tons of people on Adderall...

[randomdoc1]

So an NP recently quit the private practice I'm at because she was looking for a job with benefits which is fine. Then....I inherited a number of her patients. Almost a good half of them on are Adderall IR as first line treatment. Nearly another half are on some sort of benzo with Xanax being relatively common. The ADHD diagnosis was thrown around pretty loosely, even applied to the guy that smokes pot daily and is getting early oxycodone refills. Interestingly when I called him and told him he needs further work up including a UDS, he disappeared, never to be heard by the clinic again. Some of these ADHD diagnoses are newly made in people in their 40's with no pediatric history. Today I discontinued stimulants on two people. One person got irritable on the Adderall IR. Another person lost too much weight on the Vyvanse and she turned out to be on huge doses of benzos from her PCP which explains the inattention. I discontinued a bunch of Xanax on a guy who was also on a good dose of oxycodone. W...T....F... man....

I guess it is good that the clinic caught this early. I believe the liability would be on the medical director of the clinic who is an MD. These are just all patients from today. I guess this explains why I kept getting these bogus ADHD referrals despite me not being easy to get stimulants from, the stimulants were coming from elsewhere in the clinic!

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[Shikima]

After opiates get their day in court, next will be Xanax and after that, Adderall.

 

[3lefts]

I bet she had really good patient satisfaction ratings.


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[LasVagus]

Ugh... sounds like you will have A LOT of cleaning up to do.

And cut to...

"What!?! I don't understand why you won't prescribe something that's been working so well for me!"

 

[Stagg737]

Yet another thread with perfect examples of why midlevels shouldn't have full practice rights. This is the kind of stuff that always makes me wonder if the NP was actually that terrible or if she just didn't really care...

 

[thoffen]

After opiates get their day in court, next will be Xanax and after that, Adderall.

Unfortunately I disagree as these meds don't (easily) kill people.

 

[Armadillos]

Unfortunately I disagree as these meds don't (easily) kill people.

Seems like stims kind of get lumped in erroneously with benzos/opiates because they are controlled. But if you step back there are probably hardly any medications in all of medicine that treat what they are approved for as effectively and safely as stimulants in ADHD. Granted, this is assuming you are actually treating ADHD which was obviously not the case in this post.

 

[birchswing]

Unfortunately I disagree as these meds don't (easily) kill people.

Prescribing guidelines and state rules are changing based on whether a person is on an opioid and a benzodiazepine, but not specifically for benzodiazepines. For example, in my state, if you prescribe an opioid and a benzodiazepine long-term, you are now required to prescribed naloxone to that patient--but not if if either is prescribed in isolation. Massachusetts has tried a couple of times to pass a bill on benzo prescribing that specifically addresses informed consent, tapering guidelines, etc. There was just a mass mail-in of FDA MedWatch reports yesterday on benzodiazepine adverse events. I have a feeling something will change in the next 10-20 years.

I don't think doctors will be the first wave of change, though. This was posted just a few days ago:
Talk to a doctor in minutes, 24/7

And benzos are still some of the most prescribed drugs.

I think it will come from the legal system, which unfortunately will cause its own unintended effects.

EDIT:

On the other hand just saw this:
FDA to Consider Orphan Designation for Intranasal Anti-Anxiety Medication

 

[FlowRate]

nvm

 

[randomdoc1]

nvm

No! I want to know what you said though! This is the second post I have seen censored from you. Which just makes me even more interested to hear what it was

 

[FlowRate]

No! I want to know what you said though! This is the second post I have seen censored from you. Which just makes me even more interested to hear what it was

I censored because I felt it was too tangential. The short version is that sometimes I wonder why medications for performance enhancement or enjoyment are treated differently than cosmetic procedures. If it were legal/ethical to Rx Adderall for cognitive enhancement, then at least we wouldn't have a bunch of people convinced they have "ADHD." Or benzos for "anxiety."

Then there would be a way for these same people to obtain these medications legally, but in a more restricted quantity to avoid dependence/tolerance. Since you're not actually prescribing them to treat a condition, it wouldn't necessarily need physician oversight. I don't know if it would work, but maybe that would help with harm reduction.

This is, of course, the drug legalization/drug use facility argument.

 

[chicagochildpsych]

Giving a nurse who did an online masters degree a prescription pad didn't work out well? That's shocking....


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[Shikima]

Giving a nurse who did an online masters degree a prescription pad didn't work out well? That's shocking....


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kek.

 

[cbrons]

Midlevels should not be allowed to prescribe controlled subtances.

 

[carlosc1dbz]

Midlevels should not be allowed to prescribe controlled subtances.

You are probably right. Its a complex issue prescribing and managing controlled medications. Probably not the best place for them to focus their practice. A little primary care would be fine, I think that was the whole idea, for them to help out with the primary care burden. Psychiatry is a specialized field with patients that are high risk.

 

[PikminOC]

Unfortunately I disagree as these meds don't (easily) kill people.

Only matters what Dea thinks. Not us

 

[PikminOC]

Seems like stims kind of get lumped in erroneously with benzos/opiates because they are controlled. But if you step back there are probably hardly any medications in all of medicine that treat what they are approved for as effectively and safely as stimulants in ADHD. Granted, this is assuming you are actually treating ADHD which was obviously not the case in this post.

Diversion and abuse are big issues

 

[OldPsychDoc]

...
On the other hand just saw this:
FDA to Consider Orphan Designation for Intranasal Anti-Anxiety Medication

I wonder if I can add a few drops to my home essential oils diffuser....

 

[Salpingo]

Midlevels should not be allowed to prescribe controlled subtances.

Just to play Devil's advocate, why do you think MD's have any better discretion? If anything, they have more incentive to run pill mills (ranging from high debts, deferred income, and possibly --MAYBE-- a little on the narcissistic side).

 

[Salpingo]

I censored because I felt it was too tangential. The short version is that sometimes I wonder why medications for performance enhancement or enjoyment are treated differently than cosmetic procedures. If it were legal/ethical to Rx Adderall for cognitive enhancement, then at least we wouldn't have a bunch of people convinced they have "ADHD." Or benzos for "anxiety."

Then there would be a way for these same people to obtain these medications legally, but in a more restricted quantity to avoid dependence/tolerance. Since you're not actually prescribing them to treat a condition, it wouldn't necessarily need physician oversight. I don't know if it would work, but maybe that would help with harm reduction.

This is, of course, the drug legalization/drug use facility argument.

I'm kind of with you on this. My feelings are that if caffeine was synthetically derived and didn't have such a large place in multiple cultures, it would be the biggest "substance of abuse" out there (and with worse dependency issues than stimulants). Similar to the argument people make that if Bayer tried to get aspirin through today, it would barely make it through the FDA, much less an OTC medication. What is considered a drug vs medication vs crap thrown into a first aid kit is often dependent on history and context.

I would make an exception for benzos given the severity of dependence and tachyphylaxis. There's also the fact that drugs can be diverted, while procedures/caffeine, etc, can't.

 

[cbrons]

Just to play Devil's advocate, why do you think MD's have any better discretion?

On the whole, yes I do.

If anything, they have more incentive to run pill mills (ranging from high debts, deferred income, and possibly --MAYBE-- a little on the narcissistic side).

People who spent 1/4 of their life in school to do something have a lot more to lose by losing their license than people who went to a 2-3 year online degree program. What's more, it's about what is appropriate in society. IF you spend the decades studying to be a physician you should have the sole power to prescribe these drugs and no one else (unless you are dentist or podiatrist within your scope of practice, etc.)

 

[WingedOx]

After opiates get their day in court, next will be Xanax and after that, Adderall.

Seems like wishful thinking, but hey... "lemme' live that fantasy..."

 

[randomdoc1]

Frankly, I'm concerned about anyone who is not a physician or in the field of psychiatry/neurology/sleep medicine/maybe palliative care prescribing stimulants. I've seen way too many PCPs putting people on Adderall/Vyvanse, etc. This stuff mechanistically is basically methamphetamine. Recently started seeing a new patient who was on Vyvanse for years. I've questioned his ADHD diagnosis ever since the intake. Fortunately, he was motivated and insightful enough to be agreeable to seeing me when I told him I wouldn't be the one continuing this stimulants (PCP was the one who started and continued him on those). On getting to know him more, he has a notable family history of depressive and anxiety spectrum disorders. He is coming to terms that he probably doesn't have ADHD but clung on to the diagnosis because it was less stigmatizing in his mind. After years of being on Vyvanse, his depressive and anxiety sx progressed and now he is feeling the burn of the side effects from Vyvanse which is the insomnia. Glad I could have helped clear things up for him.

Don't get me wrong, there are legitimate ADHD cases out there. But I see far more often people turning to that diagnosis as an answer to their problems. People can get a false sense of security from it and we end up just putting on a temporary bandaid (which can have major adverse side effects) as opposed to going after the real underlying issue.

 

[Shikima]

So here's an interesting document I found;
http://www.uacap.org/uploads/3/2/5/0/3250432/stimulant_equivalency.pdf

 

[WisNeuro]

On the whole, yes I do.


People who spent 1/4 of their life in school to do something have a lot more to lose by losing their license than people who went to a 2-3 year online degree program. What's more, it's about what is appropriate in society. IF you spend the decades studying to be a physician you should have the sole power to prescribe these drugs and no one else (unless you are dentist or podiatrist within your scope of practice, etc.)

I really don't see much difference in prescribing between NPs and MD/DOs when it comes to stims and anxiolytics in my settings. Makes all of the hand wringing a little disingenuous. Are there any good resources that break prescribing patterns by provider type? Something more than just a QI type of project at one facility?

 

[AnnoyedByFreud]

I really don't see much difference in prescribing between NPs and MD/DOs when it comes to stims and anxiolytics in my settings. Makes all of the hand wringing a little disingenuous. Are there any good resources that break prescribing patterns by provider type? Something more than just a QI type of project at one facility?

Agree. Two psychiatrists in my community retired. I have been inheriting their patients and inappropriate benzo, stimulants, and opiates abound. I have seen some terrible polypharmacy from md psychiatrists. I literally inherited an elderly woman on alprazolam bid, vyvanse (70mg!), venlafaxine, lamotrigine, and quetiapine. The venlafaxine and lamotrigine were both low doses. This patient came to me from a psychiatrist. She had fallen 6 times in the past year.

 

[MacDonaldTriad]

I would postulate that the need for these drugs is a real, but infrequent event. What we have now are a bunch of providers who either never write for these things, or who write for them a lot. It smells fishy to me.

 

[Armadillos]

Diversion and abuse are big issues

I guess I don't get so hung up on if once in a while a patient "tricks me", I would much rather do my due dilegence and have it turn out an occasional patient was diverting despite my best efforts, than to withhold treatment from someone who needs it. Remember that ADHD is not a benign condition.

 

[psyxh]

Agree. Two psychiatrists in my community retired. I have been inheriting their patients and inappropriate benzo, stimulants, and opiates abound. I have seen some terrible polypharmacy from md psychiatrists. I literally inherited an elderly woman on alprazolam bid, vyvanse (70mg!), venlafaxine, lamotrigine, and quetiapine. The venlafaxine and lamotrigine were both low doses. This patient came to me from a psychiatrist. She had fallen 6 times in the past year.

Nurse AnnoyedByFreud,

What is meant by the phrase "md psychiatrists." Are you distinguishing between "MD Psychiatrists" and "DO Psychiatrists"?

Surely you don't mean to imply that there's such a thing as an "NP Psychiatrist."

Thanks,
Dr. Psyxh

 

[AnnoyedByFreud]

Nurse AnnoyedByFreud,

What is meant by the phrase "md psychiatrists." Are you distinguishing between "MD Psychiatrists" and "DO Psychiatrists"?

Surely you don't mean to imply that there's such a thing as an "NP Psychiatrist."

Thanks,
Dr. Psyxh

what? Of course there is no such thing as an NP psychiatrist. I meant this is a physician with an MD and residency completed in psychiatry who had the aforementioned patient on an inappropriate and dangerous regimen.

 

[PikminOC]

I guess I don't get so hung up on if once in a while a patient "tricks me", I would much rather do my due dilegence and have it turn out an occasional patient was diverting despite my best efforts, than to withhold treatment from someone who needs it. Remember that ADHD is not a benign condition.

What is your due diligence

 

[Armadillos]

What is your due diligence

I actually don't have that many stimulant patients in the current clinic, but all the pts I do have were diagnosed and started on stimulants before their 20s. No early refills, no refills for lost or stolen meds. Very occasional UDS to see if they are taking.

Like I said, this is a relatively small group of patients for me, but some folks I know don't even want to prescribe to them which seems crazy as it's the gold standard treatment.

 

[Salpingo]

On the whole, yes I do.


People who spent 1/4 of their life in school to do something have a lot more to lose by losing their license than people who went to a 2-3 year online degree program. What's more, it's about what is appropriate in society. IF you spend the decades studying to be a physician you should have the sole power to prescribe these drugs and no one else (unless you are dentist or podiatrist within your scope of practice, etc.)

The amount of time spent in school doesn't necessarily make someone more scrupulous. The only things we learned between medical school and residency that could really get you in trouble with your license is abusing drugs/alcohol yourself or sexual misconduct with patients. Oh, and pain was a fifth vital sign and we were basically committing malpractice if not prescribing opiates (oops).

Its not like restricting prescription of controlled substances to MDs would lead to less prescriptions. Its not like these patients are going to throw up their hands after finding out their NP can't prescribe, and won't just find an MD running "group sessions" with prescriptions passed out like fliers at the end.

 

[birchswing]

I wonder if I can add a few drops to my home essential oils diffuser....

When I first read about it, I thought it would make more sense if it was being marketed like rectal Valium for seizures, but whatever I read talked about panic attacks. But then I found the manufacturer's web-site and it is actually for a specific seizure disorder:

AXIUM-Anti-Seizure / Anti-Anxiety Medications 

They also have a sub-lingual spray of Ativan.

The way I have seen orphan drug status used makes it look shady.

The first way was with Vayarin, the constituents of which were already being sold as an OTC supplement by the same company that applied for orphan drug status. There are two arguments you can make for orphan drug status: that the disease the drug treats affects less than 200,000 people or that the costs of making the drug will never be recovered. ADHD obviously affects more than 200,000 people, and the OTC supplement was already surviving in the marketplace. So I don't see how it was approved.

I'm assuming this nasal spray got FDA approval because it's intended to treat a rare seizure disorder. But there's no reason it shouldn't work for more types of seizures.

This is what the FDA says about the unprecedented 568 requests for orphan drug status in 2016 (twice as many as 2012):

"The uptick in designation requests reflects, among other factors, advances in science that allow researchers to target rare diseases that were previously not readily amenable to therapy. "

But the two I am familiar with are: 1) An already available OTC supplement of dubious value and that treats a non-rare disease (ADHD) and 2) a decades old benzodiazepine that treats a non-rare phenomenon (seizures).

I wouldn't exactly call that advances in science.

 

[medhead1990]

Correct me if I'm wrong but wasn't the intention of mid level providers to handle with the day to day bread an butter type scenerios so the clinicians could focus more on pt. Managment amd making changes within the plan? Granted I'm still a studnet but in my head if the pt. Is stable a simple med check is exactly where I think a mid level can excel. If during the conversation it appears there may be a need for a dose adjustment or some other change in the plan, call in the doc or at minimum consult before any change is made.

 

[Shikima]

Correct me if I'm wrong but wasn't the intention of mid level providers to handle with the day to day bread an butter type scenerios so the clinicians could focus more on pt. Managment amd making changes within the plan? Granted I'm still a studnet but in my head if the pt. Is stable a simple med check is exactly where I think a mid level can excel. If during the conversation it appears there may be a need for a dose adjustment or some other change in the plan, call in the doc or at minimum consult before any change is made.

One would expect this to be the case, however healthcare is increasingly hostile towards physicians to manage new and old complaints without delegation.

 

[randomdoc1]

One would expect this to be the case, however healthcare is increasingly hostile towards physicians to manage new and old complaints without delegation.

Apparently we don't have the unassailable experience of being an RN. So our 4 years of undergrad beating the curve, 4 years of grueling med school with two years of clinicals, 4 years of residency and exams after exams after exams mean absolutely nothing. There are some great NPs out there, don't get me wrong. And they illustrate beautifully what their roles were meant to do. But I was totally appalled after inheriting these patients. She completely FAILED to consider polypharmacy in her differential and just added more meds.

Sneak peak at next week's line up: someone on topamax diagnosed with ADHD in her 40's, someone else on tons of benzos diagnosed in mid life with ADHD. Vyvanse/Adderall for all. She also interpreted response to medication as diagnostic of ADHD.

I've only seen a few diagnoses in all of her patient charting:
-MDD
-GAD
-bipolar disorder
-ADHD
No personality disorders or AODA?!
There were also some very borderliney sounding patients ending up on antipsychotics, ADHD meds and Xanax....
Someone went into DTs and she thought it was bipolar disorder...

It's funny how at the end of the day when things go terribly wrong and needs some serious intervention who gets called...

 

[Jules A]

Apparently we don't have the unassailable experience of being an RN. So our 4 years of undergrad beating the curve, 4 years of grueling med school with two years of clinicals, 4 years of residency and exams after exams after exams mean absolutely nothing. There are some great NPs out there, don't get me wrong. And they illustrate beautifully what their roles were meant to do. But I was totally appalled after inheriting these patients. She completely FAILED to consider polypharmacy in her differential and just added more meds.

Sneak peak at next week's line up: someone on topamax diagnosed with ADHD in her 40's, someone else on tons of benzos diagnosed in mid life with ADHD. Vyvanse/Adderall for all. She also interpreted response to medication as diagnostic of ADHD.

I've only seen a few diagnoses in all of her patient charting:
-MDD
-GAD
-bipolar disorder
-ADHD
No personality disorders or AODA?!
There were also some very borderliney sounding patients ending up on antipsychotics, ADHD meds and Xanax....
Someone went into DTs and she thought it was bipolar disorder...

It's funny how at the end of the day when things go terribly wrong and needs some serious intervention who gets called...

You can always file a written complaint. It is my understanding boards of nursing tend to be quicker to respond and more likely to sanction a NPs license then the board of physicians, although maybe that's just the states I have knowledge of.

 

[DD214_DOC]

When will we, as a profession, agree to stop hiring these poorly-trained charlatans?

 

[DD214_DOC]

So here's an interesting document I found;
http://www.uacap.org/uploads/3/2/5/0/3250432/stimulant_equivalency.pdf

Pretty good info on this chart, though I'd like to confirm some of the information from other sources.

 

[cbrons]

Agree. Two psychiatrists in my community retired. I have been inheriting their patients and inappropriate benzo, stimulants, and opiates abound. I have seen some terrible polypharmacy from md psychiatrists. I literally inherited an elderly woman on alprazolam bid, vyvanse (70mg!), venlafaxine, lamotrigine, and quetiapine. The venlafaxine and lamotrigine were both low doses. This patient came to me from a psychiatrist. She had fallen 6 times in the past year.

What is an "MD psychiatrist"?

I simply dont believe your story, or you are leaving out a key part of it. I see far more inappropriate prescribing from NPs and do not believe they have the requisite education/training to solely determine who needs to be on controlled substances.

 

[Shikima]

What is an "MD psychiatrist"?

I simply dont believe your story, or you are leaving out a key part of it. I see far more inappropriate prescribing from NPs and do not believe they have the requisite education/training to solely determine who needs to be on controlled substances.

Opposite of a DO psychiatrist?

 

[thoffen]

What is an "MD psychiatrist"?

I simply dont believe your story, or you are leaving out a key part of it. I see far more inappropriate prescribing from NPs and do not believe they have the requisite education/training to solely determine who needs to be on controlled substances.

I don't have enough experience and knowledge with NP/training to evaluate your recommendation as a whole, but I will say that I have plenty of patients who come to my inpatient unit from the community with similar polypharmacy and transparent substance abuse problems. Bad treatment is perhaps more likely with mid-levels, but it's far from exclusive.

 

[cbrons]

Bad treatment is perhaps more likely with mid-levels, but it's far from exclusive.

Obviously. Did someone say it wasn't?

 

[AnnoyedByFreud]

What is an "MD psychiatrist"?

I simply dont believe your story, or you are leaving out a key part of it. I see far more inappropriate prescribing from NPs and do not believe they have the requisite education/training to solely determine who needs to be on controlled substances.

Nope. I've left out nothing. I inherited this woman after he retired, I even reviewed about ~20 pages of his notes that confirmed this treatment approach with her over and over again.

An inpatient psychiatrist (a different one) dc'd my elderly male pt on Adderall, Ativan, and Ambien to treat his hypersomnia and fatigue as well as anxiety (never mind that the man has untreated OSA and I in the middle of referring him for a sleep study). The pt got in a car accident 3 weeks later. I am not making that up. Am I saying NPs are perfect and do not make terrible decisions sometimes? Of course not. But truly, I have seen horrendous prescribing choices made by psychiatrists and if it's a war of anecdotes you want, I have plenty...

 

[cbrons]

Nope. I've left out nothing. I inherited this woman after he retired, I even reviewed about ~20 pages of his notes that confirmed this treatment approach with her over and over again.

An inpatient psychiatrist (a different one) dc'd my elderly male pt on Adderall, Ativan, and Ambien to treat his hypersomnia and fatigue as well as anxiety (never mind that the man has untreated OSA and I in the middle of referring him for a sleep study). The pt got in a car accident 3 weeks later. I am not making that up. Am I saying NPs are perfect and do not make terrible decisions sometimes? Of course not. But truly, I have seen horrendous prescribing choices made by psychiatrists and if it's a war of anecdotes you want, I have plenty...

Sorry, but I think you are just making stuff up. If somehow its true that a person was given that cocktail by an inpatient psychiatrist at discharge (for "hypersomnia" - is that something that earns you an admit to the psych ward these days?), said individual should lose their license. Kind of hard for me to believe such an individual could make it through the hundreds of hurdles placed in the way to practice medicine independently (medical school, several board exams, 4-year residency, specialty board exam, etc.). I'm not even sure I would believe a mid-level would be capable of that level of stupidity, in part because they are usually supervised to some degree on the inpatient setting and/or can't by law write for C-II's.

But again, I think you are either making this story up, or leaving out important/modifying details. If indeed your story is true, then it needs to be a news story and the physician in question should be put in prison for criminal incompetence.

 

[AnnoyedByFreud]

Sorry, but I think you are just making stuff up. If somehow its true that a person was given that cocktail by an inpatient psychiatrist at discharge (for "hypersomnia" - is that something that earns you an admit to the psych ward these days?), said individual should lose their license. Kind of hard for me to believe such an individual could make it through the hundreds of hurdles placed in the way to practice medicine independently (medical school, several board exams, 4-year residency, specialty board exam, etc.). I'm not even sure I would believe a mid-level would be capable of that level of stupidity, in part because they are usually supervised to some degree on the inpatient setting and/or can't by law write for C-II's.

But again, I think you are either making this story up, or leaving out important/modifying details. If indeed your story is true, then it needs to be a news story and the physician in question should be put in prison for criminal incompetence.

Of course the person wasn't inpatient for hypersomnia. He was inpatient for SI. How his inpatient psychiatrist missed that the patient likely has sleep apnea is beyond me. I am not making up either story. Really. I see stuff like this all the time and those are two cases I have had in the past year. I'm not leaving out some obvious detail otherwise my SPs would point it out. There's no way for me to prove it to you, but I see stuff like this with disturbing frequency. Some of your colleagues seem to agree that these cases I'm dealing with are not that all that rare, sadly. And yes, I considered filing a complaint to the medical board about that doctor. For HIPAA reasons I changed minor details of these cases, but yes, both of those cases actually happened. Please come to our community and fix it/get rid of these bad doctors! Hah.

 

[VA Hopeful Dr]

Sorry, but I think you are just making stuff up. If somehow its true that a person was given that cocktail by an inpatient psychiatrist at discharge (for "hypersomnia" - is that something that earns you an admit to the psych ward these days?), said individual should lose their license. Kind of hard for me to believe such an individual could make it through the hundreds of hurdles placed in the way to practice medicine independently (medical school, several board exams, 4-year residency, specialty board exam, etc.). I'm not even sure I would believe a mid-level would be capable of that level of stupidity, in part because they are usually supervised to some degree on the inpatient setting and/or can't by law write for C-II's.

But again, I think you are either making this story up, or leaving out important/modifying details. If indeed your story is true, then it needs to be a news story and the physician in question should be put in prison for criminal incompetence.

I can't speak to this particular poster's anecdotes, but I (a PCP) see stuff like that at least once/month. A local psychiatrist retired last year and all of his patients are filtering through to everyone else trying to get refills. No takers so far.

 

[cbrons]

I can't speak to this particular poster's anecdotes, but I (a PCP) see stuff like that at least once/month. A local psychiatrist retired last year and all of his patients are filtering through to everyone else trying to get refills. No takers so far.

There's bad prescribing, and then there's prescribing amphetamines (with benzos) to elderly patients as a discharge Rx when you're an inpatient psychiatrist.

 

[AnnoyedByFreud]

There's bad prescribing, and then there's prescribing amphetamines (with benzos) to elderly patients as a discharge Rx when you're an inpatient psychiatrist.

This is exactly what happened. Z drug + benzo + stimulant combo to an elderly patient (who then got into an accident). The d/c paperwork is in the chart. I am seriously considering making a board complaint now, but this happened a while ago.