Medication Safety

By: InsideADHD.org

Your child has ADHD, and was just given a prescription for a psychostimulant medication.

You already know that safety is important when taking any prescription drug. It’s especially important to handle your child’s ADHD medicine correctly, because it’s classified as a “controlled substance.” This means that there are legal limits on prescribing and using this drug for ADHD, or for any other medical reason.

Jane’s Story

My 16-year-old daughter Haley just started taking medicine for her ADHD and she’s still getting used to it. Actually, ALL of us are still getting used to it. Last weekend, Haley took her medicine at breakfast and then she went to take a shower. She was supposed to put the pill bottle back in the cabinet over the bathroom sink, but she must have left it ON the sink instead. She didn’t put the cap back on all the way, either. At some point the bottle fell on the floor, and the steam from the shower made the pills wet.

We put the pills on a towel on the kitchen counter to let them dry. Later on, I came in the kitchen and Haley had an extra pill in her hand and was about to take it with some water. When I asked her what she was doing, she said she didn’t think her regular pill worked that morning, so she was going to take another one! I grabbed it away, and told her not to do that again. Besides, since the pills got wet, I don’t know if they’re ok to take anyway. We’ll probably have to throw them in the trash.

What can be learned from Jane’s story?

Jane’s story is scary on several different levels:

*Haley’s medication was usually stored in the bathroom cabinet

*Anyone using the bathroom could easily find the pills

*Steam and dampness can damage medication

*Haley didn’t fully replace the cap on the pill bottle, or put the bottle away

*Visitors, family members, small children or pets could find the medicine and eat it

*The pills were left on the counter to dry, where anyone could grab them

*Haley decided on her own that the medication wasn’t working, and that she needed to take another pill

*It’s dangerous to change any medication dose without speaking with the doctor who prescribed it

*Prescription medication should be safely stored and handed out by a responsible adult

*Haley’s mother thought that the pills should be thrown in the trash if they were no good

*Call the doctor’s office with any questions about medication safety

*Throwing medication in the trash could hurt animals, the environment, or other people who come across it. Get disposal instructions from your doctor’s office

What should I consider when storing my child’s medicine?

Because ADHD medications are legally-controlled substances, they need to be handled very carefully.

Ask yourself the following questions:

Who knows that my child takes medication?

Who has access to my house and, by default, has access to this medication? Household members? Friends? Extended family? Children’s friends? Household workers and repair staff?

If I hide this medication in a safe place, will I remember to have my child take it?

Will hanging a calendar or chart on the wall, with dates and times marked, help me to remember when my child needs to take this medicine?

Diversion, and safe medication storage

Diversion is when someone takes legally-prescribed medication and sells (or gives) it to someone who isn’t supposed to have that drug. It’s illegal to divert drugs, whether the medication is going to a friend, or to someone who sells it on the street.

Be creative, thoughtful and safe about storing ADHD medication:

Bad storage locations: The kitchen table, bathroom cabinet, nightstand, or in your unsecured purse

Good: In a locked cabinet or drawer, a safe, or a locked suitcase

Medication safety and effectiveness

You may be nervous when your child starts taking ADHD medication. Psychological tests, blood work and lab tests won’t tell you if the medication is effective, so how will you know that it’s working as well as it should?

While each doctor has his/her own method, daily questionnaires are often used to track a child’s behavior at home and at school; they’re returned to the pediatrician for review. If your child’s behavior goals aren’t being met, the medication may need fine-tuning.

What to do if the medication isn’t working

Keep giving the medication to your child as prescribed, but call the doctor as soon as possible. The dosage or the medication may need to be changed.

It’s not safe to adjust the dosage of your child’s medication on your own! Speak to the doctor first. Increasing the dosage may increase the drug’s side effects Your child will run out of medication too soon for a refill



Your child may, unfortunately, become used to a higher dose than necessary

Do not take any extra medications that you have on hand Adding another medication may lead to serious side effects



Getting rid of medications

Your child’s doctor may need to try several medications, at different dosages, before selecting the one that’s best for your child. As a result, you might have medication on hand that’s no longer being used. This extra medication can harm others, and needs to be disposed of properly. Use the following guidelines:

Get rid of all prescription medication that’s expired, and any medication that isn’t used or needed If you aren’t taking it now, don’t save it “just in case” To dispose of medication safely, put it in a child-resistant container along with a small amount of water When the drug has dissolved, add some flour, sawdust or kitty litter, and put the cap back on the bottle. Place the bottle in a bag or another container to keep it from being identified in the trash

Don’t flush leftover medicine down the toilet. Some drugs can get into the water supply and harm living organisms

Some communities have waste disposal or pharmaceutical take-back programs that you can use to get rid of medicine

Your state’s Department of Environmental Quality can provide information on household hazardous waste programs.

Filling prescriptions

It’s important for your child to have his or her medication on a regular basis, and not to run out. Running out won’t cause any specific physical problems for your child, but his or her ADHD symptoms will become worse.

Here are some tips for filling ADHD prescriptions:

Stimulants used to treat ADHD are controlled substances: There are special laws about how they can be prescribed and refilled.

According to a December 2007 ruling, a physician can, in one office visit, write several prescriptions that add up to a 90-day supply of ADHD medication. Patients are required to see their doctors for new prescriptions four times per year.

In some states, ADHD prescriptions can’t be called in to a pharmacy. See your child’s doctor for a new prescription, even if it’s for the same medication that your child has been taking all along.

Your child needs to take the prescribed amount of his or her medication: The dosage should never be changed, or shared with others. A new prescription will not be issued if the last prescription runs out too soon.

If your insurance doesn’t pay for the prescribed medication, have the doctor switch to a covered medication, provided that it is equivalent to what the doctor prescribed.

Some myths about handling medication

Stimulant medication that’s not used safely can be dangerous. Take a few minutes to learn some of the myths – and the truth – about handling these drugs.

Myth #1: Splitting pills in half is a safe way to save money

Truth: Splitting pills might save money, but it’s not safe. Time-release medication can be dangerous if cut in half, because it changes the way that the drug is absorbed. Also, it’s possible to get an upset stomach if pills that have a special coating on them are cut.

Myth #2: The bathroom cabinet is good for storing medication

Truth: Never store medication in the bathroom, because it could be stolen, or damaged by high temperatures or steam. Keep it in a dry, dark, locked place, where the temperature stays between 65-80 degrees F.

Myth #3: It’s OK to be creative when I give my child his medication, because he hates taking it

Truth: Being creative is fine, but make sure that your methods are safe:

Never pretend to take your child’s medication

Don’t refer to any medicine as “candy”

Know what you’re giving to your child – never hand out medication in the dark

Summary

Having a prescription for ADHD stimulant medication is a big responsibility – both for you and for your child.

Keep the following in mind:

ADHD medication is a controlled substance. It needs to be stored safely and used properly

The best place to store ADHD medication is in a locked cabinet, drawer or safe

Never change the drug’s dosage on your own – speak to the doctor first

Get rid of any expired or unused medication by dissolving it in water and mixing it with flour, sawdust or kitty litter

Your child will need a new set of prescriptions for his stimulant medication every 90 days, and prescriptions may have to be filled in person – not over the phone. To obtain a 90 day, supply the physician is allowed to postdate some of the prescriptions. Medication that runs out too soon will not be refilled right away

ADHD stimulant medication that’s used safely and correctly can help put your child on a positive and equal footing with his friends and family. It’s a good – and reachable – goal.

References

Federal Register. (2007, November). 72, 222, 64921. Issuance of multiple prescriptions for schedule II controlled substances. Retrieved March 3, 2008.

Reift, M. I. (Ed.). (2004). ADHD: A complete and authoritative guide (pp 79-81). Elk Grove Village, IL: American Academy of Pediatrics.