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 warranted by an appropriate diagnosis and all policy criteria outlined here has 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. We do not prescribe off-label doses or for off-label diagnoses. Anyone receiving CDS from this practice must be able to pass a drug screen demonstrating that 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 here or at another practice. 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. Additionally, most of the patients we screen for ADHD are either not diagnosed with ADHD or we are effectively able to treat their ADHD withOUT stimulants. Therefore, we may prescribe stimulants in the treatment of ADHD, but only after a minimum 60-day trial of NON-stimulant medication(s) has been found ineffective. This period also gives us adequate time to thoroughly ensure an ADHD diagnosis is accurate and to rule out the huge number of medical and psychiatric disorders or traits that may mimic or worsen ADHD symptoms. If there are other co-existing disorders they typically need to be treated for optimal outcomes, whether they are mimicking ADHD symptoms or making existing ADHD worse. We follow this same 60-day process for both newly evaluated patients and anyone who may have been prescribed stimulant ADHD medication at another practice in the past unless all of the following apply:

To be eligible for consideration of stimulant prescribing during your initial evaluation with us, all of the following must apply: You have been diagnosed with ADHD at another practice but needed to find a new practice for a valid reason (such as relocation to Maryland), you have had your official records sent directly from the prescribing practice (for this purpose we cannot accept records received from patients) to our practice a minimum of 72 hours prior to your evaluation date, you have not had a gap in prescription medication treatment for a period of time equal to or greater than 30 days, and we concur with the diagnosis after conducting our own evaluation. All of these must apply for consideration of immediate stimulant prescribing and even then prescribing is not guaranteed if the provider does not feel it would be safe or appropriate. If all of these criteria do not apply you would be required to complete the same 60-day non-stimulant trial outlined previously. Please note that any time spent on trials of non-stimulant medications prescribed at other practices will not be considered and will not reduce the 60-day requirement at this practice. If someone reports intolerable side effects from a non-stimulant medication we may discuss alternative non-stimulant medications or focus on treating other disorders that may be causing or worsening symptoms. However, nothing will reduce the 60-day requirement for patients new to the practice except potentially meeting all of the criteria outlined above.

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.