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Comment by colejohnson66 | Hacker News Reader

> Also ridiculous but only tangentially related: Psychiatrists (or similar functions) cannot send prescriptions for ADHD drugs (Adderall / Amphetamines etc) to pharmacies (by any method). You need to pick up the physical prescription from the health care provider, then take it to any pharmacy. The pharmacy may not even have the medication, and certainly will need some time to fill it on the spot.

This is not true, at least in California. I take a certain ADHD medicine that’s a Schedule 2 drug. So I’m limited to 30 day prescriptions with no refills (so my doctor sends in 3 at a time), but my doctor can most definitely send them direct to my pharmacy.

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That's odd that you can't get a 90-day supply. I'm also on a Schedule 2 drug for ADHD in California and have gotten a 90-day supply with Kaiser.

Granted, when I was seeing an individual psychiatrist prior to having Kaiser, she said I could only get a 30-day supply as well and would just send 3 at a time too. I feel like there is a way to do a 90-day supply that many providers either don't want to do or don't know about.

Edit - It might be something that's possible with electronic scripts and not possible with paper.

It can also be related to your insurance and employer's choices when setting up the benefits.

I don't think insurance will allow you to triple fill something and don't prescriptions for controlled substances expire?

You don't triple fill all at once. The doctor calls in one prescription for, say January, then one prescription for February, then one for March. You have to go to the pharmacy each month, but the doctor only 4 times a year. Basically the doctor can prescribe a prescription that doesn't start until a certain time. So the start time on the three prescriptions differs.

That's how it's done in FL for non-opioid schedule II. None of our Dr's can call or transmit Schedule II Rx, they have to be hand carried paper scripts.

Opioids are limited to a 3 day supply tho (with some tight exceptions, for those patients that can afford a PM Dr).

With Kaiser at least, if a doctor sends an Rx to the pharmacy the pharmacy can likely see the history. If the doctor sends a 90 day Rx and the last fill date was around 90 days prior, it's plain from that data the abuse is unlikely. They can also easily ping the doctor to verify the Rx and after so many Rx'es would flat the Rx as ok for 90 day supplies. But that's just me spitballing.

Some random pharmacy can't see the fulfillment history from other pharmacies. They only way they could see abuse would be after the fact. They don't want to set themselves up for a lawsuit or criminal investigation so they just limit their Rx amounts.

It varies state-to-state. In Michigan it is as op described. You have to go in person to get a physical prescription. A few years ago it changed briefly but it changed back. Since COVID the rules have been relaxed at least in MI.

Yep. For a long time in Michigan it was physical prescription only, but they could write you two additional 30 day scripts at the time, or you could get a longer script if you were going to be out traveling. But you still have to take it to the pharmacy yourself every 30 days in most cases. (again, much of this has been relaxed.)

My gut says that a lot of this is because of all of the regulations around handling and amount-on-hand rules in MI. There is one not-terrible side effect to the resulting process however; Since typically you'd just wait to get it filled (or pick it up ASAP,) It limits the risk of an electronic fill sitting around and getting 'lost'.

For healthcare purposes, a fax is usually considered a "paper copy" (unlike, say, an email) so it is quite likely that this is in fact legal.

I’m in Minnesota and take both a stimulant and testosterone. You can pick up the prescription from the doctor and deliver it to the pharmacy, or they can mail it in. They can’t use their online system, which I would think would actually be the most secure out of those three options. 30 days only for the stims, 90 days for testosterone.

My psychiatric nurse practitioner certainly wanted to reduce her own possible COVID-19 exposure here in the Seattle area but stressed that she could not call or send in the prescriptions for Adderall because of government regulations. Unclear who that regulating body is however.

IANAL

So I looked it up because that is very perculiar, and my quick skimming of the laws seem to imply that Schedule II through V drugs can be sent electronically:[0]

> (1) Information concerning a prescription for a controlled substance included in Schedules II through V, or information concerning a refill authorization for a controlled substance included in Schedules III through V, may be electronically communicated to a pharmacy of the patient's choice pursuant to the provisions of this chapter if the electronically communicated prescription information complies with the following:

> ...

[0]: https://app.leg.wa.gov/RCW/default.aspx?cite=69.50.312

Thanks for checking! :) I'll bring it up with her.

I think all of us agree that the paper prescriptions are ridiculous, especially at this time.

I wonder if we have the same practitioner. I'm having the same issue with mine; she's part of a couple, they practice in Redmond.

I doubt this is an issue specific to the NP. Regardless, we have different providers.

Maybe it's a lowly nurse practitioner vs deeply trusted MD issue?

Doubtful and she works with a MD.

I have many friends in the medical field. This MD vs NP hatred needs to stop.

NPs can be specialized and have great knowledge and experience in their particular field.

And my NP visit is cheaper - absolutely worth it to me.

I think you misunderstood the parent comment. The commenter is not saying NPs are a problem, they are pointing out that NPs aren't treated with due respect. The sarcastic use of "lowly NP" gives it away.

Can confirm!

Sarcasm comes across poorly in online communication, so I should probably use it less :)

My understanding is that an NP is considered as autonomous as a physician. I know several of my friends who are PAs and they're lobbying to be treated the same as NPs, as they feel that some of their restrictions are unnecessary and bureaucratic, logistical issues only, rather than based on patient care.

Exactly. Lots of MDs are of course frustrated because they spent more time and money on education.

The focus should absolutely be on patient care.

My GP doc in WA sends electronic prescriptions of Adderall. When I was using a solo psychiatrist, he would give 3 mos of (1 per month) printed hardcopy prescriptions.

Note, getting the scrip from my GP requires an annual HIPAA privacy waiver and random piss tests. Privacy waiver is because they share medical records of patients prescribed controlled substances with law enforcement or any other local or federal government agency that wants to take a peek.

Super valuable info. Thanks for that.

> requires an annual HIPAA privacy waiver... Privacy waiver is because they share medical records of patients prescribed controlled substances with law enforcement or any other local or federal government agency that wants to take a peek.

So, how good is a regulation if you need to waive it for something as basic as getting your medication?

Makes me respect GDPR even more.

Yes, it totally sucks, and it almost caused me harm trying to avoid it. I am sure I was not the only one. I imagine some poor souls got into some real trouble even suicide.

The American Medical Association, et al., sold out their patients in exchange for not being held accountable for the US opioid crisis. (my opinion of course.)

My doc didn't think it was any big deal, she said I was her first patient to question it. She thought the waiver had some limitations, I showed her that it did not have any limitations except that access had to be for official use (which is not much of a limitation.) The records are stored in an electronic registry that various local or federal government agencies can access without warrants or notice.

As a lawyer I cannot imagine voluntarily entering into such an agreement against the interest of my clients. I still find it shocking.

I had a similar issue with refusing to give a podiatrist I saw one time my SSN.

The rationale was, prior to getting a surgery once, I was asked in pre-op to review my EMR information by the nurse. The info was completely wrong and very dated. I asked the nurse where the info was from since I had never been to that hospital chain before. Her comment was an affiliated urgent care I went to years ago was in their medical system. But the brand name was different because they were acquired. I was pissed. What if I had been rolled in unconscious and that EMR record was meaningfully inaccurate against my wellbeing?

So now it raises eyebrows but I refuse to provide any nonlegally required info. And to OPs point the response is one of almost mocking surprise. But the counter argument is, why would I trust you to not sell my data going forward? What if I'm wheeled into a hospital unconscious and your medical records from 20 years ago somehow cause me harm? Absolutely no way.

What are they testing for? To make sure you’re taking the ADHD meds or to make sure you aren’t taking other meds?

It is a general drug abuse screen, referred to as: PAIN MANAGEMENT PANEL 4 RFLX

It tests for dozens of drugs, including THC.

All patients prescribed a controlled substance have to take it.

Here is a link to a random lab describing it: https://etd.paml.com/etd/display.php?id=8412

>All patients prescribed a controlled substance have to take it.

I was told that I "may need to" take this test at some point. I never have and have been taking adderall for many years.

I guess I did overstate it. I was thinking about the health system I use.

I assume the drug testing requirements may depend on the state or the provider. It benefits the provider/health system by providing evidence they are taking reasonable precautions to limit abuse.

Also, I don't know if psychiatrists in WA are held to a different reporting standard than general practitioners. When I used a solo psychiatrist, no testing or privacy waiver required. When my insurance changed, I lost that psychiatrist and went to a regular doc in a large health system (UW Physicians). They require the testing and waiver.

But the law was changing when I made the change, so it may apply to psychiatrists now, too.

UW is a special case. By law they have to accept everyone in the state and medicare has special requirements for some medications. To avoid discrimination they have everyone take the same tests.

I just realized I didn't answer your question.

They are testing for abusive behavior to identify drug abusers, re-sellers, or negligent providers (over prescribing).

I have read some people complaining that their provider will not prescribe the drug they need if THC comes up in the test. That is not universal, it probably depends on the individual provider or the health provider system.

The best part is that law enforcement can review the records at will (as long as they can articulate an official reason which is a very low bar.)

> The best part is that law enforcement can review the records at will (as long as they can articulate an official reason which is a very low bar.)

True, but a positive test wouldn't be enough to arrest someone for drug possession. I doubt it would even be enough to get a search warrant with.

This is exactly what my doctor in Oregon does. I've never had to deal with a handwritten prescription.

If they imposed this in California you'd see mass exodus of Adderall addicted techies leaving.

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