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Controlled Substances: Safety & Policy
Fishtown Medicine•3 min read

Controlled Substances: Safety & Policy

Clinical guardrails for safety and sustainability. How we manage powerful tools with precision and care.

On This Page
  • Table of Contents
  • What are Controlled Substances?
  • Our Prescribing Framework
  • Safety Monitoring and Refills
  • Guidelines from the Clinic
  • Actionable Steps for Medication Safety
  • Common Questions
  • What controlled substances does Fishtown Medicine prescribe?
  • Why do you require regular follow-ups for controlled substances?
  • What is the Prescription Drug Monitoring Program?
  • Why won't you provide early refills?
  • Can I transfer my ADHD or anxiety medication to Fishtown Medicine?
  • Do you prescribe controlled substances at the first visit?
  • Will I need a urine drug screen?
  • What if I want to taper off a controlled medication?

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TL;DR · 30-second take

Fishtown Medicine prescribes controlled substances like ADHD stimulants, short-term sleep aids, and gabapentinoids using clear safety guardrails. We use the state Prescription Drug Monitoring Program (PDMP), require regular follow-ups, do not provide early refills, and do not prescribe Schedule II opioids for chronic pain.

Controlled Substances: Safety & Policy

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 exactly 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).
  • Sleep Aids: Ambien, Lunesta.
  • Gabapentinoids: Gabapentin, Pregabalin.
Note: Fishtown Medicine does not prescribe Schedule II opioids for chronic pain management.

Our Prescribing Framework

We never rush into prescribing a controlled substance. We assess the whole picture first.
  1. Medical Necessity: Documented through a thorough diagnostic evaluation.
  2. Safer Alternatives First: We always explore integrated strategies or non-controlled options before moving to more intensive therapeutics.
  3. 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.
  4. 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.
  • Periodic Follow-ups: Regular consults (telehealth or in-person) are required for all patients on controlled medications.
  • 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.

Guidelines from the Clinic

Dr. Ash
"My goal is not to be a gatekeeper. It is to be a safety partner. These medications are powerful tools, but they work best inside a strategy of sleep, metabolic health, and nervous system regulation. We use firm boundaries not to limit your care, but to make sure your treatment plan stays sustainable for the long haul."

Actionable Steps for Medication Safety

Build a sustainable strategy.
  1. 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.
  2. Monitor Your Response: Use simple energy and focus notes in the app to track how your medications affect your daily life.
  3. Tapering Discussions: If you feel you are becoming dependent or the meds are losing their effect, start a conversation. We do supervised, gradual tapering.
  4. Plan Refills Early: Request refills at least 5 business days before you run out, so we have time to schedule any required follow-up.

Frequently Asked Questions

Common Questions

Fishtown Medicine prescribes ADHD stimulants (Adderall, Vyvanse, Ritalin), select benzodiazepines (Ativan, Xanax, Valium) for acute and short-term use, sleep aids (Ambien, Lunesta), and gabapentinoids (Gabapentin, Pregabalin) when clinically appropriate. We do not prescribe Schedule II opioids for chronic pain.
We require regular follow-ups for controlled substances because the law and clinical safety both require it. Follow-ups let us track effectiveness, screen for side effects, check vitals, and adjust the plan. They also keep us aligned with state and federal prescribing rules.
The Prescription Drug Monitoring Program (PDMP) is a state database that records every controlled prescription you receive. We check it before refilling controlled medications to confirm there are no safety concerns and that your history matches your chart.
We do not provide early refills because state and federal law set strict limits, and early refills are a known signal of misuse. The same rule applies to lost, stolen, or misplaced medications. Plan ahead and contact us 5 business days before running out.
Yes, you can transfer ADHD or anxiety medication to Fishtown Medicine. We ask for prior records and may require a focused evaluation visit before continuing the prescription. The goal is continuity of care, not restarting from zero.
We rarely prescribe controlled substances at the first visit. The first visit is for evaluation, history, and labs when needed. Most controlled prescriptions begin at a follow-up visit once we have full context, although urgent situations are handled case by case.
You may need a urine drug screen for higher-risk medications, before starting some controlled prescriptions, or at random points during ongoing treatment. The purpose is to confirm therapeutic consistency, not to catch you. We explain exactly when and why before any test.
If you want to taper off a controlled medication, we plan a supervised reduction over weeks to months. Stopping suddenly, especially for benzodiazepines, can be unsafe. We adjust the schedule to your symptoms and add support like sleep, nutrition, and therapy work as you taper.

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*Dr. Ash is a board-certified internal medicine physician specializing in preventive medicine and healthspan optimization at Fishtown Medicine in Philadelphia.*

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Medical Disclaimer: This resource provides clinical context for educational purposes. In the world of Precision Medicine, there is no "one size fits all"; the right plan must be matched to your unique lab work, physiology, and goals. Consult Dr. Ash to determine if this approach is right for you, especially if you have chronic health conditions or are taking prescription medications.

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