Multiple Prescriptions Allowed for Stimulant Medications

Beginning December 19th medical practitioners will be allowed to issue multiple prescriptions for Schedule II controlled substances during one office visit according to new policy issued by the Drug Enforcement Administration (DEA). The prescriptions will have to be filled on different dates, and the total amount of medication prescribed under the new regulations must not exceeed a 90-day supply. The prescriptions could be filled sequentially, for the same scehdule II controlled substance.

This will help many families and adults with ADHD who take prescribed stimulant medications to treat their condition. Previously multiple contacts were required with the practitioner's office to get a new prescription. This was cumbersome, expensive, and time consuming both for prescribers and patients, adding a significant amount of office work, including answering and recording a telephone request, obtaining the chart, noting the refill in the chart or medication log, and addressing and mailing the prescription.

In September, 2006 the DEA published in the Federal register a Notice of Proposed Rulemaking (NPRM) proposing to amend its regulations to allow practitioners to provide individual patients with mutliple prescriptions, to be filled sequentially, for the same schedule II controlled substance, with such multiple prescriptions having the combined effect of allowing a patient to receive over time up to a 90-day supply of that controlled substance.

The DEA received 264 comments about the NPRM, the vast majority of which supported the NPRM. Comments received from parents of children with ADHD were supportive of the proposed rule, generally stating that they will no longer have to take their children to their prescribing practitioners every month for a new prescription. As a result they will be able to take less time off from work (especially burdensome for single parents) and their children will have fewer absences from school.

This month's teleconference features psychologist, Ari Tuckman, PsyD. MBA who will be speaking on Coping Mechanisms That Work for Adults with ADHD.

Sign up for this important teleconference by going to myADHD.com. Join this teleconference on Wednesday, January 9, 2008 from 8:30 - 9:30 pm Call: (646) 519-5883 Pin: 2648 at 8:30 pm EST to join the teleconference.

The following ADHD research abstracts were provided by Dr. Sam Goldstein, editor of the Journal of Attention Disorders

Curtis, D.F., Pisecco, S., Hamilton, R.J., & Moore, D.W. (2006). Teacher perceptions of classroom interventions for children with ADHD: A cross-cultural comparison of teachers in the United States and New Zealand. School Psychology Quarterly, 21, 171-196.

These authors evaluated teacher perceptions of classroom interventions for ADHD. Participants read one of six vignettes describing a child with symptoms representative of ADHD. The number and type of symptoms were consistent across all vignettes. Then teachers rated description of the daily report card, response cost technique, classroom lottery and medication interventions and rated their acceptability using a behavior rating scale. Cross cultural differences were observed for both behavioral and pharmacological interventions based upon teacher nationality. Teachers in the United States perceived both types of interventions as more acceptable, effective and to have more timely effects than teachers in New Zealand. Interaction was also demonstrated between student gender, nationality and intervention preference. The authors suggest that these disparities infer that there may be experiential and ideological differences between the way that teachers in each of these two countries view the identification and treatment of hyperactive, impulsive and inattentive behaviors in the classroom. Such influences are especially important considerations in an effort to promote efficient and effective interventions when children struggle in the classroom.

Faraone, S.V., Biederman, J., & Mick, E. (2006). The age-dependent decline of ADHD: A meta-analysis of follow-up studies. Psychological Science, 36, 159-165

The authors analyzed data from published follow-up studies of ADHD. These studies met a stringent set of criteria. A meta-analysis regression model was used to separately assess the syndromatic and symptomatic persistence of ADHD. When those meeting full criteria for ADHD had persistent ADHD, the rate of persistence was low, less than 15% at age 25. However, when cases consistent with DSM-IV's definition of ADHD in partial remission, the rate of persistence was much higher, approximately 65%. The authors suggested estimates of ADHD persistence rely heavily on how persistence is defined. These analyses demonstrated that evidence for ADHD lessens with age.

Gehricke, J.G., Whalen, C.K., Jamner, L.D., Wigal, T.L., & Steinhoff, K. (2006). The reinforcing effects of nicotine and stimulant medication in the everyday lives of adult smokers with ADHD: A preliminary examination. Nicotine and Tobacco Research, 8, 37-47.

Smoking prevalence rates in the general population are declining yet rates among those diagnosed with ADHD continue to be elevated. The authors suggest that previous research supports that nicotine may improve attention and mood, suggesting that nicotine may help ameliorate symptoms associated with ADHD. A total of 10 smokers with ADHD who were being treated with stimulant medication were asked to abstain from smoking while participating in the study. Participants underwent four conditions in randomized order involving nicotine patch, stimulant and placebo. Each condition continued for two days during which self-reports of ADHD symptoms and moods were obtained using electronic diaries. Light weight ambulatory monitors recorded cardiovascular activity at each diary entry. Smoking abstinence was verified by expired carbon monoxide and salivary cotinine analysis. Results demonstrated that nicotine patches and stimulant medication alone and in combination reduced difficulty concentrating compared with placebo patch only. Borderline improvement in patients and self-control was seen with nicotine patch administration, primarily in day one. Nicotine patch also tended to elevate systolic and diastolic blood pressure compared with placebo. The findings suggested smokers with ADHD experienced nicotine related reductions in ADHD symptoms during their every day lives.

Below are some Treatment Tools from myADHD.com to help design behavior management programs at home and school:

• #3003 Daily Report Card
• #3004 Home Token Economy
• #3030Bedtime Job List
• #3059 Sample Classroom Reward Tickets