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November 10, 2004

Stimulants and Attention-Deficit/Hyperactivity Disorder—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(18):2214. doi:10.1001/jama.292.18.2214-b

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.