Controlled Substance Prescribing: What to Expect
Understand requirements for ADHD stimulants, benzodiazepines, and other controlled medications: policies, monitoring, refills, and safety.
Clinically Reviewed: Board-Certified Psychiatrist |Next Review: May 2025
Key Takeaways
- Controlled substances require comprehensive evaluation, signed agreements, and regular monitoring
- PDMP (Prescription Drug Monitoring Program) checks are mandatory
- Refills require consistent follow-up appointments—no early refills for lost/stolen medications
- Non-controlled alternatives are prioritized when clinically appropriate
- These policies protect patient safety and comply with state/federal regulations
What Are Controlled Substances?
Controlled substances are medications regulated by the DEA due to potential for misuse or dependence. In psychiatry, this includes:
- Stimulants: ADHD medications (Adderall, Ritalin, Vyvanse)
- Benzodiazepines: Anti-anxiety medications (Xanax, Ativan, Klonopin)
- Sleep medications: Some (Ambien, Lunesta)
Requirements for Prescribing
- Comprehensive evaluation: Medical history, symptom assessment, prior treatment documentation
- Written agreement: Signed treatment agreement outlining responsibilities
- PDMP review: Check prescription history before prescribing
- Regular follow-ups: Consistent appointments to monitor safety and effectiveness
- ID verification: Valid government ID required at visits
- Drug screening: Urine tests may be requested periodically
Refill Policy
- Request early: Submit refill requests 3-5 business days before running out
- No early refills: Lost, stolen, or misplaced medications cannot be refilled early
- In-state pharmacy required: Prescriptions sent to pharmacies within your state of residence only
- Appointment-tied refills: Missed visits may pause refills until you're seen
- Communication: Use patient portal for non-urgent refill requests
Frequently Asked Questions
Why are controlled substances treated differently?
Controlled substances have potential for misuse, dependence, and diversion (giving/selling to others). Federal and state laws require stricter prescribing practices to ensure appropriate medical use and patient safety.
What's required before getting a controlled substance prescription?
Comprehensive evaluation (medical history, symptom assessment, prior treatments), PDMP check (reviews your controlled substance prescription history), written treatment agreement outlining responsibilities, and sometimes urine drug screening.
Can I get stimulants for ADHD on my first visit?
Generally no. We need time to review your history, confirm ADHD diagnosis, rule out contraindications, and establish a treatment plan. This protects your safety and ensures appropriate prescribing.
What if I lose my controlled substance prescription?
Unfortunately, lost or stolen controlled medications generally cannot be refilled early. This is a federal regulation, not our policy. We can provide documentation for insurance/work if needed, but early refills create liability and compliance issues.
How often do I need to see the doctor for refills?
At least every 1-3 months for controlled substances, depending on the medication and your stability. Missed appointments may pause refills until you're seen. Consistent follow-up is required by law and medical best practice.
Will you prescribe benzodiazepines for anxiety?
Rarely and only short-term. Benzodiazepines (Xanax, Ativan, Klonopin) carry significant risks of dependence and cognitive effects. We prefer SSRIs, SNRIs, buspirone, or therapy for anxiety. Benzos may be used briefly in crisis situations under close monitoring.
What's a PDMP check?
Prescription Drug Monitoring Program—a state database showing all controlled substance prescriptions you've received. We're required to check this before prescribing controlled medications to ensure safe, coordinated care.
Can I fill controlled substances at any pharmacy?
We'll send prescriptions to your preferred pharmacy within your state. Federal law prohibits mailing controlled substances across state lines. Changing pharmacies frequently may raise red flags and require additional documentation.
References
- 1. DEA Practitioner's Manual (2021). "An informational outline of the Controlled Substances Act."
- 2. Federation of State Medical Boards. (2017). "Guidelines for the chronic use of opioid analgesics." [Adapted principles apply to psychiatric controlled substances]