TABLE 2

Discussion Points for Anticipatory Guidance Regarding Stimulants and Substance Use

Proper administration
 At each clinic visit, review with the patient how he or she is taking his or her stimulant medication.
 • Only take the amount of medicine prescribed. Do not take extra medication.
 • Take your stimulant medication exactly as prescribed. Do not change the dose or timing. Speak to your doctor if you do not think your medication is working as it should or if you are experiencing adverse effects.
 • Do not use alcohol, tobacco, marijuana, or other illicit substances. Drug use worsens problems with attention, leads to medication noncompliance, and can interact with stimulant medication.
 • If stimulant medication is administered at school, it should be dispensed at school nurse’s office or other safe location with adult supervision.
Risk of misuse, diversion, and abuse
 For people who do have ADHD, when stimulant medications are taken as prescribed, there is no increased risk of abuse; rather, stimulant medication appears to decrease the risk of developing an SUD.
 • Explain that some people who do not have ADHD may take stimulant medications inappropriately.
 • Inform patient and parent that children and adolescents may be asked to give away or sell their stimulant medications but should never do so. Parents may role play appropriate responses so that the child will be prepared if asked. Have the patient and parents keep medication in a safe location (either at home or in a locked office at school). Medications should never be carried in a backpack or purse.
Transition of care
 Transitioning of administration of stimulant medication from caregiver to child/adolescent should be done incrementally. Parents and patients should be counseled that ADHD generally persists into adulthood.
 • To start a transition, the child/adolescent must be able to remember to take medication as prescribed. Signs suggesting readiness should include the ability to name the medication, dose, and timing of administration as well as emerging signs of independence in other areas, such as being home alone, carrying a key, completing homework independently, or participating in care for a pet.
 • The caregiver should continue to periodically supervise medication administration and monitor the child’s/adolescent’s overall school, social, and family functioning. Weekly pill dispensers can allow burgeoning autonomy for the child/adolescent while allowing the caregiver to monitor doses and control the supply.
 • If concerns develop regarding medication misuse or diversion or use of other drugs, the parent should resume control of the medication, dispense each dose, and monitor carefully.