Controlled Dangerous Substances (CDS) Policy

This section only applies to Controlled Dangerous Substances (CDS). All other appropriate prescription medications can be prescribed without any special restrictions.

Baltimore Psychiatry may prescribe limited CDS in the treatment of certain psychiatric disorders when warranted by a diagnosis, medically appropriate, and the benefits outweigh the risk. This information is provided so prospective patients can determine if we may be able to meet their treatment needs only. The decision to prescribe or not prescribe CDS is still always at the discretion of the provider. However, they can only do so when all policy criteria have been met. They cannot override these practice policies, negotiate, or make exceptions. We will never guarantee CDS prior to completing an evaluation, regardless of past history or evaluations.

We do not prescribe more than one controlled substance per patient and cannot accept or manage patients taking more than one controlled substance. Before considering writing a controlled substance prescription a multi-state database is cross-referenced to review the individuals controlled substance history. The database is referenced before every controlled substance prescription issued.

When CDS are prescribed we never prescribe doses higher than the FDA has approved for the indicated diagnosis or prescribe off-label doses or for off-label diagnoses. Anyone receiving CDS from this practice must be able to pass a drug screen (demonstrating no illegal substances are being used, including prescription medications that were not prescribed, or even legal substances if they may pose a risk in treatment).

When CDS are prescribed at this practice, patients must attend at intervals determined to be safe and appropriate. Intervals may be more frequent but will not be less frequent than at least twice the first month the medication is prescribed, monthly for the next 6 months, every 2 months for the next eighteen month period, and then every 3 months will be considered if and when appropriate. Minimum appointment intervals must be routinely kept based on the time-frame requested, independent of medication availability or use for proper monitoring. This requirement applies even for those who have been on these medications previously. Additionally, CDS are never prescribed without an appointment under any circumstances; if an appointment is missed, another appointment must be attended before medication will be prescribed, without exception.

• Stimulants: For those with a legitimate ADHD diagnosis who depend on these medications, we want to ensure they have appropriate access without enduring stigma or facing arbitrary roadblocks. At the same time, we are keenly aware that individuals without ADHD attempt to inappropriately obtain these medications and have safeguards in place to prevent this. While we may prescribe stimulants in the treatment of ADHD this will only be done after a trial of a non-controlled substance has been found ineffective. If you taken medication for ADHD previously and would like to receive immediate consideration for a stimulant, we will require that you have your medical records sent to us prior to considering the prescribing of a stimulant. We must also agree with the diagnosis after conducting our own evaluation. If stimulants have already been discontinued the requirement for a non-stimulant trial will still apply. Anyone receiving stimulants from this practice must be able to pass a drug screen. It is unsafe to prescribe these medications at all for those with a history of certain medical and psychiatric disorders. Those with significant cardiovascular risk factors or bipolar disorder may be able to take these medications with careful monitoring but we are not able to prescribe for these individuals in this practice setting. We do not prescribe stimulants for anyone taking any other controlled substance medication.
• Benzodiazepines and barbiturates: We NEVER prescribe these medications at this practice UNDER ANY CIRCUMSTANCES. These medications are generally only indicated for short-term use in a limited number of situations due to serious health and safety risks. Long-term use is often counterproductive and can lead to worsening baseline symptoms instead of improvement.
• Hypnotic sedatives/sleep aids: We prescribe NON-controlled substance sleep aids on a fairly routine basis and these are often effective. Before considering the use of short-term controlled substance sleep aids, we must have record of a completed (in-person) sleep study. In the event that a sleep study is cost-prohibitive for an individual that we believe may benefit from a short-term controlled sleep aid, these medications may be prescribed by the provider on a discretionary basis, but will only be considered for individuals who have been treated at our practice for a minimum of 6 months. We will not be able to prescribe these for new patients or accept new patients who are currently taking these medications and seeking renewal. In all cases, before considering these medications the combination of lifestyle changes, sleep "hygiene," and non-controlled substance sleep aids must have proven ineffective and the medication must be deemed to have a highly favorable benefit to risk ratio. We do not prescribe controlled sleeping medications for anyone taking any other controlled substance medication.