Why Can’t I Get Refills On My Stimulant? (and other related questions)

Note: This is from my perspective as an outpatient psychiatrist in Illinois. I don’t generally prescribe opioids (e.g. Suboxone, Methadone, Oxycontin), and I have not prescribed controlled substances in all of the other states, so I can’t speak to how things may differ in those cases.

  • Why can’t I have a 90 day supply of this medication?
  • Why does it say I have no refills?
  • Why can’t I move this medication to a different pharmacy?
  • Why was I told that the prescription you sent for me has “expired”?
  • How come my Xanax has refills but my Adderall never does?

To answer these questions, we have to understand what a controlled substance is.

Controlled, or “scheduled” substances are those for whom there is higher than normal potential for abuse. They range from illegal substances (e.g. LSD) to medications such as pain meds, cough suppressants, ADHD medications, and benzodiazepines (e.g. Xanax).

Because of the higher risk for abuse, the Drug Enforcement Agency (DEA) and state licensing agencies have placed limitations on how they can be prescribed and filled. There are also registries in which any fills of these medications are tracked. These measures are helpful in preventing doctors from prescribing in unethical ways, and from patients from getting these medications in unhealthy quantities.

In my practice, the controlled substances that I prescribe are generally psychostimulants (i.e. ADHD medications such as Adderall and Ritalin) and, to a lesser degree, benzodiazepines (anxiety medications such as Xanax, Klonopin, and Valium). The rules for these two classes of medications differ in Illinois.

Here are some of the relevant portions of the Illinois Controlled Substances Act as of February 5, 2010:

“No prescription for a Schedule II controlled substance may be refilled…

A prescription for a Schedule II controlled substance shall not be filled more than 90 days after the date of issuance. A written prescription for Schedule III, IV or V controlled substances shall not be filled or refilled more than 6 months after the date thereof or refilled more than 5 times unless renewed, in writing, by the prescriber.”

There are other codes and restrictions that apply to these substances, and that are found in other places. For our purposes, though, here are some take-home points about stimulants and benzodiazepines:

Stimulants Cannot Have Refills

Any time you look at a bottle or box of your ADHD stimulant, then, it will indicate that there are no refills. I will commonly send people who are stable on their ADHD medications several months’ worth of their stimulants. What this entails, then, is sending three separate 30 day prescriptions, all authenticated with various levels of security, with “Do not fill until …” instructions on one dated for about a month from now, and another one dated for about two months from now. The pharmacy will hold on to the latter two prescriptions until you’re ready to have them filled. Some tips, then:

  • Even if your doctor has sent several months’ worth of prescriptions for you in this way, each bottle will say “no refills” on it, and you’ll never be able to use the automated phone service to refill these prescriptions, the way you might for another medication.
  • You are in essence having sent for you several separate prescriptions that are not connected to one another in any way.
  • You will generally have to call or go in person to the pharmacy to get your next month’s worth of stimulant.
  • As some staff members can be very literal with their words, instead of calling and asking for a “refill” or whether there’s a “prescription ready”, and then taking “no” for an answer, I’d suggest that you ask whether there is a prescription “on file” or “in your system” that “can be filled now,” and, if so, to “have it filled”.
  • The above is not usually an issue for the first prescription that is sent, with instructions/permission to fill right away. This applies to subsequent prescriptions that were sent previously.
    Independent pharmacies (in our area, these include Conney’s, Dundee, Tarpey’s, Local Health, and Pro-Health) have great customer service, and will often call you when it’s time for the next prescription, to ask you whether you’d like it filled. Also, they generally deliver! Capsule is on online pharmacy service that lets you make the same decisions via an app.

Prescriptions Expire

Say you take Concerta (methylphenidate extended release) to manage your ADHD symptom, but only on days when your workload is high, resulting in a month’s worth of medication lasting several months. If you’ve been sent two 30-pill prescriptions to last until your next appointment several months away, you might want to pick up the second prescription as soon as the Do Not Fill date has been passed. Once 90 days have passed since your stimulant prescriptions were sent, it won’t matter how many prescriptions were sent in advance – you won’t be able to fill them, and will have to ask your doctor for new ones.

You Can’t Transfer These Prescriptions To Different Pharmacies On Your Own

Say you want your prescription filled somewhere that is now more convenient for you, or that the pharmacy where it was sent needs to order it and won’t have it for another week. You will have to call your doctor and have a new prescription sent to the new pharmacy. Some advice: if the latter happens to you, check with the next pharmacy that they have your med in stock, or you’ll have to do this process all over again. If you’re staying within a certain chain of pharmacies, have the pharmacy find out where it’s in stock for you.

You Can’t Get Benzodiazepines or Stimulants Much Sooner Than 30 Days After The Last Fill

Do your best NOT to let these meds fall into the sink or get lost or stolen, because you can’t really blame pharmacies for being skeptical if you tell them that one of these things happened to you. They hear it a lot. Whereas with other medicines it might not be so hard to get a replacement bottle, or even to have the pharmacy give you a few pills until you get another refill, there’s far less leniency with these meds.

On a Related Note: Schedule and Attend Your Appointments Regularly

Hopefully, all of the above has already convinced you to do this.

Benzodiazepines Can Have Refills and Don’t Expire Until 180 Days

Benzodiazepines and Stimulants Can’t Be Given In Supplies Greater Than 30 Days At Once

Well, there you have it. I hope this was helpful!

Birju Patel, MD

Sources

https://www.deadiversion.usdoj.gov/schedules/index.html

https://www.idfpr.com/profs/ContSub.asp

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