~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ This message is from PedTalk! To reply to the group, use "" ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Dear Kevin: We have occasionally had mysterious dosage increases, or lost prescriptions, or meds "spilled down the drain" with every med we prescribe, but it is only really worrisome when the med in question is a controlled substance. I can think of some other alternatives to divorcing this family from your practice, such as having all medication doses administered at school. In fact, one of the moms in our practice asked us to arrange this when her estranged husband took their son's Ritalin. Another option would be to communicate with the school, in a 3-way conference call with the mother, to be sure everybody knew just how well the child was doing, and on what dosage of medication. Usually, once a family knows that we are "watching" the Ritalin prescriptions, the hanky-panky appears to stop. I can tell you that we are all careful about Ritalin refills, too. Just a few years ago, one of the busy pharmacies in town was investigated by the DEA for Ritalin prescription filling practices. We were notified by the DEA with lists of Ritalin scrips which had been filled by that pharmacy for our patients, all of which had to be checked for accuracy. By the way, the pharmacy was innocent of wrongdoing. This peripheral involvement with the DEA was enough to keep me toeing the line for the rest of my career. Sincerely, Dave Arkin, MD On Tue, 21 Oct 1997 11:54:11 -0500 (Kramer, Kevin) writes: >I would be interested in others opinions of this. Yesterday, I got a >call from the gmom of a patient who seems reliable and she reported to >me that the uncle of one of the patients I have on Ritalin for ADHD is >selling his Ritalin and mixing it with crystal. She called to warn me >because the mom was coming in later that day. Well, sure enough she >tried to convince me that his dose wasn't enough, even though he is >doing ok in Head Start, and she came in with her neighbor who brought >her daughter in for, you guessed it an ADHD eval. Her other daughter >is >also on Ritalin. Now, I have seen these kids and believe their >symptoms >are legitimate, but I have opted to separate them all from the >practice. I also notified the local police dept. I would be >interested >in others' opinions. I also notified the other physicians in our >group >about this. Obviously, I have no proof, but didn't feel the risk >justified any further relationship with them. I also have separated >the >child's cousins as they also have one child with ADHD. Kevin Kramer, >MD,FAAP > >