Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
In Reply: Although the stimulants used to treat
ADHD have abuse liability, short-term controlled studies do not indicate new
onset or recurrence of substance abuse in adults with ADHD who are treated
with stimulants under close medical supervision. Nevertheless, it is prudent
to avoid stimulants in an adult with active substance abuse because of concerns
of misuse or diversion. Although no guidelines exist on the monitoring of
stimulants in adults, in general we see patients in the office monthly until
an appropriate dose level and tolerability of the stimulants are established.
We monitor patients every 3 to 6 months thereafter. Between office visits,
because stimulants are nonrefillable and require hard copies of the prescription,
requests for refills are managed by telephone (or e-mail) and left for pickup
or mailed to the patient’s home.
Wilens TE, Faraone SV, Biederman J. Stimulants and Attention-Deficit/Hyperactivity Disorder—Reply. JAMA. 2004;292(18):2214. doi:10.1001/jama.292.18.2214-b