Need ADHD meds, am not Jesse Pinkman!
January 13, 2016 8:08 AM Subscribe
My PCP has decided to discontinue prescribing my (long-standing, very stable) ADHD medication. I pretty much just want to continue with the meds that have worked for me, with a minimum of additional trouble, expense and extra time. How can I find a new provider without seeming sketchy or drug-seeking?
I have pretty classic inattentive-type adult ADHD, and I've been on a stable dose of 20mg Adderall XR starting 8 years ago, with two 2+-year breaks for pregnancies/ breastfeeding. This was initially prescribed by a sequence of two psychiatrists, but after an interstate move, I'd been getting the prescriptions from my family doc for a total of about two years.
When I recently contacted the PCP about resuming the prescription after my most recent pregnancy/bf break, she wrote one month's worth, but then declined to refill it, with a bit of attitude that's left me feeling as though she felt it was somehow suspicious or shady of me to have requested this prescription in the first place. As a very law-abiding sort, I'm now feeling super self-conscious about finding another doc: I have a demanding job and virtually no spare time/money, so I'd very much like to shop around for someone who won't require lengthy monthly counselling sessions or extensive new-patient testing, but based on the way things were handled at the last place, I'm afraid that calling up and asking about this will make me seem like a criminal who's looking to score easy meds for nefarious purposes.
Thus, the question: could anyone advise me on the simplest/easiest likely way to go about finding a new provider at this point? Should I try to book a psychiatrist, or is this something that other family docs might be able to help with? Will I need to document my condition somehow? If so, any advice for doing that, given that I've changed insurance plans since the initial diagnosis 8 years ago, and no longer have the names/ contact info from my two initial psychiatrists? And lastly, what questions re: convenience and time investment can I fairly ask when shopping providers and which ones should I avoid? (US here, btw-- and I know this seems like a lot of hand-wringing over the process of obtaining legal medication for a condition I most definitely have, but the old doc did make me feel pretty crappy about the whole situation-- to the point of blushing and feeling vaguely guilty when amphetamine subplots turn up on TV!) Thanks so much, Metafilter!
I have pretty classic inattentive-type adult ADHD, and I've been on a stable dose of 20mg Adderall XR starting 8 years ago, with two 2+-year breaks for pregnancies/ breastfeeding. This was initially prescribed by a sequence of two psychiatrists, but after an interstate move, I'd been getting the prescriptions from my family doc for a total of about two years.
When I recently contacted the PCP about resuming the prescription after my most recent pregnancy/bf break, she wrote one month's worth, but then declined to refill it, with a bit of attitude that's left me feeling as though she felt it was somehow suspicious or shady of me to have requested this prescription in the first place. As a very law-abiding sort, I'm now feeling super self-conscious about finding another doc: I have a demanding job and virtually no spare time/money, so I'd very much like to shop around for someone who won't require lengthy monthly counselling sessions or extensive new-patient testing, but based on the way things were handled at the last place, I'm afraid that calling up and asking about this will make me seem like a criminal who's looking to score easy meds for nefarious purposes.
Thus, the question: could anyone advise me on the simplest/easiest likely way to go about finding a new provider at this point? Should I try to book a psychiatrist, or is this something that other family docs might be able to help with? Will I need to document my condition somehow? If so, any advice for doing that, given that I've changed insurance plans since the initial diagnosis 8 years ago, and no longer have the names/ contact info from my two initial psychiatrists? And lastly, what questions re: convenience and time investment can I fairly ask when shopping providers and which ones should I avoid? (US here, btw-- and I know this seems like a lot of hand-wringing over the process of obtaining legal medication for a condition I most definitely have, but the old doc did make me feel pretty crappy about the whole situation-- to the point of blushing and feeling vaguely guilty when amphetamine subplots turn up on TV!) Thanks so much, Metafilter!
Your pcp is a moron and a shitty doctor, for knowing your 8 year history of the medication and still treating you like a shady child, shame on her.
Find a neurologist who treats ADHD in adults. I was super nervous about being able to get a prescription after many years out of the country but I found my excellent neurologist on a referral from my migraine neurologist and the first appointment was me saying "I took ritalin in high school but it was prescribed by my pediatrician 15 years ago and he is now dead and I don't trust psychiatrists" and the new doctor was like "do you still want ritalin or do you want to try something different" and we went from there. At no point was I treated like a drug addict doing something shady, even when we switched around meds and amounts and brands multiple times over a few months.
posted by poffin boffin at 8:28 AM on January 13, 2016 [10 favorites]
Find a neurologist who treats ADHD in adults. I was super nervous about being able to get a prescription after many years out of the country but I found my excellent neurologist on a referral from my migraine neurologist and the first appointment was me saying "I took ritalin in high school but it was prescribed by my pediatrician 15 years ago and he is now dead and I don't trust psychiatrists" and the new doctor was like "do you still want ritalin or do you want to try something different" and we went from there. At no point was I treated like a drug addict doing something shady, even when we switched around meds and amounts and brands multiple times over a few months.
posted by poffin boffin at 8:28 AM on January 13, 2016 [10 favorites]
How hard would it be to find your original psychiatrists? Could you call your old insurance provider and ask for their names? You can search the AMA's Doctor Finder by specialty and location; there's also the American Psychiatric Association, which has a "Find a Psychiatrist" database. The AMA's state licensing boards probably also have databases - maybe that would prompt your memory?
posted by cotton dress sock at 8:30 AM on January 13, 2016
posted by cotton dress sock at 8:30 AM on January 13, 2016
I was recently in a similar situation—and facing similar fears. Since I'm a scruffy-looking guy in his 20s I was sure I'd seem like a drug seeker to my next doc. Instead I booked an appointment with a psychiatrist who handles ADHD cases and was in and out in 30 minutes. I explained why I needed a new doctor, they took a case history, and we're ramping back up to my original dose.
posted by Polycarp at 8:34 AM on January 13, 2016 [4 favorites]
posted by Polycarp at 8:34 AM on January 13, 2016 [4 favorites]
You're worrying for nothing, promise! I had a doc that would only prescribe three months at a time, and wanted you to come in for a refill. They'd give me the stink eye and question me about it so I said fuck that and found a better doctor! Avoid. "Family practice" and go for an Internal Medicine doc. They make a great PCP. If one doesn't work, just keep looking til you find someone you gel with.
posted by wwartorff at 8:35 AM on January 13, 2016 [1 favorite]
posted by wwartorff at 8:35 AM on January 13, 2016 [1 favorite]
As a very law-abiding sort, I'm now feeling super self-conscious about finding another doc: I have a demanding job and virtually no spare time/money, so I'd very much like to shop around for someone who won't require lengthy monthly counselling sessions or extensive new-patient testing, but based on the way things were handled at the last place, I'm afraid that calling up and asking about this will make me seem like a criminal who's looking to score easy meds for nefarious purposes.
It might feel more comfortable to phrase these questions as general requests for information: not "Will you make me jump through this specific hoop?" but "What would be the process for transferring my existing ADHD prescription into your care?"
But it also sounds like you're catastrophizing this a bit. It is 100% legal to ask your doctor questions. "Drug-seeking behavior," for all it's a stigmatizing and shitty label, is not a crime. Neither is "sketchiness." You are absolutely within your rights to ask a prospective doctor questions in order to find out whether their practice will be a good fit for you.
It's also worth remembering that doctor's attitudes towards Schedule II drugs aren't personal judgments against you. Your old doctor may well have been super uncomfortable writing an Adderall prescription. But that doesn't mean there was anything about you specifically that made her think "sketchy" or "criminal" — or, indeed, anything you could have said or done differently that would have made her more comfortable with this. There definitely isn't any perfect, magical phrasing you can use that will make any doctor happy to work with you.
My hunch is that in the long run, the way to make this whole situation feel more comfortable is to look at your own internalized stigma around ADHD meds, rather than trying to pre-emptively make a good impression on a doctor.
posted by nebulawindphone at 8:44 AM on January 13, 2016 [4 favorites]
It might feel more comfortable to phrase these questions as general requests for information: not "Will you make me jump through this specific hoop?" but "What would be the process for transferring my existing ADHD prescription into your care?"
But it also sounds like you're catastrophizing this a bit. It is 100% legal to ask your doctor questions. "Drug-seeking behavior," for all it's a stigmatizing and shitty label, is not a crime. Neither is "sketchiness." You are absolutely within your rights to ask a prospective doctor questions in order to find out whether their practice will be a good fit for you.
It's also worth remembering that doctor's attitudes towards Schedule II drugs aren't personal judgments against you. Your old doctor may well have been super uncomfortable writing an Adderall prescription. But that doesn't mean there was anything about you specifically that made her think "sketchy" or "criminal" — or, indeed, anything you could have said or done differently that would have made her more comfortable with this. There definitely isn't any perfect, magical phrasing you can use that will make any doctor happy to work with you.
My hunch is that in the long run, the way to make this whole situation feel more comfortable is to look at your own internalized stigma around ADHD meds, rather than trying to pre-emptively make a good impression on a doctor.
posted by nebulawindphone at 8:44 AM on January 13, 2016 [4 favorites]
Toxicologist chiming in to say that comments like these--"Your pcp is a moron and a shitty doctor"--are not helpful at all. Dextroamphetamine carries an FDA-mandated black box warning that advises physicians to prescribe "sparingly." No matter how comfortable pop culture has become with Adderall, the threshold for getting a black box warning on a drug is very high and has strong, legally relevant meaning in the medical world.
What may have led your doctor to stop writing refills is this part of the same insert:
"The effectiveness of ADDERALL® for long-term use has not been systematically evaluated in controlled trials. Therefore, the physician who elects to use ADDERALL® for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient."
This lack of supporting efficacy and safety data is common in many drugs we prescribe that have been clinically evaluated for short term use, but for which long term evidence of safety and efficacy comes almost exclusively from post-marketing surveillance. This freaks out a lot of physicians, especially for black box drugs. What you read as attitude from your doctor might be just attitude from your doctor, but the context isn't quite that simple.
As you seek new physicians, they will or they won't ask you about your history of use. I don't think there's a simpler or easier way to find this out than by simply calling up physician offices and asking them if they'll review your situation. If you haven't already, you should ask your previous PCP, the one you're parting ways with, for copies of your medical records. Family practices might be your better bet, because psychiatric offices are very (very) weary of calls asking for prescriptions in lieu of intake, screening, and medical history procedures.
posted by late afternoon dreaming hotel at 11:42 AM on January 13, 2016 [3 favorites]
What may have led your doctor to stop writing refills is this part of the same insert:
"The effectiveness of ADDERALL® for long-term use has not been systematically evaluated in controlled trials. Therefore, the physician who elects to use ADDERALL® for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient."
This lack of supporting efficacy and safety data is common in many drugs we prescribe that have been clinically evaluated for short term use, but for which long term evidence of safety and efficacy comes almost exclusively from post-marketing surveillance. This freaks out a lot of physicians, especially for black box drugs. What you read as attitude from your doctor might be just attitude from your doctor, but the context isn't quite that simple.
As you seek new physicians, they will or they won't ask you about your history of use. I don't think there's a simpler or easier way to find this out than by simply calling up physician offices and asking them if they'll review your situation. If you haven't already, you should ask your previous PCP, the one you're parting ways with, for copies of your medical records. Family practices might be your better bet, because psychiatric offices are very (very) weary of calls asking for prescriptions in lieu of intake, screening, and medical history procedures.
posted by late afternoon dreaming hotel at 11:42 AM on January 13, 2016 [3 favorites]
I don't have any specific suggestions aside from "don't panic"; I've changed providers several times since I was diagnosed, and so far the worst problem I've had is that some providers wanted me to come in every month for a new prescription. Nobody has ever refused to prescribe me ADD meds, and the good ones will write three months of prescriptions at a time.
posted by shponglespore at 2:55 PM on January 13, 2016
posted by shponglespore at 2:55 PM on January 13, 2016
Speaking as a prescriber: yay for you, for being so determined to find a way to get treatment so that you can do your work, take care of your family, and have a good life. I'm sorry that you were so invalidated. I hate it when I feel ashamed, and I hope you are soon over this feeling. (It's so ironic that people who use psychostimulants conscientiously are usually the ones who suffer so much shame and embarrassment.)
I recommend making two appointments: one with a new primary care provider, (pcp) and one with a psychiatrist or psychiatric nurse practitioner, ideally one specializing in ADHD. Your appointment with the psych prescriber will likely be months away, but having that pending appointment lets you reassure the pcp that you are not asking them to prescribe the Adderall for long; it is getting harder for non-specialists to prescribe controlled medication. I think it's fine to call and explain to potential pcp offices that you are seeking coverage of your Adderall until you can get in with a new psych prescriber, and try to get an answer about whether that office does prescribe that medicine before making an appointment. Your manner is so genuine, most people will want to help you, even if just by telling you what they can't do.
They will worry that you have addiction, because they don't know you yet, and society and the FDA expects them to prevent Adderall from getting on the street. There are a lot good suggestions up above about how to reassure the pcp: Google your old prescribers and see if you can bring there names and contact info in; get a print-out of your prescriptions from your pharmacy; bring a recent pill bottle; and my favorite-- bring an adult family member to the visit if you possibly can. Nothing sets my mind at rest like having an obviously-caring loved one tell me that this med has done lots of good and caused no harm to you.
Sorry if this is too long; I'm rooting for you!
posted by seacats at 3:14 PM on January 13, 2016 [2 favorites]
I recommend making two appointments: one with a new primary care provider, (pcp) and one with a psychiatrist or psychiatric nurse practitioner, ideally one specializing in ADHD. Your appointment with the psych prescriber will likely be months away, but having that pending appointment lets you reassure the pcp that you are not asking them to prescribe the Adderall for long; it is getting harder for non-specialists to prescribe controlled medication. I think it's fine to call and explain to potential pcp offices that you are seeking coverage of your Adderall until you can get in with a new psych prescriber, and try to get an answer about whether that office does prescribe that medicine before making an appointment. Your manner is so genuine, most people will want to help you, even if just by telling you what they can't do.
They will worry that you have addiction, because they don't know you yet, and society and the FDA expects them to prevent Adderall from getting on the street. There are a lot good suggestions up above about how to reassure the pcp: Google your old prescribers and see if you can bring there names and contact info in; get a print-out of your prescriptions from your pharmacy; bring a recent pill bottle; and my favorite-- bring an adult family member to the visit if you possibly can. Nothing sets my mind at rest like having an obviously-caring loved one tell me that this med has done lots of good and caused no harm to you.
Sorry if this is too long; I'm rooting for you!
posted by seacats at 3:14 PM on January 13, 2016 [2 favorites]
Memail me if you are in the SF Bay Area so I can refer you to my fabulous medication shrink.
posted by Bella Donna at 5:18 PM on January 13, 2016
posted by Bella Donna at 5:18 PM on January 13, 2016
I had a doc that would only prescribe three months at a time, and wanted you to come in for a refill.
I think that's actually a legal requirement? Every doctor I've ever gotten an Adderall prescription explicitly said they could only write me 90 days worth of prescriptions at a time.
posted by Jacqueline at 7:39 AM on January 14, 2016 [1 favorite]
I think that's actually a legal requirement? Every doctor I've ever gotten an Adderall prescription explicitly said they could only write me 90 days worth of prescriptions at a time.
posted by Jacqueline at 7:39 AM on January 14, 2016 [1 favorite]
You may've already handled this, but if you're not happy with your current doctor, and you're a mother, why not talk with your child's pediatrician? I assume it's someone you already have a good relationship with - just have your old office fax your past record to your child's pediatrician and make an appointment. Pediatricians are actually (as i understand it) more knowledgeable than your general care physician because ADHD is so often diagnosed in children/adolescents. But they typically also take adult patients and even if this one does not, they may be willing to write you a prescription for a month or two while you're waiting on your psychiatrist appt.
You should never be made to feel ashamed by your doctor. It's probably happened to all of us but it sucks when it does. Particularly in this instance when you're genuinely trying to take care of yourself and the reputation surrounding amphetamines so often keeps people like you from seeking treatment. Good luck to you!
Also: love the title of your question! Made me laugh out loud:)
P.S. One of the posters mentioned a neurologist - does anyone know if this is common for folks with ADHD to see a neurologist? Is there a benefit to seeing a neurologist vs a psychiatrist? I assume psychiatrist is more effective particularly for patients who also have depression/anxiety as a result of lifelong adhd.
posted by zettoo at 2:46 PM on March 4, 2016
You should never be made to feel ashamed by your doctor. It's probably happened to all of us but it sucks when it does. Particularly in this instance when you're genuinely trying to take care of yourself and the reputation surrounding amphetamines so often keeps people like you from seeking treatment. Good luck to you!
Also: love the title of your question! Made me laugh out loud:)
P.S. One of the posters mentioned a neurologist - does anyone know if this is common for folks with ADHD to see a neurologist? Is there a benefit to seeing a neurologist vs a psychiatrist? I assume psychiatrist is more effective particularly for patients who also have depression/anxiety as a result of lifelong adhd.
posted by zettoo at 2:46 PM on March 4, 2016
« Older London lettings agents: as dubious as they're... | I am the photographer (or I would like to be). Newer »
This thread is closed to new comments.
Our experience was one 1.5 hour intake appointment, then monthly .5 hour check in appointments (we haven't found the right mix of meds yet), and my understanding is that once we're good with the medication and dosage, we can go down to once every three month appointments for prescriptions.
Do you have any of your original bottles, or access to prescription records showing the prescriptions? That might be helpful in showing that you were at least prescribed this before.
Not answering the question, but I am really sorry that you're going through this - it sucks that there was no communication and she just decided to stop prescribing it.
posted by needlegrrl at 8:24 AM on January 13, 2016 [1 favorite]