6 questions to ask before you inherit an adult ADHD stimulant prescription
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ADHD is one of the most diagnosed and treated disorders in modern American medicine. And yet, it lacks a unified, authoritative framework for diagnosis and medication management. This void creates major inconsistencies in clinical practice.
—Lauren Grawert, MD, via Op-Med
Attention deficits can be found in PTSD, some forms of depression and anxious disorders, some postpartum women can suffer from it, a lack of sleep can cause it, etc. It’s not the most uncommon complaint but it’s not always fixed by ADHD treatments.
—@EndlessCourage via Reddit
The patient in front of you was diagnosed during a 20-minute telehealth visit, has been taking stimulants for 8 months, and just transferred care to your practice. The refill request is sitting in your inbox. Do you sign it?
As psychiatric access remains constrained, family physicians and internists increasingly manage ADHD and stimulant prescribing in adults.[][][] Stimulant prescribing is now firmly within the scope of primary care—but only when clinicians apply a structured approach to diagnosis, monitoring, and risk mitigation.[][]
The timing is complicated. More than 70% of adults prescribed stimulants report difficulty obtaining their medications amid ongoing shortages, while approximately one-third of adults with ADHD received no treatment in the previous 12 months.[] At the same time, stimulant prescribing has increased in recent years, particularly among women and adults aged 35 years and older.[][]
“ADHD is one of the most diagnosed and treated disorders in modern American medicine,” Lauren Grawert, MD, an addiction psychiatrist, wrote for Op-Med. “And yet, it lacks a unified, authoritative framework for diagnosis and medication management. This void creates major inconsistencies in clinical practice, leaving physicians vulnerable to scrutiny without an agreed upon medical roadmap.”[]
Related: Mindfulness meditation may help reduce adult ADHD symptoms, study findsBefore you click “renew,” consider these six questions.
How was the ADHD diagnosis made?
A prior prescription is not proof of a comprehensive diagnostic evaluation. Adult ADHD shares symptoms with anxiety disorders, depression, sleep disorders, substance use disorders, thyroid disease, and other conditions that can impair attention and executive functioning.[]
When patients transfer care, clinicians should document evidence that diagnostic criteria have been met in the new medical record. Validated tools such as the Adult ADHD Self-Report Scale (ASRS) and the Diagnostic Interview for ADHD in Adults (DIVA-5) can help support the diagnosis and standardize documentation.[]
“Attention deficits can be found in PTSD, some forms of depression and anxious disorders, some postpartum women can suffer from it, a lack of sleep can cause it, etc. It’s not the most uncommon complaint but it’s not always fixed by ADHD treatments,” @EndlessCourage, MD, a primary care physician, wrote in r/FamilyMedicine.
Related: How diet affects ADHD symptoms: Updated patient guidance for cliniciansCan you re-document symptom burden and impairment with a validated rating scale?
ADHD treatment should target functional impairment associated with symptoms—not simply inattentiveness, distractibility, or productivity concerns.
Validated rating scales provide an objective baseline and create a framework for monitoring response to treatment over time. They may also help distinguish patients experiencing clinically significant impairment from those seeking medication primarily for performance enhancement.[]
For PCPs inheriting ADHD care, repeating a validated assessment can strengthen the chart, support prescribing decisions, and provide measurable outcomes for future follow-up visits.
Is there a controlled-substance agreement and monitoring plan in place?
Before assuming prescribing responsibility, confirm that key safeguards are documented, including prescription drug monitoring program (PDMP) review, refill policies, follow-up intervals, and, where appropriate, a controlled-substance agreement.
Inherited stimulant prescriptions should be managed with the same safeguards used for other controlled substances, including clear expectations around refills, pharmacy changes, and ongoing monitoring.
The stimulant shortage has transformed medication management into a logistical challenge. According to CDC survey data, 71.5% of adults prescribed stimulant medications reported difficulty filling prescriptions because of shortages.[]
Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) has described the shortage as a persistent barrier to care that forces many patients to alter treatment plans or go without medication altogether.[]
Clinicians may need contingency plans when preferred stimulant formulations are unavailable. If generic immediate-release mixed amphetamines are unavailable, will you switch formulations? Consider lisdexamfetamine? Transition to a non-stimulant such as atomoxetine or viloxazine?
Have you addressed cardiovascular risk, pregnancy, and breastfeeding?
Before continuing stimulant therapy, review blood pressure, heart rate, personal cardiovascular history, family history of sudden cardiac death, and symptoms such as syncope, chest pain, or palpitations.
Routine ECG screening is not universally recommended, but cardiovascular risk factors and concerning findings warrant further evaluation.
Patients of childbearing potential should be asked about pregnancy intentions and breastfeeding status. Decisions regarding stimulant use during pregnancy require individualized risk-benefit discussions.
These conversations are easy to overlook during a transfer visit—and easy to regret later if they never occurred.
Is this treatment addressing disability—or drifting toward overmedicalization?
Stimulant prescribing has increased substantially over the past decade. CDC data show significant increases in stimulant dispensing between 2016 and 2021, with particularly notable increases among women and adults aged 35 years and older.[][]
Debate continues over telehealth-driven prescribing, adult ADHD overdiagnosis, and the line between treating impairment and enhancing performance.[] The goal is not gatekeeping. ADHD remains underdiagnosed and undertreated for many adults.
PCPs must determine whether ongoing stimulant therapy is addressing meaningful functional impairment or whether treatment goals have shifted.
Inheriting a stimulant prescription does not mean inheriting someone else's clinical judgment—it means making your own.
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