At Fishtown Medicine, we believe in honest, evidence-based care. That includes how we approach controlled substances—medications that can help in the right context but carry serious risks if misused.
We prescribe these medications only when clinically appropriate, and with thoughtful guardrails to protect your safety, dignity, and long-term health.
🔒 What are controlled substances?
Controlled substances are medications regulated by federal and state law because of their potential for misuse, dependence, or addiction. These include:
Stimulants (e.g., Adderall, Vyvanse)
Benzodiazepines (e.g., Ativan, Xanax)
Sleep aids (e.g., Ambien, Lunesta)
Opioids (e.g., oxycodone, codeine, tramadol)
Gabapentinoids (e.g., gabapentin, pregabalin—controlled in some states)
🧭 Our approach:
We assess the full picture—your health history, past treatments, goals, and risks—before making any prescribing decision. If a controlled substance is part of your care plan, it’s because:
It meets a clearly documented medical need
No safer or equally effective option is available
We’ve discussed risks, benefits, and alternatives
A monitoring plan is in place
We never shame patients for needing support. But we do set firm, safety-driven boundaries about when, how, and why these medications are used.
🚫 What we don’t prescribe:
We do not prescribe Schedule II opioids (like oxycodone or hydrocodone).
We do not manage chronic pain with long-term opioid therapy.
We do not prescribe benzodiazepines long-term (e.g., for daily use of Xanax or Klonopin).
We do not prescribe controlled medications for out-of-state patients due to licensing laws.
✅ What we may prescribe—with strict criteria:
🧠 Stimulants (for ADHD)
Prescribed only after thorough evaluation and documented need
Requires review of outside records and PDMP (prescription monitoring)
May include additional screening for anxiety, sleep, or substance use history
Periodic follow-up and refill monitoring required
😔 Short-term benzodiazepines (e.g., Ativan for a procedure)
Short courses only
Documented indication (e.g., MRI prep, severe panic attack)
Typically prescribed for <7 days with no refills
Not used for daily or long-term anxiety
💤 Sleep aids (e.g., Ambien)
Used only after other strategies have failed
Time-limited, with clear stop dates
Regular reassessment for dependency or rebound effects
🔍 How we monitor controlled medications:
PDMP checks (prescription drug monitoring program)
Follow-up visits (telehealth or in-person depending on med)
Urine drug screens (for certain higher-risk meds)
Pill counts or pharmacy verification when needed
Clear refill policies — no early refills, no exceptions for lost/stolen meds
Tapering plans if we believe risks outweigh benefits
We document every step, and we’re transparent with you about why decisions are made.
🫂 A trauma-informed note:
We understand that some patients have been dismissed, labeled, or retraumatized by past experiences with these meds.
Our goal is never to shame or punish—only to keep you safe, informed, and supported.
We’ll always explain our reasoning and work with you to find safer, sustainable options when possible.
💡 Bottom line:
Controlled substances are tools—not cures. We use them cautiously, only when they serve your health, and never without a safety net.
If you’re not sure whether a medication you’ve taken before falls under this policy, message us—we’re happy to walk through it together.
Want to see our full Controlled Substance Treatment Agreement? Read it here.