How often do I HAVE to see my shrink?

September 30, 2013 6:44 PM

The doctor who prescribes my Ritalin and Lamictal is telling me that the state licensing board in Maryland requires that he see me once every three months. I've never heard of this before. I believe that it may be recommended that a doctor see a patient on some defined basis, especially with new prescriptions, but I've been seeing him for years, been taking these for years and never had any issues. The only justification I can imagine is the overall crackdown on Schedule II prescriptions. I really don't want to spend the time and money to sit there and tell him everything is fine 4 times per year. Is he really required to do this? Is it medically justifiable and necessary?
posted by anonymous to Health & Fitness (17 answers total)

Sounds federal. I had to do it for our minor children & the appts are kept even when non-schedule drugs for ADD are prescribed.
posted by tilde at 6:57 PM on September 30, 2013

I can't really speak to the actual requirements, so I know it's not a direct answer, but I can say that I'm in Ohio and have been told explicitly by my psychiatrist that he's required to give me no more than three months' worth at a time (with do-not-fill-before-date prescriptions, not refills) and that it does have to do with the diversion problem. I'm similarly on a pretty stable regimen and it annoys me because my financial situation makes it difficult, but it seems to be normal.
posted by Sequence at 6:59 PM on September 30, 2013

My husband couldn't get more than 3 months' Adderall at a time, and the pharmacy was extremely fussy about not refilling until it had been 3 months since the last refill (and my mail-order had a big asterisk on amphetamines that they wouldn't refill more than 3 months, though they would of other things). I thought it was federal.
posted by Lyn Never at 7:04 PM on September 30, 2013

I think this is the relevant page from the DOJ.
posted by hoyland at 7:05 PM on September 30, 2013

+1 Hoyland. I googled "adderall three months prescription" and got this:

http://www.deadiversion.usdoj.gov/pubs/manuals/pract/section5.htm

posted by chesty_a_arthur at 7:07 PM on September 30, 2013

This could be related to the start of Maryland's Prescription Drug Monitoring Program, PDMP for short. NY is setting up a similar registry right now on what appears to be the same timeline, as are many other states. Enforcement in NY (that every prescribing provider consult the online registry when prescribing Schedule II-IV narcotics) was scheduled to begin in August, though they're backlogged on getting everyone up and running on the web platform. I haven't seen anything in NY that suggests how often providers see patients, just that they have to consult the registry every time. You might call the board directly and ask. Or you could speak to someone at the facility where your doctor practices; it could be something mandated at that level.

Is this sort of thing medically justifiable for you? As far as I can tell, probably not. These sort of registries exist to prevent illegal abuses of prescription drugs by tracking who gets what when and from whom.
posted by ThePinkSuperhero at 7:07 PM on September 30, 2013

FWIW, I work with/for a fellow (in Minnesota) who takes Adderall (sch II) and he gets by just fine with 2x a year psychiatrist visits. But they are pretty adamant about those visits.
posted by edgeways at 7:11 PM on September 30, 2013 [1 favorite]

My husband takes Lamictal and has to go every 3 months as well. He sees a nurse practitioner who is attached to his therapist's practice thought so it's quick and the office visit charge is not much at all. (I think $35.) So if cost is an issue, finding an NP might be a good choice.
posted by dawkins_7 at 7:12 PM on September 30, 2013 [1 favorite]

I don't think this is federal. I'm in WA. I get my ritalin script from my GP and she can only write me a 3-month script. But she doesn't make me have an appt. - I just call her office and she leaves a script at the front desk for me to pick up.
posted by lunasol at 7:31 PM on September 30, 2013

The three-months a time script limit can also be a function of your health insurance plan. Mine has the same limits.
posted by nubianinthedesert at 7:40 PM on September 30, 2013 [1 favorite]

Is he really required to do this?

Sort of, federal law is that three 30 day prescriptions can be issued at once, in writing and signed by the practitioner. Your state might be more restrictive.

Is it medically justifiable and necessary?

No.

Some doctors are a bit more flexible with scheduling and pricing the very short appointment they would need for seeing a patient. Most doctors don't seem to know their own prices, but you can usually ask at the front desk how much an appointment would cost if it was just to come in for refills. A nurse practitioner would be fine for this too.
posted by yohko at 7:44 PM on September 30, 2013 [1 favorite]

FWIW, if expense is an issue, and you can prove your income is below a certain threshold, Obamacare is already up and running in a lot of places...well worth looking into...you'll have to do it soon enough anyway...
posted by sexyrobot at 9:31 PM on September 30, 2013 [1 favorite]

I've been taking Adderall for 10+ years. I call my doc once/month to request a prescription for Adderall, which I pick up from the receptionist—fee is $20. It's been more than 2 years since I've laid eyes on my doctor. (Illinois)
posted by she's not there at 2:50 AM on October 1, 2013

Call it a combination of federal and state law. The feds have an expansive set of laws and regulations for categorizing pharmaceutical substances, which the states can't do anything about.* But the states are responsible for things like licensing physicians and pharmacists, which the feds can't do much about. So even though there is a uniform federal regulatory scheme for controlled substances, there is some degree of variation in how that scheme is implemented on the state level.

So the answer to "Is this a federal or a state law?" is probably "Yes."**

*This is why state efforts to legalize marijuana, e.g., Colorado, Washington, and California, have some degree inherent futility. The only reason more growers in Denver aren't facing federal charges is because the Obama administration has decided to look the other way. It could change its mind at any time, and all bets are off on January 20, 2017.

**Don't ask me about which specific laws/regulations though. Not licensed in Maryland, and that's the kind of thing I'd have to charge by the hour to research anyway.
posted by valkyryn at 5:29 AM on October 1, 2013

I can't answer questions about state policies of Maryland, but since you asked "Is it medically justifiable and necessary?"—well, actually I would argue that it is justifiable. You're on an anti-convulsant and a stimulant, long-term. I'm glad it's been working fine for so long! Sometimes over the course of long-term drug treatment, there are new things to try, old things to stop trying, and things to learn. Our reactions to drugs change over time. Receiving medical care—interacting with a doctor!—can help prevent problems from remaining undiagnosed, can give you early warning, can help give you feedback on situations you might or might not realize are developing.

I understand this sounds like hassle to you, and perhaps it is. Your solution might be to argue him down, or change doctors, or something else. Or maybe you'll just be healthier than most of us.
posted by RJ Reynolds at 6:10 AM on October 1, 2013 [3 favorites]

I could never get more than 1 month of Adderall prescribed at a time so I'm amazed that you're getting as long as 3 months between visits!
posted by Jacqueline at 2:55 PM on October 1, 2013

Last time I spoke to the pediatrician about this (based on a conversation with a friend with a similar child/situation) I was told that rather than driving in every month for the prescription (in Florida, they have to be written on specific Rx paper and cannot be distributed by mail order as far as I can tell) I could keep my quarterly med check appts and get three prescriptions at a time (post dated appropriately) or I could have them mailed to me. I've been with this ped since my eldest was 2 (a tween now) and he said he was fine with that; newer patients he'd seen less than a year probably not.
posted by tilde at 6:15 AM on October 2, 2013