Fishtown Medicine prescribes controlled substances like ADHD stimulants, testosterone, short-term sleep aids, and gabapentinoids using clear safety guardrails. We use the state Prescription Drug Monitoring Program (PDMP), require an in-person visit every 6 months, prescribe these medications in Pennsylvania and New Jersey only, do not provide early refills, and do not prescribe opioids at all. We manage these medications for members.
TL;DR: Controlled substances, like stimulants for ADHD or short-term sleep aids, need close clinical oversight to keep you safe and prevent dependence. At Fishtown Medicine, we use clear, transparent guardrails to protect your health while making sure you get the support you need without judgment.
This policy explains which medications are covered, how we evaluate need, how refills work, and what monitoring looks like. The goal is to keep care predictable for you and safe for everyone.
Table of Contents
- What are Controlled Substances?
- Our Prescribing Framework
- Safety Monitoring and Refills
- Guidelines from the Clinic
- Common Questions
What are Controlled Substances?
Controlled substances are medications regulated by federal and state law because they have a potential for misuse or physical dependence. Examples include:
- Stimulants: Adderall, Vyvanse, Ritalin (for ADHD).
- Benzodiazepines: Ativan, Xanax, Valium (for acute anxiety or specific procedures).
- Z-drug sleep aids: Ambien (zolpidem), Lunesta (eszopiclone), Sonata (zaleplon).
- Gabapentinoids: Gabapentin, Pregabalin.
- Testosterone: cypionate and enanthate injections, gels and patches (AndroGel, Androderm), and oral forms (Jatenzo).
Note: Fishtown Medicine does not prescribe opioids. That holds for every schedule, every length of course, and every reason, including buprenorphine (Suboxone, Subutex) and methadone for opioid use disorder. The pharmacology is what decides here, not what the medication is being used for. Acute pain that needs an opioid belongs in urgent care or the emergency department, ongoing pain belongs with pain management, and opioid use disorder belongs with addiction medicine, so we refer rather than prescribe.
Naltrexone is a different medication. It blocks opioid receptors rather than activating them, so it is not an opioid and none of the above applies to it. We prescribe it, including low-dose naltrexone.
Our Prescribing Framework
We never rush into prescribing a controlled substance. We assess the whole picture first.
- Medical Necessity: Documented through a thorough diagnostic evaluation.
- Safer Alternatives First: We always explore integrated strategies or non-controlled options before moving to more intensive therapeutics.
- PDMP Review: We use the state Prescription Drug Monitoring Program (PDMP), a database that tracks controlled prescriptions across providers, to make sure your history is consistent and safe.
- Clinical Audit: We review outside records from previous providers to maintain continuity of care.
Safety Monitoring and Refills
To keep care safe and sustainable, we follow clear monitoring and refill rules. These sit on top of the medication refill policy that covers every prescription here, controlled or not.
- Periodic Follow-ups: Regular consults (telehealth or in-person) are required for all patients on controlled medications.
- An In-Person Visit Every 6 Months: Every controlled prescription carries a standing requirement to see you in person at least twice a year. It is a continuity obligation rather than a hurdle, and we book it well ahead so a refill never ends up waiting on it.
- Pennsylvania and New Jersey Only: Dr. Ash is licensed in more states than these two, and non-controlled medications have more room across all of them. Controlled prescribing is narrower, because it is tied to where you are physically located and to that in-person requirement.
- No Early Refills: For safety and legal compliance, we do not provide early refills for lost, stolen, or misplaced medications.
- Urine Drug Screening: May be requested for specific higher-risk medications to confirm therapeutic consistency.
- Pill Counts and Pharmacy Verification: For select higher-risk situations, we may ask for a pill count or verify fill history with your pharmacy. We explain the reason before we ask.
Guidelines from the Clinic
Actionable Steps for Medication Safety
Build a sustainable strategy.
- Request Records: If you are joining from another practice, have your records sent to us through your patient portal so we can review them before the first visit.
- Monitor Your Response: Use simple energy and focus notes in the app to track how your medications affect your daily life.
- Tapering Discussions: If you feel you are becoming dependent or the meds are losing their effect, start a conversation. We do supervised, gradual tapering.
- Plan Refills Early: Request refills at least 5 business days before you run out, so we have time to schedule any required follow-up.
Dr. Ash is a board-certified internal medicine physician specializing in preventive medicine and healthspan optimization at Fishtown Medicine in Philadelphia.
Related at Fishtown Medicine
- An Alternative to Done ADHD - responsible adult ADHD care, and what to do if an online ADHD service closed
- ADHD: A Detailed Guide to Diagnosis & Care - the whole-system approach to evaluation and treatment
Frequently Asked Questions
Common Questions
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