Why such stringent restrictions or Ritalin?

[Khadaji]

Ritalin is a mild stimulant and my doc has prescribed it for my chronic fatigue. It actually works quite nicely, but I am curious as to why the restrictions on it are more strenuous than - well any other drug I’ve ever taken (and I’ve taken some strong pain killers.)

You cannot have the doctor call it in, you must take a hand-written script in.
You cannot get refills, you must always take a new script in.

I’m not complaining mind you, I’m just curious why this one is more regulated than say, Oxycontin.

[Tapioca_Dextrin]

Some folks abuse it.

Methylphenidate is a drug of abuse. Methylphenidate like other stimulants increases dopamine levels but at therapeutic doses the increase is slow and thus euphoria does not typically occur except in rare instances. The abuse potential is increased when methylphenidate is crushed and snorted or when it is injected producing effects almost identical to cocaine. Cocaine-like effects can also occur with very large doses taken orally. The dose, however, that produces euphoric effects varies between individuals. Methylphenidate is actually more potent than cocaine in its effect on dopamine transporters. Methylphenidate should not be viewed as a weak stimulant as has previously been hypothesised. The primary source of methylphenidate for abuse is diversion from legitimate prescriptions

Ritalin and Oxycontin are both Class II substances, BTW.

[Mr.Excellent]

@Tapioca_Dextrin

Some folks abuse it.

Ritalin and Oxycontin are both Class II substances, BTW.

Interesting - I’d not known that Ritalin produced euphoria in high doses. I’ve known people who abused it, but only as a study aid - not as a genuinely recreational drug.

[Khadaji]

Thanks for the information - in particular I found the quote

Methylphenidate should not be viewed as a weak stimulant as has previously been hypothesised.

rather interesting and I will ask my doc about that.

But back to my original question - people abuse Oxycontin too - but the restrictions are not as tough. You can get refills and they can call it in.

[WhyNot]

Ritalin and Oxycontin are both Schedule II drugs, and both should have similar or identical restrictions: written prescriptions, no refills, etc.

The reason for both of them being Schedule II drugs is that they both have a high potential for addiction and abuse, as well as the development of drug tolerance, requiring higher doses for the same therapeutic effect. If a person has too free access to the drug, the worry is that they’ll increase their dose, either for recreation or therapeutic effect, to a dangerous level without their doctor’s knowledge.

http://www.justice.gov/dea/pubs/abuse/1-csa.htm#Schedule%20II

ETA: On preview: the two drugs you mentioned are scheduled the same. If your pharmacy is treating the two differently, it’s because of company policy or the personal preference of the pharmacist on duty.

[Khadaji]

Maybe I am misremembering - perhaps they never called in my pain meds. (My brain is swiss cheese as I get older.)

[Tapioca_Dextrin]

@Khadaji

But back to my original question - people abuse Oxycontin too - but the restrictions are not as tough. You can get refills and they can call it in.

US law says

No prescription for a controlled substance in schedule II may be refilled.

[PuddingCat]

Sorry for very slightly wandering OT, but what does “refill” mean in this context? As a non-American I’d always assumed it meant having the prescription reordered by the doc, allowing you to pickup the same medication & dosage as before but without physically visiting the doc.

But reading this makes it sound more like a refill is a “Hi Pharmacist dude, I’d like a repeat issue of this prescription I gave you a couple of weeks ago” sort of thing, i.e. you can request a refill without a doctors involvement or approval.

[Nametag]

If you were getting refills of oain medication, it wasn’t Oxycontin. More likely an oxycodone blend like Percocet or Percodan.

[lazybratsche]

@trmatthe

Sorry for very slightly wandering OT, but what does “refill” mean in this context? As a non-American I’d always assumed it meant having the prescription reordered by the doc, allowing you to pickup the same medication & dosage as before but without physically visiting the doc.

But reading this makes it sound more like a refill is a “Hi Pharmacist dude, I’d like a repeat issue of this prescription I gave you a couple of weeks ago” sort of thing, i.e. you can request a refill without a doctors involvement or approval.

Not quite. When the doctor writes the prescription the first time, she can specify that a number of refills are allowed. So, commonly the prescription will be for a month’s supply of a drug, with two or more refills allowed. The patient can only get so many refills before going back to the doctor for a prescription.

[Khadaji]

Man it sucks getting old. This morning I would have *sworn *to you that I had had refills on my pain meds in the past. (obviously I would have been wrong.)

Thanks for the information!

trmatthe, when I get a script for say verapamil, which is for blood pressure, the doc writes it something like this: Verapamil 240 mg, one daily - 5 refills.

The pharmacy then will sell me a month’s supply and when I’m out, I just go back and they sell me another month’s supply, up until 5 months. Once the number of refills have expired, the doc will call in another, or will give me another script.

[Nametag]

@trmatthe

Sorry for very slightly wandering OT, but what does “refill” mean in this context? As a non-American I’d always assumed it meant having the prescription reordered by the doc, allowing you to pickup the same medication & dosage as before but without physically visiting the doc.

But reading this makes it sound more like a refill is a “Hi Pharmacist dude, I’d like a repeat issue of this prescription I gave you a couple of weeks ago” sort of thing, i.e. you can request a refill without a doctors involvement or approval.

Sort of. A “refill” is a pre-authorized re-issue by the pharmacist; i.e., your doctor will write the original prescription to permit a certain number of refills. For some medications, such as treatment for chronic conditions, or conditions that require more than a month’s treatment, this is a great idea. For acute pain medications, antibiotics, and the like, it’s rarely a good idea. And for some, it’s illegal.

[Tapioca_Dextrin]

@trmatthe

what does “refill” mean in this context?

There’s actually a little box on the original prescription form marked “refill”. The doctor can write “3 refills”, and you can use use one piece of paper to get a total of four doses of medicine from the pharmacist, before having to see the doctor again.

[Khadaji]

@Nametag

If you were getting refills of oain medication, it wasn’t Oxycontin. More likely an oxycodone blend like Percocet or Percodan.

Ah! Well that *is *possible. That makes me feel less like I am getting senile. (only a little less, but less none-the-less.)

[WhyNot]

@trmatthe

Sorry for very slightly wandering OT, but what does “refill” mean in this context? As a non-American I’d always assumed it meant having the prescription reordered by the doc, allowing you to pickup the same medication & dosage as before but without physically visiting the doc…

When a doctor writes a prescription for a long term medication, it’s usually for a 30 or 90 day supply of the medication, with a number of “refills” of the same amount. Here’s a sample form. See the Refill line on the bottom left? That means that after this bottle runs out, the patient can buy another from the pharmacy, and when that one runs out, he can order one more. After that, he’s got to go back to the doctor for more.

Basically, it’s a way to control how much medication a person has in their possession at once. It reduces the chances of patients taking expired meds, and it gets them into the doctor’s office semi-regularly, in case their situation has changed or they need labs run.

[Qadgop_the_Mercotan]

@Nametag

If you were getting refills of oain medication, it wasn’t Oxycontin. More likely an oxycodone blend like Percocet or Percodan.

Nope. Oxycodone-containing meds like percocet and percodan are also Schedule II and can’t be refilled either.

Vicodin (hydrocodone & acetaminophen) is schedule III and can be refilled.

[Khadaji]

@Qadgop_the_Mercotan

Nope. Oxycodone-containing meds like percocet and percodan are also Schedule II and can’t be refilled either.

Vicodin (hydrocodone & acetaminophen) is schedule III and can be refilled.

Back to feeling senile!

In my defense, usually when I filled these I was fresh out of the hospital and my brain was pretty much mush from the morphine. (I hate what morphine does to my brain!)

[TriPolar]

Sometimes doctors provide a minimal prescription so that you have to pay for another appointment to get a refill. This is not any kind of blanket condemnation of doctors, but if that is how your medication is precribed, you should ask about a longer term approach. Good doctors will also want to monitor what is happening to you. So you can’t diagnose this problem only by looking at the symptoms.

[anson2995]

@ed malin

Sometimes doctors provide a minimal prescription so that you have to pay for another appointment to get a refill. This is not any kind of blanket condemnation of doctors, but if that is how your medication is precribed, you should ask about a longer term approach.

Then you should ask your legislator, not your doctor. The law says docs can only give you a 30-day prescription with no refills for many drugs.

[TriPolar]

@anson2995

Then you should ask your legislator, not your doctor. The law says docs can only give you a 30-day prescription with no refills for many drugs.

I wasn’t addressing any medication in particular. Medical questions should be addressed to doctors. If the limit is based on regulations, then I agree with you. The regulations may even be in conflict with people’s medical needs. That may be a worse situation than a greedy doctor.