Controlled Substance Policy

Last updated on 11/18/2021

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To ensure all our patients receive safe, effective care, we prioritize clear communication about our prescription process. Some medications, known as controlled substances, are regulated by the government due to their potential for addiction and overuse. When considering the use of controlled substances in your treatment, Legion must abide by federal and state laws to ensure your safety. Please read this policy to understand Legion’s process for prescribing controlled substances, and the role you play in this process. Your provider may refer to this policy during your care to help decide if treatment with a controlled substance at Legion is right for you.

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I. Stimulants

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• Uses: Enhance alertness, attention, and energy by boosting brain neurotransmitters like dopamine and norepinephrine.

• Names: Examples include Adderall, Ritalin/Concerta/Focalin, Dexedrine, Vyvanse, Provigil, and Nuvigil.

• Side Effects: Can cause decreased appetite, weight loss, sleep issues, increased heart rate, anxiety, and mood swings. Given their abuse and dependence potential, stimulants are prescribed carefully. Note: Withdrawal from stimulants is not life-threatening.

 

Legion’s Stimulant Policy

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• Stimulants are prescribed only for FDA-approved conditions, typically ADHD.

• Dosages of stimulant medications will not exceed FDA-approved limits.

• Prescriptions are issued in 30-day supplies.

• Patients must consult their provider monthly to refill prescriptions; no refill without a provider visit.

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Continuing Stimulant Prescriptions from Previous Providers

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• To continue your current stimulant dose, you need:

  • Documentation of current medication and prescription

  • Prior ADHD diagnosis from your referring provider

  • A physical exam in the last 12 months (EKG and lab tests may be needed based on your medical history)

  • A urine toxicology test

• For dose increases or medication changes, you also need:

  • A diagnostic test such as neuropsychological testing by an independent neuropsychologist, or a continuous performance task (CPT) test.

    • We can help you register for a CPT test called QbCheck™

 

New Stimulant Prescriptions

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• For patients new to stimulants or those who haven't taken them for over 2 years, requirements include:

  • A diagnostic test such as neuropsychological testing by an independent neuropsychologist, or a continuous performance task (CPT) test.

    • We can help you register for a CPT test called QbCheck™
       

  • A physical exam in the last 12 months (EKG and additional lab tests may be needed based on your medical history).

  • A urine toxicology test.

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Additional Processing Time for Stimulants

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• Prescriptions for stimulants are generally ready within 24 hours post-visit.

• A supervising physician's review is legally required, and may extend processing time to 72 hours.

• Due to a national stimulant shortage, please confirm medication availability at your pharmacy before Legion sends your prescription.

• If a stimulant is out-of-stock in your selected pharmacy, your provider may ask to you confirm your medication's availability at 1-2 backup pharmacies.

• If a stimulant is out-of-stock in your selected pharmacy, in some instances you may request a one-time transfer of your prescription directly through your pharmacist.

• To manage processing times and shortages, schedule appointments at least 5 business days before your current supply ends.

• Stimulant refills require a monthly visit with your provider, no exceptions.

• Stimulant prescriptions are not issued on weekends.

 

II. Benzodiazepines

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• Uses: Treats acute anxiety, panic disorders, insomnia, certain bipolar disorder symptoms, and severe depression with anxiety.

• Names: Examples include Xanax, Ativan, Klonopin, Valium, Restoril, and Halcion.

• Side Effects:

  • Dependence and Withdrawal: Long-term use can cause dependence. Withdrawal can be severe, potentially causing anxiety, insomnia, seizures, and in extreme cases, death. Prescribed for short terms at the lowest effective dose.

  • Tolerance: May develop, requiring higher doses for the same effect, increasing dependence and adverse risks.

  • Cognitive and Psychomotor Impairment: Can affect memory, coordination, and alertness, impacting daily activities and increasing fall risk.

  • Potential for Abuse: Due to sedative effects, there's a overuse risk, especially when combined with other substances, raising overdose and death risks.

  • Note: Consult your provider before discontinuing.

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 Legion’s Benzodiazepine Policy

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• Legion advocates for short-term benzodiazepine use at minimal effective doses.

• Prescriptions are for FDA-approved conditions only, within FDA-approved dosage limits.

• Benzodiazepine prescriptions are written in 30-day supplies.

• Patients must consult their provider monthly to refill prescriptions; no refill without a provider visit.

• A benzodiazepine cannot be prescribed for any patient taking another benzodiazepine medication, an opioid medication, or with active alcohol overuse

• Schedule appointments at least 5 business days before your medication supply ends to avoid missed doses or withdrawal.

 

Continuing Benzodiazepine Prescriptions from Previous Providers

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• To continue at the current dose, you need:

  • A psychiatric diagnosis approved for benzodiazepine use by the FDA

  • An agreement to gradually reduce your dose or switch to a non-benzodiazepine alternative.

  • A history of using the medication responsibly.

  • A urine toxicology test.

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New Benzodiazepine Prescriptions

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• Legion rarely starts new benzodiazepine treatments and does not initiate benzodiazepine prescriptions for long-term use.

• For patients established in treatment at Legion for >6 months, short-term, one-time, or limited as-needed benzodiazepine use may be considered for:

  • Specific phobias like aerophobia (as needed only).

  • Antidepressant initiation in MDD/GAD (up to 2 weeks).

  • Severe panic disorder.

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III. Hypnotics/Sleep Medications

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• Uses: Aids in falling asleep, staying asleep, and treating insomnia.

• Names: Examples include Ambien, Lunesta, Sonata, Belsomra, Dayvigo, and Quviviq

• Side Effects: May cause daytime sleepiness, dizziness, headaches, nausea, dry mouth, muscle weakness, unusual dreams, memory issues, and infrequent sleepwalking.

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Legion’s Hypnotic Policy

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• Prescribed only for FDA-approved conditions, within approved dosage limits.

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IV. Patient Agreements and Acknowledgements

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By signing, I confirm I've reviewed the policy and agree to:

 

History and Interactions

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• I've accurately disclosed my treatment history, including all medications/supplements, past treatments, and substance use.

• I'll inform Legion of any new prescriptions from other providers.

• I'll notify my provider if I plan to become or discover I'm pregnant.

• I acknowledge the prohibition of illicit drug use while on prescribed controlled substances and consent to possible drug screenings.

• I understand the discouraged use of alcohol and marijuana due to potential health risks.

• My provider may consult with other healthcare professionals or authorities for information about my care.

 

Diversion and Overuse

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• I agree to use controlled substances only as prescribed, not share or sell them, and keep them secure. I will report any thefts immediately and may need to file a police report. Replacement of lost or stolen medication is at my provider's discretion.

 

Scheduling and Pharmacy

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• It's my responsibility to schedule appointments within 5 business days before my medication runs out.

• Controlled substance prescriptions require a provider appointment.

• Alternatives to controlled substances may be prescribed.

• In case of medication shortages, I must collaborate with my provider to locate a stocked pharmacy.

• Prescription re-sends to new pharmacies may delay processing.

• Stimulant medication processing may exceed 24 hours due to supervisory review.

 

Provider Relationship

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• Non-compliance may lead to alternate treatment suggestions or termination of the patient/provider relationship.