Request for Advice Doctor Won’t Prescribe

[honda]

After receiving a letter from the College of Physicians & Surgeons my doctor will not prescribe any type of stimulant medication for my ADD. He can still prescribe if he wants, but if he does the College of Physicians & Surgeons will be watching his every move. I don’t understand why the College of Physicians & Surgeons is behaving this way. I have never abused drugs, and have a copy my ADHD Assessment Report. It seems that the only way to get the medication I need, is to go to another doctor, but that may prove to be very difficult, as any person walking off the street into a walk-in-clinic, and asking for a controlled substance is going to be met with much suspicion. I need to know what I should, and should not do. How to find a doctor who is open to prescribing ADHD medication? How should I present myself? Should I tell him I already have another doctor? Also I am not good at expressing myself, I get tongue tied, and keep forgetting what I want to say.

I need advice, suggestions and ideas. Hope this forum can help. You will not only be helping me but, the many others who find themselves in the same predicament. I think a whole article could be written on this subject.

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[blackdog]

@honda

This is very strange. And it’s not the first time someone has posted about it here. I don’t understand what this letter from the College of Physicians & Surgons is about, or why its being sent out to doctors.

I can’t really give you much advice about how to get a prescription because I don’t understand the situation. You are correct that going to a walk-in clinic and asking for a controlled substance is not a good idea. They won’t write you a prescription, not even with proof of your diagnosis. Also, they will send a report back to your doctor, which could make the situation worse.

Now that I think about it, this could explain why my doctor suddenly seemed hesitant to prescribe medication for me when 10 years ago he practically tried to shove it down my throat. I ended up asking him for a referral to a psychiatrist who does ADHD assessments. The psychiatrist recommended Vyvanse, and the doctor went along with it, though reluctantly.

The only thing I can suggest is taking to your doctor about it and trying to get through to him. If that doesn’t work, ask for a referral to a psychiatrist who will prescribe medication. It is probably better if you have a referral than just going to another doctor on your own, which may look suspicious. You could also try asking him to prescribe a non-stimulant medication, such as Welbutrin. It might be better than nothing. (just be sure to check out all the options first and know what the side effects are and if it is a good choice for you or not)

As for having trouble expressing yourself, that is a common problem for a lot of us. Try to work out what you want to say ahead of time and write it all down. Then just read from your notes, and don’t let him interrupt you or cut you off. If you can take a friend or family member with you for support that would be great.

Good luck and keep us posted.

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[honda]

Hello Black Dog. During the last visit to my doctor I asked for a referral. We talked about it for a while and then he decided it was not necessary. I haven’t given up yet. I am going to bring it up again on my next visit.

I think the way the College of Physicians & Surgeons is behaving is an over reaction to the illegal use of stimulant medication. They punish the people who need it, to keep it out of the hands of the people who abuse it. Nothing is accomplished by doing that. People who use it illegally can still buy it on the street, and the people who need it, and want to buy it legally are the ones who suffer.

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[blackdog]

Good for you, don’t give up.

It is an extreme overreaction, when you think about it. People who want to abuse drugs, or have a problem with addiction, are going to find a way to use drugs no matter what. Even if they put a complete ban on prescription stimulants it wouldn’t make a difference. There are plenty of other drugs available.

 

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[deebee]

Perhaps there was some new notice concerning the Narcotics Monitoring System that requires identification of everyone who is prescribed narcotic or stimulant drugs, as well as people who pick them up for someone else. I moved here from the States, where prescriptions for controlled substances have long required both prescribers and dispensers to demand and record individual identification – and diagnosis – for each prescription.

I am sure that in the early days of such regulation, doctors were very nervous about compliance. I don’t understand, though, why you’re having the problem NOW, several years after the law went into effect.

UNLESS: Did the doctor get a letter specifically about YOU? That can happen if your name turns up sign of duplicative prescriptions, multiple doctors prescribing stimulants for you in the same month, or other red flags of abuse. If the doc got an individual’s letter, rather than a general notice, you should ask what it said, in case it was wrong.

Good luck!

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[onewithmany]

Education, Learn, Learn, Learn!

My advice is to educate your self as much as you can, as the adhd medication politics stands right now is a mess. The best thing you can do is to learn about stimulant medications and how they work in the human system. Once you know how things work you can make good arguments to your doc. Best thing is if you make him/her understand that not giving you the medication you need is unethical, that way it becomes a personal morale situation to him/her, witch improve’s your chances of getting treatment you deserve and need.

Best of luck to you.

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[blackdog]

@deebee

I don’t really know much about the regulations myself, aside from the fact that if I go to get my prescription filled even a day or two early they tell me they can’t do it, which is really annoying. Although the head pharmacist seems to have the ability to override that because there was one time when the girl told me no she heard and called out “it’s okay” and then filled it for me.

The pharmacy I use just started requiring ID for narcotics about… no, exactly… 3.5 years ago. I remember because I was picking up meds for my dad and they asked for ID and I was confused because they never did before.

I meant to ask my doctor about this letter thing, because I don’t understand it, but I forgot. But it depends a lot on the individual doctors, their knowledge of the medications, and ADHD, and any preconceptions they might have.

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[deebee]

Actually, legally every doctor has to comply. Trying to figure out how to get health care in Ontario (saving that for my next post)- mainly for ADD, but other issues too – I went to the Ministry of Health’s website and read the whole law that was passed at that time, as well as all the information posted about it. (I tried to post a link to it, but botched it, posting an apparent link to a bunch of text instead.) It is intended to make every prescription identifiable by doctor, pharmacy, patient, and anyone else who might pick it up. Hence, the both doctor and pharmacy are required to get ID, and the doctor has to record some other things like a diagnosis.

Another purpose of the law is to snag people who are getting too much of the controlled substances, either by going to multiple doctors, filling prescriptions too soon. Or too LATE, perhaps on the theory that if you can go longer than the designated interval to refill, you didn’t really need so much to begin with. I wonder if having ADD and constantly forgetting can actually get one in legal hot water?

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[blackdog]

Well, my doctor has known me for…. Yikes! It’s been 28 years. Geez, I’m getting old. Anyway, medical records pretty much take care of both the ID and the diagnosis, so I don’t really understand that part. Unless it applies to those who don’t have a regular doctor and have to rely on the walk in clinics. The clinics don’t prescribe narcotics as a general rule, but if you don’t have a doctor they sort of create a file for you, if you always go to the same one, so I guess they might make an exception.

The pharmacy has known me just as long as the doctor, though I think there is only one of the original employees from way back then left. Most of them do ask for my ID, just as a formality, but when they are really busy or they know I’m in a hurry they just grab my pills for me.

If they start cutting people off because they forget to get their prescriptions filled, I’m gonna be screwed. Though I think my doctor is beginning to understand that forgetting my meds doesn’t mean I don’t need them.

It’s not so easy to have multiple doctors to get multiple prescriptions anymore, since doctors are in such short supply. But I guess some people still do it somehow.

As for getting health care in Ontario, it depends on your situation I guess.

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[blackdog]

Okay, I just looked up the NMS.

I looked at the “patient brochure”, which no one ever showed me and basically just uses a lot of words to say “take ID with you when you go to the pharmacy”.

The FAQ section is pretty much equally redundant. One answer I got from it though is that the pharmacists do have the ability to use their own judgement when they receive a DUR, as the manager did for me that one time when I was  too early.

So, knowing how the system works, it is possible that the pharmacy might refuse to fill a prescription if they get a DUR that the patient has been using multiple pharmacies.

But it still doesn’t explain this letter thing. I see no way that the College of Physiscians and Surgeons could send out a letter specifically targeting one patient. They shouldn’t have access to the information to begin with. According to what I read, even your own doctor can not access the data collected through the NMS. And they are not responsible for monitoring patient care or anything that I know of.

I don’t know, but the whole thing is part of the ehealth system, which has been messed up from the start, so no surprise if it is causing problems.

I wasn’t able to read the Narcotics Safety and Awareness Act because I’m on an iPad  and it doesn’t seem to be accessible on mobile. Perhaps there is something there that would explain it.

Here’s the link to the info on the Narcotics Monitoring System:

http://www.health.gov.on.ca/en/public/programs/drugs/ons/

 

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[deebee]

This law trumps patient privacy laws. From the Ministry of Health and Long-Term Care website, Public Information section:

Section 8 of the Act permits the Minister and the Executive Officer to direct a prescriber (e.g., doctor, dentist), a dispenser (e.g., pharmacist) or an operator of a pharmacy to disclose information about the monitored drugs they prescribe or dispense, to the Minister or the Executive Officer. For example, the Minister and the Executive Officer may direct the disclosure of information regarding:

the prescriber of the monitored drug (name, address, registration number),
the person for whom the monitored drug is prescribed (name, address, date of birth, gender, unique number appearing on a form of identification listed on the ministry’s website), and
the monitored drug itself (name, strength, quantity, length of therapy, directions for use, drug identification number, prescription number, date of prescription, date of dispensing).

In addition, if a person who has been prescribed a monitored drug authorizes someone else to pick up the drug from a dispenser, the Minister or the Executive Officer may direct a dispenser to disclose certain personal information about that person to the Minister or the Executive Officer (i.e. the person’s name and address, and the distinguishing number appearing on a form of identification that verifies the person’s name and address).

Once this information has been collected, the Minister and Executive Officer may only use or disclose it as permitted or required by the Act, the Freedom of Information and Protection of Privacy Act, and the Personal Health Information Protection Act, 2004. For example, subsection 5(5) of the Act permits the Minister and the Executive Officer to disclose personal information about a person who has been prescribed a monitored drug, to a prescriber, a dispenser or an operator of a pharmacy who has prescribed or dispensed such a drug to the person in the past.

You’re right; doctors don’t have access, but the gub’mint does. The clearest thing I’ve read is the monitoring FAQ at

Sorry if I’ve botched the HTML again.

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[deebee]

Hmmm. My apology actually IS the link!

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[deebee]

My request is even more basic than honda’s: Can anyone give me a suggestion for a particular family doctor in Toronto? Preferably one with a sympathetic ear for the ADDled, but I am really hoping to find good all-around primary care. I am downtown, but am open to anyone accessible by public transportation.

I know how to find all the official lists of doctors; what I’m looking for are recommendations based on personal experience. I’d be so grateful to anyone generous enough to give me a name or two.

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[Patte Rosebank]

@Deebee, I found my family doctor when a new group-practice (Patient Networks, at Yonge & Richmond) opened near me. He was fresh out of medical school, as are the other doctors there. All medical records are electronic, and shared by all of the doctors, so it doesn’t matter which of them you see.

They’re not “officially” taking new patients, because each doctor has reached the limit they’re allowed to have, but they offer walk-in appointments to anyone. Most patients there are technically “walk-ins”, but they’ve been going for several years.

My doctor doesn’t prescribe ADHD meds, because he knows it’s a specialty that he isn’t trained in. However, he was happy to refer me to an ADHD clinic that has a doctor who specializes in ADHD meds and getting each patient through the tricky trial-and-error process of finding the right med(s) and dose(s) for him/her, as well as psychologists and coaches, all of whom specialize in treating ADHD.

I go to Springboard Clinic, which is 1 block north of Rosedale subway station. Laura MacNiven, the guest at the next TotallyADD webinar (8 pm, April 1, 2015 – http://totallyadd.com/webinars/), is part of the Springboard team. Maybe you can ask her about it during the webinar.

Since it’s a specialized clinic, you’ll need a referral from your doctor. You can download a referral form from Springboard’s website. I filled in most of the info myself, and my doctor went through it with me before signing it. He appreciated this!

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[hullupoika]

I’m in the lower 48.  For Adderal, and for my present Ritalin, I’m required to bring my pill bottle with me for a pill count before getting my next 28/29 30 or 31 day prescription.  The prescription must be hand signed, and only I can pick it up.  It can’t be sent electronically to the pharmacy.  I must again show a government photo ID to pick it up.

I don’t have to do that with my Zoloft and Xanax.

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