Hi all, I was hoping to get some advice on your approach to dealing with inappropriate stimulant use. I joined a practice recently that has excessive stimulant use for ADHD. From what I’ve seen there was no work up or evaluation for the vast majority of cases. It seems people were started on adderall after mentioning trouble with concentration. This is all adults from young 20s and working up to 80s and retired. Most have been on them for years. There is very little psych access as I’m in a rural area. The one psych clinic I have referred to only has NPs who seem to just continue the same meds and from documentation I don’t see any discussion of the need for meds or for further evaluation. They just prescribe more adderall.

I previously would refer to neuro psych for adhd evaluation at a former job but the closest neuro psych is 45 mins away and patients refuse.

So I’m realizing that because of the limited resources I am going to have to do this myself which I’m willing to do. I was hoping you could give me some guidance on doing ADHD eval as a PCP for patients who have been on adderall for years and is 100% convinced they have ADHD. I have had a couple successes in elderly patients to start weaning after discussing risks but largely meet resistance. Some of these patients I am sure need it and I am happy to prescribe, most probably don’t.