The Arkansas State Medical Board recently published an update of Regulation 7 governing the use of stimulant medication. This update was a much needed revision of a previous regulation which included outdated diagnostic terminology, inadequate inclusion of all stimulants on the market and ambiguity in the clarification of physician requirements for prescribing. The update was given much thought and included editing by the Arkansas Psychiatric Society in order to provide acceptable guidelines that reflect the current standard of practice.
A public hearing was conducted and testimony was heard regarding the proposed amendment. Though it was initially adopted, there have been a number of letters expressing confusion regarding the changes in Regulation 7. This article is designed to address those concerns and provide better clarification.
There were questions regarding which diagnoses are considered legitimate medical indications for stimulants. Several diagnostic terms in the original document were replaced (i.e. hyperkinetic disorder) as they are outdated or no longer utilized in the literature. Physicians are encouraged to review the DSM 4 for current psychiatric medical terminology. At this time, attention deficit hyperactivity disorder with or without hyperactivity and narcolepsy are the only approved FDA indications for stimulants. However, physicians use stimulants in a variety of off-label conditions. The update of Regulation 7 is partly designed to make more diagnoses appropriate for stimulant usage.
It is asked, however, that when treating off-label conditions such as other sleep disorders, augmentation of antidepressants or post-stroke depression that appropriate medical rationale and documentation of evidence based research and experience be
There was more confusion about the wording that “no second or subsequent prescription for these controlled drugs may be written for the patient until the physician reassesses the patient and documents in the medical record.” Concerns expressed by interested physicians reflected uncertainty of what was meant by “a reassessment” and whether or not the patient needed to be seen on a monthly basis. It is not the intent of the authors of Regulation 7 to have stable patients seen on a monthly or more frequent basis. The spirit of the reassessment requirement is to ensure that a physician adequately reassess the need for medication, as well as the appropriateness of dose and the consideration of side effects....Look at this entire issue
Copyright © 2001 - 2012, Arkansas State Medical Board. All rights reserved.