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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by PhoenixGirl on January 2, 2001, at 11:50:46
Does anyone know what the laws are about getting controlled substances like modafinil and ritalin for depression?
Do insurance companies tend to pay for them only if they are being used for the FDA-approved purposes? I don't think any controlled substance has been approved for depression, even though they are used for it.
One doctor said he would be arrested for prescribing ritalin! He was stupid in a lot of ways, though, and the pharmacist said that doctors can prescribe ritalin whenever they want to. I don't know what to think.
I want to try things like ritalin and modafinil, probably ritalin first because I guess modafinil is very expensive? Hope someone can answer these questions.
Posted by MarkinBoston on January 2, 2001, at 17:20:10
In reply to Controlled substances, what are the rules?, posted by PhoenixGirl on January 2, 2001, at 11:50:46
> Does anyone know what the laws are about getting controlled substances like modafinil and ritalin for depression?
> Do insurance companies tend to pay for them only if they are being used for the FDA-approved purposes? I don't think any controlled substance has been approved for depression, even though they are used for it.
> One doctor said he would be arrested for prescribing ritalin! He was stupid in a lot of ways, though, and the pharmacist said that doctors can prescribe ritalin whenever they want to. I don't know what to think.
> I want to try things like ritalin and modafinil, probably ritalin first because I guess modafinil is very expensive? Hope someone can answer these questions.Your pharmicist is correct. There are different schedule classes of drugs:
Schedule I. - "No medical value", illegal. Drugs like pot and GHB that do have some medical value but lots of political value too. Others would be LSD, heroin, E etc..
Schedule II. Medical value, but dangerous or addictive. Need a written script with Dr's. DEA number on it. Max one month supply, no refills. Ritalin and other stimulants, pain killers generally in this catagory.
Schedule III. Medical value, some danger or abuse potential. Valium, Xanax, other benzo's, anabolic steroids. Can be called in and have refills. I think the Dr.'s DEA # is needed.
Schedule IV. All other prescription meds, "unscheduled"
Schedule V. over the counter meds.A doctor will get looked at by insurance companies if they prescribe more than the maximum normal therapeutic dose, and get a letter. A psychiatrist shouldn't have any problems with scripts for Ritalin or Valium, but wouldn't be expected to write scripts for Percocet or other pain killers.
Unless your doctor has enough experience working with you, being young and seeking drugs with abuse potential might raise concern. You might try negotiation and ask for a few days worth since there is no delayed effect with Ritalin or amphetamines. They usually become less effective and side-effective over time and you may not like the jaw-clench or too much coffee feeling side effects. These drugs are likely to cause agitation if you are prone to it, and result in unhealthy behavior.
Modafinil does have delayed onset, but a doctor can write scripts for other than FDA approved uses. Doing this raises their risk of getting sued for malpractice or having a complaint filed against them with the medical board. Is the doctor more confident this drug might help you than worried about ruining his career?
Posted by J. Lester on January 2, 2001, at 18:00:13
In reply to Controlled substances, what are the rules?, posted by PhoenixGirl on January 2, 2001, at 11:50:46
> Does anyone know what the laws are about getting controlled substances like modafinil and ritalin for depression?
> Do insurance companies tend to pay for them only if they are being used for the FDA-approved purposes? I don't think any controlled substance has been approved for depression, even though they are used for it.
> One doctor said he would be arrested for prescribing ritalin! He was stupid in a lot of ways, though, and the pharmacist said that doctors can prescribe ritalin whenever they want to. I don't know what to think.
> I want to try things like ritalin and modafinil, probably ritalin first because I guess modafinil is very expensive? Hope someone can answer these questions.I believe doctors must be registered/licensed with DEA in order to be able to prescribe controlled substances. At least for the most restrictive schedules. Correct me anybody if I am wrong. It's completely futile to ASK a doctor to prescribe a controlled substance. No way whatsoever. Insurance may cover controlled drugs as it does with the rest of medications (it may not distinguish at all). My insurance (Merck Medco) does not care what the diagnosis and the medication were (so far), just any script filled at a pharmacy is covered automatically thru their computer system.
J.L.
Posted by J. Lester on January 2, 2001, at 18:57:49
In reply to Re: Controlled substances, what are the rules?, posted by MarkinBoston on January 2, 2001, at 17:20:10
> Your pharmicist is correct. There are different schedule classes of drugs:
> Schedule I. - "No medical value", illegal. Drugs like pot and GHB that do have some medical value but lots of political value too. Others would be LSD, heroin, E etc..
> Schedule II. Medical value, but dangerous or addictive. Need a written script with Dr's. DEA number on it. Max one month supply, no refills. Ritalin and other stimulants, pain killers generally in this catagory.
> Schedule III. Medical value, some danger or abuse potential. Valium, Xanax, other benzo's, anabolic steroids. Can be called in and have refills. I think the Dr.'s DEA # is needed.
> Schedule IV. All other prescription meds, "unscheduled"I am confused here. I thought modafinil is schedule IV which implies that ANY 'conventional' prescription drug simply CANNOT be in the schedule IV.
Am I wrong ?..> Schedule V. over the counter meds.
>
> A doctor will get looked at by insurance companies if they prescribe more than the maximum normal therapeutic dose, and get a letter. A psychiatrist shouldn't have any problems with scripts for Ritalin or Valium, but wouldn't be expected to write scripts for Percocet or other pain killers.
>
> Unless your doctor has enough experience working with you, being young and seeking drugs with abuse potential might raise concern. You might try negotiation and ask for a few days worth since there is no delayed effect with Ritalin or amphetamines. They usually become less effective and side-effective over time and you may not like the jaw-clench or too much coffee feeling side effects. These drugs are likely to cause agitation if you are prone to it, and result in unhealthy behavior.
>
> Modafinil does have delayed onset, but a doctor can write scripts for other than FDA approved uses. Doing this raises their risk of getting sued for malpractice or having a complaint filed against them with the medical board. Is the doctor more confident this drug might help you than worried about ruining his career?
Posted by r.anne on January 2, 2001, at 19:38:07
In reply to Controlled substances, what are the rules?, posted by PhoenixGirl on January 2, 2001, at 11:50:46
My opinion about getting certain controlled drugs is that some doctors just choose not to prescribe them for whatever the reason. I've asked my doctor about prescribing some controlled stuff and he said he doesn't prescribe it. I guess they have a right to prescribe what they want.
Posted by rogdog on January 3, 2001, at 0:00:04
In reply to Controlled substances, what are the rules?, posted by PhoenixGirl on January 2, 2001, at 11:50:46
Hi phoenix girl, you can actually get modafinil through mail order and no prescription required.
one question; have you tried these medications and do they work? ritalin is a schedule 2 drug and all the schedule 2's are really under scrutiny by the fda, and it is hard to find a doc to stick his neck out. I am on xanax , which is a schedule 4 and even then doctors are wary about prescribing any controlled substances, especially for depression. they like to stick to the "normal antidepressants" such as prozac etc. which have no scheduling.good luck to you, Rogdog
Posted by MarkinBoston on January 3, 2001, at 17:16:30
In reply to Re: Controlled substances, what are the rules?, posted by J. Lester on January 2, 2001, at 18:57:49
> > Schedule IV. All other prescription meds, "unscheduled"
>
> I am confused here. I thought modafinil is schedule IV which implies that ANY 'conventional' prescription drug simply CANNOT be in the schedule IV.
> Am I wrong ?..I could be wrong. I typed this from memory. The difinitive places to look are on FDA and DEA .gov web sites and search for schedule or the like. I might be wrong about schedule V., confusing it with FDA stage V..
Basicly, most drugs that make you feel good are going to be controlled substances.
Posted by danf on January 12, 2001, at 13:36:49
In reply to Re: Controlled substances, what are the rules? » J. Lester, posted by MarkinBoston on January 3, 2001, at 17:16:30
This varies from state to state.... in some states ritalin is very restricted for adults.
All scheduled drugs ( I thru V ) are restricted.. this means a significant chance of addiction or abuse.. Schedule V drugs still have significant addiction potential.
Regular prescription meds, like for BP control are not scheduled.
Posted by stjames on January 12, 2001, at 16:50:52
In reply to Re: Controlled substances, what are the rules?, posted by danf on January 12, 2001, at 13:36:49
> This varies from state to state.... in some states ritalin is very restricted for adults.
>
> All scheduled drugs ( I thru V ) are restricted.. this means a significant chance of addiction or abuse.. Schedule V drugs still have significant addiction potential.
>james here....
Here in the states federal law governs scheduled meds, II (ritalin, Dex, Adderal) requires paper script, no refills, new script for each month.
Federal law allows any doc to perscribe any controled or scheduled med to anybody, but the DEA does watch things. So primary care docs don't usually perscribe schedule II. HMO's sometimes put age restrictions on Ritalin. At the state level, some states require tripilcate scripts
or other things but this does not change a docs ability to perscribe. The regulating board may investagate a doc who does questionable perscribing and the DEA can revolke the right to perscribe scheduled meds, II-V.james
Posted by danf on January 13, 2001, at 10:32:19
In reply to Re: Controlled substances, what are the rules?, posted by stjames on January 12, 2001, at 16:50:52
> > This varies from state to state.... in some states ritalin is very restricted for adults.
> james here....
>
> Here in the states federal law governs scheduled meds, II (ritalin, Dex, Adderal) requires paper script, no refills, new script for each month.
> Federal law allows any doc to perscribe any controled or scheduled med to anybody, but the DEA does watch things. So primary care docs don't usually perscribe schedule II. HMO's sometimes put age restrictions on Ritalin. At the state level, some states require tripilcate scripts
> or other things but this does not change a docs ability to perscribe. The regulating board may investagate a doc who does questionable perscribing and the DEA can revolke the right to perscribe scheduled meds, II-V.
>
> james
Ok here is where the confusion is... Federal law sets the basic regulation... state laws may be more restrictive & often are...In many states there are very restrictive & specific guidelines for schedule II stimulants..
They are basically allowed only for narcolepsy in adults in many states...
There are also state rules for schedule II narcotics & addiction... If a Dr. prescribes narcotics for a known addict... the patient must be in a rehab or maintenance program & the Dr. certified to treat addicts...
These rules vary from state to state & can carry criminal penalties for the Drs....
One must know the state regulations & can not make blanket assumptions
Posted by stjames on January 13, 2001, at 11:02:28
In reply to Re: Controlled substances, the real rules , posted by danf on January 13, 2001, at 10:32:19
Do you live in the states Danf ? I got my info from my doc and Rx, also I have yet to hear of an adult ADD'er in the states who cannot get Ritalin. This is despite being on several ADD lists.
james
Posted by PhoenixGirl on January 13, 2001, at 14:47:12
In reply to Re: Controlled substances, the real rules , posted by stjames on January 13, 2001, at 11:02:28
I live in Georgia, USA. They´re a bunch of conservative assholes down here, so I wouldn´t be surprised if controlled substances are overly restricted, but where can I find out?
Do you live in the states Danf ? I got my info from my doc and Rx, also I have yet to hear of an adult ADD'er in the states who cannot get Ritalin. This is despite being on several ADD lists.
>
> james
Posted by stjames on January 13, 2001, at 16:32:55
In reply to Re: Ok, how to find out about a specific state?, posted by PhoenixGirl on January 13, 2001, at 14:47:12
Call your Rx and ask !
james
Posted by danf on January 14, 2001, at 4:31:05
In reply to Re: Ok, how to find out about a specific state?, posted by PhoenixGirl on January 13, 2001, at 14:47:12
Yes, I live in Florida... which has significant restrictions... on schedule II stimulants...
Georgia has as well, to my recollection....
The restrictions are not absolute... There are a few other states where the only approved dx for dex / Sched II stims for an adult is narclepsy.
I have lived in quite a few states.. most of the very restrictive regulations were put into effect in the last 10 yrs.
Your pharmacist can give information as to how restrictive your stste is.. The restrictive states require reporting by the pharmacy...
an odd aside is that many of the restrictive states do not require multiple /duplicate prescription copies for schedule II drugs.
most of these restrictions are the result of abuse of stimulants for wt loss & not psychrotropic use. There may or may not be psych exceptions...
This varies due to the position taken by the individual state medical regulatory boards...
Most psych Drs know the regulations well... GPs may not..
Posted by Shell on January 14, 2001, at 9:41:02
In reply to Re: Ok, how to find out about a specific state?, posted by danf on January 14, 2001, at 4:31:05
I had no idea how restrictive the laws are on Schedule II drugs. I live in Ohio and was prescribed Concerta by my family doctor upon the recommendation of a psychologist. I didn't get the impression from either of them that it was unusual or difficult to prescribe stimulants for ADD adults. The only thing out of the ordinary that I encountered was the requirement to get a new prescription every month.
I am glad that you all have mentioned the variations by state. I never would have thought about it, but this will be one more thing to research the next time I have to move.
Shell
Posted by Noa on January 18, 2001, at 18:32:28
In reply to Re: Ok, how to find out about a specific state?, posted by danf on January 14, 2001, at 4:31:05
Even if your HMO restricts stimulants to narcolepsy for patients over age 19 (as mine did when I had an HMO), you can ask your doctor to submit a letter stating that it is medically necessary for treatment of whatever disorder you have (depression for me). They may require a little hoop-jumping from your doctor, like reauthorization forms every 6 months, etc., but I think it is possible to override the restriction. It is worth a try.
Personally, it annoys me greatly that I cannot refill my prescription for Adderall, and have to go to the doctor to get another scrip (although sometimes he gives me two in advance), and go to the pharmacy, etc. rather than just calling in a refill as with my other meds. I guess it is particularly annoying to me at the moment after the hassles I have had at the pharmacy--and getting oxycontin by mistake in the vial marked Adderall, which I think is far more dangerous than my having the ability to call in refills for Adderall.
As for the issue of abuse--isn't it interesting that the restrictions apply to adults, where adolescents are probably more at risk for abusing stimulants (probably more likely friends of the patient rather than the patient themselves). In any event, I also think the issue of stimulants sold on the streets, at least right now, is now as big a problem as people fear. I think right now alcohol, marijuana, and exctacy are the major street drugs for teens. I am not an expert--just MHO.
Posted by MarkinBoston on January 18, 2001, at 19:52:38
In reply to Re: Stimulant restrictions for adult patients, posted by Noa on January 18, 2001, at 18:32:28
> Personally, it annoys me greatly that I cannot refill my prescription for Adderall, and have to go to the doctor to get another scrip (although sometimes he gives me two in advance), and go to the pharmacy, etc. rather than just calling in a refill as with my other meds
>
> As for the issue of abuse--isn't it interesting that the restrictions apply to adults, where adolescents are probably more at risk for abusing stimulants (probably more likely friends of the patient rather than the patient themselves). In any event, I also think the issue of stimulants sold on the streets, at least right now, is now as big a problem as people fear. I think right now alcohol, marijuana, and exctacy are the major street drugs for teens. I am not an expert--just MHO.A couple points to consider:
1. Some docs will write a script for the maximum of the usual dose range if they trust the patient to actually take less and stretch it out.
2. If you got 20mg pills instead of 10mg, and split them, your supply would last 2 months for the same number of pills, and might only cost your HMO 30% more for the script instead of twice as much.
3. One way to help contain health costs is to use off-patent drugs like Ritalin or dexamphetamine instead of Adderall or Provigil.My pdoc asked the Provigil salesman what it cost, and he claimed not to know (she didn't believe him). Its about $8/pill. I don't know how much the Adderall is, hopefully less.
There's still a good bit of stimulant abuse: cocaine, crack, methamphetamine, MDMA/extasy, caffene, nicotine, efedrine (Ma Huang).
Unfortunately, turning Sudefed into methamphetamine often involves toxic chemical byproducts which the illegal labs usually pollute rivers and land with. When the DEA busts a lab, they spend 10's of $1,000s to decontaminate the area.
Posted by SarahB on January 19, 2001, at 20:30:46
In reply to Re: Stimulant restrictions for adult patients » Noa, posted by MarkinBoston on January 18, 2001, at 19:52:38
Hi there.... 10mgs of adderall costs under a dollar. I can fill my script of 120 of them for around $90. what's funny is I can get 60 20 milligrams for right around $50. Go figure! (my insurance, an HMO, covers it anyway) The Provigil at Planetrx is $100 for 30 100mgs. and 148 for 30 200 mgs. I have discussed this med with my doc for my ADD and at that time (almost a year ago) he didn't know enough about it yet to prescribe it. As for the legal part of it, he is an MD and a shrink, so he has never had a problem with prescribing me my Adderall. He has also offered sleeping aides. (which I didn't take) He usually gives me three scripts at a time for the next three months and when it's getting close to needing new ones, I give him a call and he'll either mail it to me or have it at his secretary's desk. If he hasn't seen me in awhile, he'll have me come in and chat for a bit and update him on my life and how the meds are doing. (I have never had an addiction or abuse problem and the only time I've ever had to ask him for more was when they were stolen over Christmas. My shrink was out of town so I called my primary doc. He would not prescribe them and treated me like a junky when I asked and told me to go to detox if withdrawl got too bad!GRRRR, still mad about that one! My shrink was livid, he keeps him up to date on my meds and he knows I don't abuse them, I guess this is another story, anyway) As far as my insurance goes I can't get my next refill until about a week before and they and my pharmacy keep very up to date on that. He had written a six month one for me once when we were going to try to do the mail in program.(can't do that with schedual II we found out) Anyway I was due for my refill so I took that to the pharmacy. I told them I just wanted a month of it. They explained that I would loose my refills if I did that, but had I paid cash for it instead of insurance, they would have given me all of them! Well, I hope I helped! You can also get alot of legal info on controlled drugs at http://www.fda.gov .
Posted by stjames on January 29, 2001, at 16:39:31
In reply to Re: stims and States, posted by stjames on January 29, 2001, at 0:49:50
> > Yes, I live in Florida... which has significant restrictions... on schedule II stimulants...
> >
>
> james here....
>
> Dan could you be more specific ? I asked on 2 ADD lists, one with 1,000 + users, my new pdoc and my Rx man. 4 Adult ADD'ers on my lists in Florida say they have no problems and had to do nothing special other than have a valid script to get Dex or Adderal filled. No one reported a state where Adult ADD'ers cannot take sch II stims. My doc and the Rx man said the same thing. I am intrested in this because I have to take Dex to function and for that reason only.
>
> I do realize HMO's can say what they will and will not pay for. I was able to appeal this with my HMO.
>
> James
This is the end of the thread.
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