You Suspect Your Patient’s Parent is Using His Medication

You have an adolescent patient with attention-deficit/hyperactivity disorder and prescribe Adderall for him. You become aware that one of your patient’s parents is demonstrating increasingly strong mood swings, is more anxious and irritable, reports an inability to fall asleep and stay asleep, and has had quick weight loss. You also become aware that this parent frequently calls for medication renewals for her child because she says she spilled the medications into the sink when she opened the container, the pharmacy dispensed fewer pills than ordered, or the family will be out of town on vacation when the renewal is due.

You are also concerned that the patient’s symptoms are not controlled well in the school setting, and he also reports that his mother does not give him his medication every day.

You suspect that your patient’s mother may be taking his Adderall. Now what can you do?

First, address your concerns with your patient’s mother. Be calm, understanding, and open. Expect a range of responses from her, from adamant denial and anger at being accused of stealing the medications to her revealing that she has been taking the medication in her desire to be the “perfect mother” because the Adderall gives her the “energy to get everything done.”

If she admits to taking the Adderall, the next step is to ask why and attempt to understand her motives so that you can decide whether further actions are needed. Here are some risk management points to consider:

• When you first suspect there may be an issue, consult with your risk management professional or attorney to best determine whether there are any child abuse/neglect reporting obligations or whether any other steps should be taken.

• Consider referring the mother for treatment/counseling.

• Order laboratory testing for the patient to determine if the patient has been taking the medication.

• If you are in a state that has a Prescription Drug Monitoring Program (PDMP), check to see whether this patient has had this medication, or another, filled by different providers. Where applicable, state PDMPs collect designated data on substances dispensed in the state as a tool to address prescription drug abuse, addiction, and diversion. Refer to the National Alliance for Model State Drug Laws for the link to your state’s statutes and regulations regarding PDMPs.

• Consider developing a contract with the mother and adhere to the prescription renewal process without exception regardless of the reasons provided for early renewal.

• Determine whether you are safely able to continue to treat the patient with medication or whether termination should be a consideration.

• Document that you had a discussion with the mother about the risks of taking controlled substances prescribed to another person.

• To reduce the potential for parental use of medications prescribed for their child, ensure that the informed consent with the prescription includes the following:

• Education on the medication and its effects.

• Requiring parental signature on the consent that the medication should be used for the child only in the prescribed dosage.

• the parents will give the child the medications as ordered.

• the medications will be secured.

• the parents will comply with the renewal process.

As with all prescribed medications, you have the responsibility to educate the patient and parents on the purpose, side effects, and appropriate monitoring to ensure that the patient is getting the medications and treatment recommended. You also have the responsibility to monitor the patient’s use of the prescribed medications and the renewal process to promote safe patient care. ■