Help me navigate this prescription issue?
January 10, 2019 1:45 PM   Subscribe

I’m having issues with my ADHD prescription and feeling anxious about it/not sure what I need to do but it feels urgent.

Background, skip if you want: A little over a year ago I was diagnosed with ADHD (both types) as a 27 y/o woman (my life is very similar to all the standard stories of women who weren’t diagnosed until adulthood). I have been on 20mg of generic Adderal XR since close to the beginning (did 1 month of 10mg first). After the 20mg was determined to be working, my doctor (an NP actually, who works in a practice with a psychologist(?) who actually signs the scrips I think) gave me 3 months worth of prescriptions, with the 2nd two having an effective date of 1 month later. We did not schedule a follow up appointment at that time. I ended up not going back in for another scrip for approx 5 months, because I was not taking the meds on weekends or vacations, and due to missing a few pills now and then, I had enough to last me that long. When I went in, my doctor expressed concern that I was going to get in trouble/suspected of fraudulent use or something because if I’m not taking it most every day, I may not actually need it (not so much that she believed it, but more that the governing bodies would think that). Since then, I fill my prescriptions approx every 30 days as my schedule allows and go in for a refill appt every 90 days, regardless of how many I have actually used (as was my doctor’s recommendation at the time, though not in so many words).

The current situation: although I now take my meds on weekends & vacations mostly, I still skip days (either accidentally because I forget the pill, see: ADHD, or because I sleep in late on weekends and don’t see the point in taking a pill at like 2pm when I’m just gonna watch tv all day). That means I end up with a decent backlog of pills, which has been fine, until now - because of the hecticness of the holidays and the fact that I had so many pills left, I just went today to fill the first prescription my doctor wrote for me on 12/18. But the pharmacist said it only was good for 21 days, so they couldn’t fill it. The pharmacist said I could have my dr write a new prescription or initial a new effective date on the existing one.

The options I see are:
1) Call my doctor ASAP (she only works until 4pm CT today and until 12pm tomorrow) and explain what happened - risks her reporting me to the state/both of us getting in trouble. I am in Texas and would not be shocked if they are unreasonable about these things.
2) Use my remaining pills (I have about 6 I think?) and just fill my next prescription dated 1/18, and don’t tell my doctor - risks an issue if she or the state pay attention to a scrip that was never filled.
3) Tell my doctor but maybe fudge the truth a little (eg that I was sick or out of town and that’s why I am only just now filling the scrip) and ask for a new/updated one. This one feels safest but I don’t want to lie if I’m just blowing this all out of proportion? I just really don’t want to be blacklisted and lose access to medication - it has been life changing for me and my current position at work would be near impossible to maintain well without it.

Sorry for any typos, I’m writing this from mobile.
posted by anonymous to Health & Fitness (16 answers total)
 
I think this is common enough that unless your doctor has seemed really paranoid about this--I've had one who was--that you can probably just call, but I'd be inclined myself to frame it as "hey, this isn't an emergency, but here's what happened, and I thought I was just being economical, and if you can't manage it I'll muddle through, but I thought I'd check" kind of thing. I'm pretty sure this isn't that uncommon.
posted by Sequence at 1:50 PM on January 10 [3 favorites]


I’ve never had anyone raise questions about an unfilled prescription. People stop taking meds, take breaks from them, and lose scripts all the time. If you want you can mention it at your next appointment but I honestly wouldn’t worry about it. You’re fine.
posted by bunderful at 1:56 PM on January 10 [2 favorites]


Today: Scripts for scheduled medicines expire all the time, it was the holidays, this seems bad because you are anxious but is actually fine. In my state we only have five days to fill scheduled meds and it is the worst hoopla. People who are selling drugs to other people don't let their scripts expire, they try to fill them more than once instead. Just call or text your NP and say "I actually wasn't able to fill my script over the holidays, could you write a new one?" Solve today's problem.

Some other day: If it isn't some weird-ass regulation, can your NP write a script for a 3-month supply going forward? Can the office mail you a script every month? Can they mail the pharmacy the script? Who gives a person with ADHD two random pieces of paper and is like, "Oh, you can't use these right now, but don't lose them for two different periods of time measured in months because they are vitally important to your health." That's dumb.
posted by Snarl Furillo at 2:03 PM on January 10 [3 favorites]


I would go with the third option. I'm seeing a couple of comments downplaying the issue and respectfully, if folks haven't ever had a long-term need to be prescribed a controlled medication, I would take their advice with a heavy grain of salt. It's not in your head! I have had awful and real experiences with feeling criminalized for needing a stimulant prescription, at all stages in the treatment process.

However! It doesn't have to be that way. I would really encourage you in the long-term to find a provider who trusts you. I feel incredibly lucky to now have a GP who prescribes my adderall, and treats me like an adult by not policing the time it takes me to fill my prescription or the weekends holidays, which I generally skip. I also ended up finding out that for me, IR is much more suited to my needs than XR-- and have come to feel that XR is yet another thing that actively limits the patient's ability to tend to their own health in favor of fending off drug panic.
posted by dusty potato at 2:29 PM on January 10 [5 favorites]


(I should add that my GP had me see a psychiatrist in the hospital network to confirm an appropriate prescription, which he then felt comfortable willing to continue to prescribe based on her judgment. She was very attentive and thoughtful, so I was pretty open with her about how anxious it made me to be prescribed exactly how much it was determined I needed with no margin of error, where dropping a pill in the sink effectively means I lose half a day of work.)
posted by dusty potato at 2:39 PM on January 10 [1 favorite]


Yeah, I was going to say that I would find a new primary care provider. It's actually pretty important to me to take stimulant breaks: I try really hard to take at least a day off every week, although sometimes that's hard when I have stuff going on that requires me to be super productive on weekends. But most of the time I can get away with having one unproductive day a week. I think that's pretty normal. Any provider who has an issue with it isn't a provider who is competent to oversee my medication.
posted by ArbitraryAndCapricious at 2:40 PM on January 10 [1 favorite]


Not offering advice, just chiming in with my own anecdotal experience: I have a similar script, and take my meds similarly (i.e. typically stretch a 3mo supply to five months). I've always thought of this as a sign that I'm using this controlled substance in moderation, and have been super transparent with my prescribing psychiatrist about it (obviously if I were doing something sneaky -- selling pills or something -- wouldn't I be running out sooner, instead of much later?).

It never occurred to me to withhold or be cagy about my less-frequent use, and she seems to trust me to accurately self-report my use and needs. That said, I message her every 4-5mo when I need a refill, and she usually puts it in the system on the same day (via Kaiser, so I only needed a paper prescription initially, when I think she wanted to be meticulous with an unknown patient). This means I'm filling the Rx promptly, but quite obviously not taking my pills as frequently as prescribed. As far as I know, this has never caused any red flags for her.

My sense (as ArbitraryAndCapricious says) is that it's really valuable to take stimulant breaks every 3-5 days, and on days when I'm especially tired and foggyheaded I'll also often take a break since I don't derive much value from stimulant use when I can't think clearly anyway. I'd really try to seek out a prescribing doctor who can respect your particular needs and use patterns, especially when they indicate that you're making healthy choices re a drug that's 1) habit-forming and controlled, and 2) just fine to take on an as-needed basis.
posted by tapir-whorf at 2:46 PM on January 10 [3 favorites]


Use my remaining pills (I have about 6 I think?) and just fill my next prescription dated 1/18, and don’t tell my doctor - risks an issue if she or the state pay attention to a scrip that was never filled.

??? use the pills and DO tell your doctor, especially if you don't have quite enough to get through till the 18th. the whole point of skipping pills when you don't need them is so that you have an emergency supply when this happens! which you do, the system works. doctors actively recommend this to patients. to me, anyway. plus, forgetting to drop stuff off and pick stuff up on time is as classic a symptom as there is. this is corroboration of your diagnosis, not cause for concern.

there is no reason for a pharmacist to flag you unless you bring in too many prescriptions too often. this is not to say they never ever would, because pharmacies. but it wouldn't make sense.

When I went in, my doctor expressed concern that I was going to get in trouble/suspected of fraudulent use or something because if I’m not taking it most every day, I may not actually need it (not so much that she believed it, but more that the governing bodies would think that


this is bizarre. it might be about weird state issues but is more probably because your prescriber is not actually a doctor. NPs and PAs are much worse about this kind of nonsensical drug-cop thing than MDs, on average, because they have less training and are sometimes more concerned with looking tough and knowledgeable, and because they may have a supervisor reviewing their prescribing.

you should be totally fine to tell a doctor you sometimes skip pills in order to take a break and build up a safety supply, doctors recommend this to people! for these meds and for painkillers too, for anything you take in the smallest and most infrequent effective dose possible. having extras for emergencies is sensible, everybody does it if they're able to.
posted by queenofbithynia at 3:35 PM on January 10 [4 favorites]


I've actually had a provider firmly recommend taking regular days off stimulant medication precisely so that you don't become acclimated and require a higher effective dose over time. Seconding those who suggest finding a provider who understands and respects your judgment on this matter if at all possible--but I know that may not be easy, given insurance and access limitations. In the meantime, I'd probably go with the third option if you are really concerned that this doctor is twitchy about the subject.
posted by karayel at 3:36 PM on January 10 [2 favorites]


2nding karayel. My daughter is on meds, her pediatrician thinks it is fine and good that she doesn't take them on non-school days.
posted by rudd135 at 4:37 PM on January 10 [1 favorite]


Echoing days off is a common accepted practice and limits tolerance building. I think it's wierd your doctor even said that too you.
posted by AlexiaSky at 6:46 PM on January 10 [2 favorites]


When you're on amphetamines, you should go in every 90 days for new prescriptions, and you should fill them each month. But missing a fill isn't going to set off any bells anywhere. Though you should just call and ask for a replacement. Because that is a completely normal thing to do.

I occasionally had to get scripts rewritten because my psych NP would forget to sign, or because it was misdated, or before the computer because she wrote for the wrong dose or version. I've lost prescriptions too. The filling of a prescrption is more important than the writing of it, and mistakes happen.

Only valid for 21 days, what? Does it have an end date on it? That seems weird. How could you get prescriptions written in advance if they're only good for 3 weeks? The 90 days thing is because 3 months is the limit in most places. Anyway, just call and ask for another one to be written if you can't get the next one filled yet. As long as you don't lose bottles of pills, it shouldn't be an issue.

Treating Adderall like the medication it is also helps reduce the perception that it is purely optional or a mere crutch. It is like pain medication for chronic pain. You're managing a condition, not feeding a habit.

I hope this all works out ok for you. Meds are great, and taking them is how they work best.

And you don't have to take breaks if you don't want to. It doesn't make a difference for everyone. For people with typical brains, tolerance builds as does physical dependence. For ADHD, in my personal experience, once you hit the right dose for you, it doesn't change very much. You don't build up tolerance and need more and more of it to get the same effect. Taking a break for a day or two just means that you didn't take your meds that day. Do what works for you.
posted by monopas at 1:40 AM on January 11 [1 favorite]


(I have ADHD and have had prescriptions for multiple controlled meds from multiple providers over time (not all at once), and have had the experience of getting them filled in 3 different states with 3 different sets of hoops. I have also had open conversations with my providers about taking breaks from ADHD meds to avoid a tolerance (my idea). I've lost scripts etc and have experienced anxiety about it which has always been proven unnecessary).
posted by bunderful at 3:54 AM on January 11


I also have that same prescription and also skip days, it’s perfectly normal. What’s also normal is messing up getting refills because adhd makes it harder to jump through all the hoops I have to jump to fill the prescription!

It is also normal, unfortunately, to have a doctor treat me like a criminal for ridiculous reasons when they find out I’m on adderall. Like the one who found it suspicious that my postal address was a P.O. Box, for heaven’s sake.

You should find a doctor who doesn’t think that everyone with adhd is a grifter.
posted by winna at 4:41 AM on January 11


When I went in, my doctor expressed concern that I was going to get in trouble/suspected of fraudulent use or something because if I’m not taking it most every day, I may not actually need it (not so much that she believed it, but more that the governing bodies would think that).

This is not a thing. Your doc has managed to fill your head with all sorts of anxieties that are not a thing.

No-one gets in trouble for not taking a medication exactly as prescribed, and it is very commonplace to not take Adderall on weekends and wind up with a bit of a stash. That stash comes in handy when, as happens periodically, the manufacturers have a manufactured shortage and every pharmacy has Adderall on backorder for a few weeks.
posted by desuetude at 8:24 AM on January 11 [3 favorites]


I would go with the third option. I'm seeing a couple of comments downplaying the issue and respectfully, if folks haven't ever had a long-term need to be prescribed a controlled medication, I would take their advice with a heavy grain of salt. It's not in your head! I have had awful and real experiences with feeling criminalized for needing a stimulant prescription, at all stages in the treatment process.

I want to clarify here that I do not think you need to downplay it because they're 100% not going to care. I am in fact on Adderall. I suggest playing down it being an emergency because my personal experiences with this are that I had a doctor who simultaneously looked down on the idea of my even taking weekends off, but also seemed to be Deeply Concerned when I called up once going "I really need a new prescription right now" because I'd lost one or not filled it on time. I do think a provider that's already a bit weird will have a higher risk of also being weird about this, but you're really unlikely to get actually blacklisted; you just benefit from acting like you're a normal person who made a mistake (even if this shouldn't be considered a mistake) and acting, basically, like you expect a minor scolding. Instead of like you're entitled to medication for your real health issue, because you should be entitled to this, but a small minority of providers do not respond well to that. But even if they take it poorly, you're probably not going to get your meds yanked away immediately.

I do want to add, here, that I agree you should work on getting a new provider because they aren't all like this.
posted by Sequence at 12:50 PM on January 11


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