is that once you've written a prescription, there's no way to cancel it (except for calling the pharmacy where it's held and speaking personally with the pharmacist. There is no way to cancel a prescription that hasn't been filed with a pharmacy. It seems stupid and drives me crazy in all kinds of ways (lots of patients continuing to get auto-refills on things like blood pressure medication that have been changed, for example).
I would NOT go to a different psychiatrist unless you are actually going to change permanently, because if your regular psychiatrist sees that you got a prescription from someone else, that is considered "doctor shopping" and would also likely constitute a breach of your medication agreement, and my guess is that your original doctor would refuse to prescribe any more medication, period. I would definitely not ask your father to prescribe for you, which could endanger his license for real.
posted by The Elusive Architeuthis at 8:02 AM on May 2, 2015 [9 favorites]
Bipolar and ADHD are difficult comorbid conditions. Here is the thing. If it was "just" bipolar, the inattention to detail (throwing out important prescription) + crying jag in office could equal the beginning of a mixed state. I have bipolar 2. When I took dexedrine as an adjunct to the bipolar med cocktail to improve some of my other symptoms, it triggered a mixed state including the two symptoms described (plus irritability). Mixed states are dangerous, potentially life threatening, and difficult to treat. I had to stop the stimulant.
With ADHD in the mix it becomes harder to differentiate inattention from ADHD symptom and mania/hypomania/mixed state symptom. This is why you need a doctor's assistance. While the stimulant has demonstrated a short term benefit for you, it might cause a long term problem. Be careful.
So yes it is important to go back to the doctor and get some feedback. This is especially true because you have bipolar. This might be a symptom of a problem. You need an exam and to consider the possibility of other meds.
In the meantime, if you have somebody you trust to give you feedback on your moods/behaviours and how they have changed in the last few weeks, please solicit their feedback now.
posted by crazycanuck at 8:22 AM on May 2, 2015
With ADHD in the mix it becomes harder to differentiate inattention from ADHD symptom and mania/hypomania/mixed state symptom. This is why you need a doctor's assistance. While the stimulant has demonstrated a short term benefit for you, it might cause a long term problem. Be careful.
So yes it is important to go back to the doctor and get some feedback. This is especially true because you have bipolar. This might be a symptom of a problem. You need an exam and to consider the possibility of other meds.
In the meantime, if you have somebody you trust to give you feedback on your moods/behaviours and how they have changed in the last few weeks, please solicit their feedback now.
posted by crazycanuck at 8:22 AM on May 2, 2015
After reading your update, it sounds like you are on the right track. Do cancel the appointment with the new shrink- it makes you look bad.
At your appointment, you can explain to the doctor what happened and either get a script for something else or a replacement script. Stress that this is ADHD medication, for your ADHD, a condition that is known for causing the sufferer to be scattered and disorganized, and you don't feel you should be punished for your condition. Say it nicely and offer to give the doctor the phone number of your last pharmacy to confirm that you don't seek out certain medications for illegal use.
It's going to be okay.
posted by myselfasme at 8:23 AM on May 2, 2015 [2 favorites]
At your appointment, you can explain to the doctor what happened and either get a script for something else or a replacement script. Stress that this is ADHD medication, for your ADHD, a condition that is known for causing the sufferer to be scattered and disorganized, and you don't feel you should be punished for your condition. Say it nicely and offer to give the doctor the phone number of your last pharmacy to confirm that you don't seek out certain medications for illegal use.
It's going to be okay.
posted by myselfasme at 8:23 AM on May 2, 2015 [2 favorites]
I'm an actual doctor who uses a controlled substances monitoring database (although not your doctor obviously and have never used your controlled substances monitoring database in TN). What I can tell you:
- Some doctors do check the database every time they write a controlled substance, but most just check it if they have a concern about a patient. They can certainly check if they want to.
- The database only logs prescriptions that are FILLED. Plenty of people still handwrite prescriptions out there. No way to track what's been written.
- There is a lag time (at least on the ones I've used) so that new scripts do not show up in your record for about 2 weeks. So I never know exactly what's been going on immediately prior to a visit. But I generally look at trends over time - someone who's never filled any controlled substance before in the state is someone I probably shouldn't be denying a new script to. Whereas people with records of filling many scripts from multiple providers are red flags.
I don't think you should need to ask your doctor for a different medication when Vyvanse worked for you. That would be silly. If you explain the story and have never had an issue with this before, she should have mercy on you and make an exception this time. If she doesn't, I would agree with find a new doctor. You could also consider going to a walk-in/urgent care and asking for a script, but you'd really be gambling on whether that provider would be willing to help you without any record of what your script is for.
Regarding erst's answer above: controlled substances cannot be called in. They must be filled with a paper script. I see you already know this is a problem. Unfortunately, that's why jaguar's strategy of having an office call a pharmacy to see if it's been filled doesn't work - because the script can be filled at any pharmacy.
posted by treehorn+bunny at 8:35 AM on May 2, 2015 [3 favorites]
- Some doctors do check the database every time they write a controlled substance, but most just check it if they have a concern about a patient. They can certainly check if they want to.
- The database only logs prescriptions that are FILLED. Plenty of people still handwrite prescriptions out there. No way to track what's been written.
- There is a lag time (at least on the ones I've used) so that new scripts do not show up in your record for about 2 weeks. So I never know exactly what's been going on immediately prior to a visit. But I generally look at trends over time - someone who's never filled any controlled substance before in the state is someone I probably shouldn't be denying a new script to. Whereas people with records of filling many scripts from multiple providers are red flags.
I don't think you should need to ask your doctor for a different medication when Vyvanse worked for you. That would be silly. If you explain the story and have never had an issue with this before, she should have mercy on you and make an exception this time. If she doesn't, I would agree with find a new doctor. You could also consider going to a walk-in/urgent care and asking for a script, but you'd really be gambling on whether that provider would be willing to help you without any record of what your script is for.
Regarding erst's answer above: controlled substances cannot be called in. They must be filled with a paper script. I see you already know this is a problem. Unfortunately, that's why jaguar's strategy of having an office call a pharmacy to see if it's been filled doesn't work - because the script can be filled at any pharmacy.
posted by treehorn+bunny at 8:35 AM on May 2, 2015 [3 favorites]
re: your father. I don't know if it's good or bad to involve him, but I can tell you that you can fill a prescription for Vyvanse out of the state it was written in. Your identifying information on the script needs to be clearly written. If they don't like that a doctor with the same last name wrote the prescription, that's another story.
posted by DMelanogaster at 8:44 AM on May 2, 2015
posted by DMelanogaster at 8:44 AM on May 2, 2015
t I can tell you that you can fill a prescription for Vyvanse out of the state it was written in.
This is not necessarily true. I have had pharmacies refuse to fill prescriptions for controlled substances, including Vyvanse, that were from out of state. If you call ahead to a pharmacy, they can probably let you know if this will be possible. I guess if all other avenues fail, maybe a family member can fill a prescription from your father and send the medications to you, although this may be frowned upon. Alternatively, do you have a family physician that you used to work with before you moved? In very specific/desperate situations, the PCP I had growing up has been willing to write me a prescription when I hadn't yet found a local primary care doctor.
With that being said, if at all possible, try to work this out with your current psychiatrist. Their policy as a general rule is understandable, but losing prescriptions is one of those things that can happen. It's especially easy to do with controlled substances that require a hard copy prescription.
Also, if there is any chance that you can locate the prescription in the trash, you might want to seriously consider putting on your least nice clothes, grabbing some heavy duty gloves, and starting to do some dumpster diving. Of course, if you live in an aparmtent building with a shared dumpster, or if the trash has already been taken, this won't be feasible.
Lastly, I don't have bipolar disorder, but I do have relatively recently diagnosed ADHD, and I can't begin to describe how amazing it has been to find a medication that works for my ADHD. If I found out that I had to go two months without Vyvanse, I'm sure I would be crying and horribly depressed and panicky as well. I think it's completely understandable that you're having such a strong emotional reaction to this.
Good luck! I really hope you find a workable solution.
posted by litera scripta manet at 10:48 AM on May 2, 2015 [1 favorite]
This is not necessarily true. I have had pharmacies refuse to fill prescriptions for controlled substances, including Vyvanse, that were from out of state. If you call ahead to a pharmacy, they can probably let you know if this will be possible. I guess if all other avenues fail, maybe a family member can fill a prescription from your father and send the medications to you, although this may be frowned upon. Alternatively, do you have a family physician that you used to work with before you moved? In very specific/desperate situations, the PCP I had growing up has been willing to write me a prescription when I hadn't yet found a local primary care doctor.
With that being said, if at all possible, try to work this out with your current psychiatrist. Their policy as a general rule is understandable, but losing prescriptions is one of those things that can happen. It's especially easy to do with controlled substances that require a hard copy prescription.
Also, if there is any chance that you can locate the prescription in the trash, you might want to seriously consider putting on your least nice clothes, grabbing some heavy duty gloves, and starting to do some dumpster diving. Of course, if you live in an aparmtent building with a shared dumpster, or if the trash has already been taken, this won't be feasible.
Lastly, I don't have bipolar disorder, but I do have relatively recently diagnosed ADHD, and I can't begin to describe how amazing it has been to find a medication that works for my ADHD. If I found out that I had to go two months without Vyvanse, I'm sure I would be crying and horribly depressed and panicky as well. I think it's completely understandable that you're having such a strong emotional reaction to this.
Good luck! I really hope you find a workable solution.
posted by litera scripta manet at 10:48 AM on May 2, 2015 [1 favorite]
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I've never tried that because it seemed like too much hassle, but maybe you can get instructions for doing the same with Vyvanse and hence be able to ration it out, and not have to worry about running out in just a week.
posted by XMLicious at 11:27 PM on May 1, 2015