Regulation 7 Governing the Use of Stimulants

Story originally printed in the Arkansas State Medical Board’s Fall 2011 Newsletter Issue #51

The Board reviewed letters from physicians expressing confusion regarding the recent changes to Regulation 7 governing the prescribing and use of stimulants. As a result, the Board voted to remove the word “subsequent” from Section 2 of the regulation. A public hearing will be conducted early next year for the Board to take testimony and possibly adopt this proposed amendment. Be sure to check our website for information of the date and time for this public hearing.

The Board also welcomes and encourages additional feedback regarding any other areas of this regulation that you feel may be confusing. Your written concerns should be forwarded to the Medical Board office by November 15, 2011 to ensure the information can be presented to the Board at the December 2011 meeting. For reference, tile current Regulation 7 is printed below:

REGULATION 7- GOVERNING THE USE OF STIMULANTS

Schedule II controlled substances are drugs that have a legitimate medical indication, but also have a high potential for abuse that may lead to severe psychological or physical dependence. Included in the list of Schedule II drugs are the stimulants: amphetamines and methamphetarnines and their salts and optical isomers (e.g. Adderall, Desoxyn, Dexedrine and Vyvanse) and methyiphenidate and its salts and isomers (e.g. Ritalin, Concerta, Focalin and Daytrana).

The ASMB believes it is prudent to provide prescribing guidelines to help ensure the safety of patients in the state of Arkansas. Therefore, in addition to tile requirement that all prescriptions for stimulants comply with both state and federal laws, this regulation will also require tile following:

1. Prescriptions for these drugs may be written by a physician for a legitimate medical indication. Such indications include Attention Deficit Hyperactivity Disorder and Narcolepsy. Other off label uses may be justified with appropriate medical rationale and documentation of evidence-based research and experience. These alternative uses include, but are not limited to, other sleep disorders, augmentation of antidepressants or treatment of post-stroke depression.

2. No second or subsequent prescription for these controlled drugs may be written for the patient until the physician reassesses the patient and documents in tilemedical record:
a. The patient’s response to the medication
b. Reports from family, educators or counselors as to the patient’s response to the medication
c. Record of an examination of the patient to identify possible adverse effects secondary to the medication
d. An informed judgment as to the overall benefit of the medication versus potential adverse or side effects
e. A written plan for providing scheduled refills and return visits.

Violations of this regulation may be interpreted by the Board as the physician exhibiting gross negligence or ignorant malpractice and shall subject the physician to all penalties provided by Arkansas Code Ann. §17-95-410.

Read this story in the AR State Medical Board’s newsletter–>