CONNECTICUT MEDICAL ASSISTANCE PROGRAM DEPARTMENT OF SOCIAL SERVICES & HEALTH INFORMATION D ESIGNS, INC.

AAP Updates ADHD Schedule Change for Carisoprodol Guidelines Effective January 11, 2012, Schedules II through V are trolled substance. The FDA The American Academy of carisoprodol (Soma®) was commonly prescribed and calculated that carisoprodol Pediatrics (AAP) recently changed to a Schedule IV dispensed drugs and have is being abused at a rate updated guidelines to help controlled substance in all an accepted medical use in similar to diazepam which In the diagnosis and states under the federal the United States. Schedule is a Schedule IV benzodi- treatment of attention-deficit/ Controlled Substances Act II drugs have the highest azepine. hyperactivity disorder (CSA). The U.S. Drug potential for psychological (ADHD) in children and Enforcement Agency (DEA) dependence or addiction The FDA found that adolescents. The AAP first enforces the CSA. The and abuse. Schedule V drugs patients who are abusing published clinical CSA, along with state laws, have the lowest potential carisoprodol are typically recommendations for the dictates the details for abuse and addiction. abusing opioids, benzodi- diagnosis and evaluation of the manufacturing, pre- azepines, cocaine, and of ADHD in children in 2000. scribing, and dispensing of Examples of Schedule I marijuana. Recommendations for treat- controlled substances. drugs include heroin and ment followed in 2001. marijuana. Examples of In 2009, the National The CSA assigns five Schedule II drugs are Survey on Drug Use and After a thorough literature different schedules of oxycodone, fentanyl, Health (NSDUH) data review evaluating new controlled substances. The methylphenidate and suggested that more than evidence, the new guidelines drug’s abuse potential, his- methadone. Hydrocodone, 100,000 12 to 17 year olds were developed to replace tory of abuse and codeine and buprenorphine reported using carisoprodol the previous guidelines and current pattern of abuse, are Schedule III drugs. for non-medical reasons recommendations published significance of abuse, and Benzodiazepines are and that almost one million in 2000 and 2001. whether the substance is Schedule IV. Schedule V 18-25 year olds reported The previous guidelines a precursor of another drugs have smaller quantities using carisoprodol for non- addressed diagnosis and substance that is already of narcotics such as cough medical reasons. treatment for children 6 scheduled are considered preparations with codeine. through 12 years of age. The when determining the The DEA reports that new guidelines expand the schedule of a drug. Carisoprodol abuse has carisoprodol is one of the age range and include increased in the last most commonly diverted children 4 through 18 years Schedule I controlled decade. Carisoprodol is FDA drugs. Doctor shopping and of age. substances have a high approved for the relief of prescription forgery are very potential for abuse, lack discomfort associated with common diversion methods Recommendations for evaluation and diagnosis: data on safe use in acute, painful musculoskeletal for carisoprodol. As of humans, and have no conditions. Carisoprodol March 2011, street prices The primary care clinician currently accepted medical metabolizes to meproba- for carisoprodol ranged should evaluate any child use in the United States. mate, a Schedule IV con- from $1 to $5 per tablet. 4 through 18 years of age

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AAP Updates ADHD Guidelines who displays academic or The primary care clinician methylphenidate may be ADHD medications with behavioral problems and should recognize ADHD as prescribed. the agreement of the symptoms of inattention, a chronic condition and adolescent and may also For children ages 6 to 11 hyperactivity, or impulsivity. consider children with prescribe behavior therapy. years, the primary care ADHD as having special It is preferred that the The Diagnostic and Statisti- clinician should prescribe healthcare needs. These clinician prescribe both. cal Manual of Mental FDA-approved ADHD children should be managed Disorders, 4th Edition (DSM medications and/or Doses of the ADHD according to the principles -IV) criteria must be met to evidence-based parent- medication should be of the chronic care model make a diagnosis of ADHD. and/or teacher adminis- titrated to achieve and the medical home. Information should primarily tered behavior therapy. maximum benefit with

be obtained from parents or The evidence is particularly minimum adverse effects. Recommendations for guardians, teachers, and strong for stimulant treatment: other school and mental medications. Evidence is References health clinicians involved in For children ages 4 to 5 sufficient, but less strong 1. Schedules of Controlled Substances: Placement of Carisoprodol Into Schedule IV. Federal Register 76 the child’s care. years, first-line treatment for atomoxetine, extended- (2011 Dec 12): 77330-77359. Available from: http:// www.gpo.gov/fdsys/pkg/FR-2011-12-12/pdf/2011- should be evidence-based release guanfacine, and 31542.pdf. [Accessed August, 2012] The primary care clinician 2. Drug Enforcement Administration. Carisoprodol. parent- or teacher- extended-release clonidine. January 2012. Available from: http:// should assess the child www.deadiversion.usdoj.gov/drugs_concern/ administered behavior carisoprodol/carisoprodol.pdf. [Accessed August, for other conditions that For adolescents ages 12 2012] therapy. If behavioral 3. ADHD: Clinical Practice Guideline for the Diagno- may coexist with ADHD, to 18 years, the primary sis, Evaluation, and Treatment of Attention-Deficit/ interventions do not provide Hyperactivity/Disorder in Children and Adolescents. including emotional or care clinician should Subcommittee on Attention-Deficit/Hyperactivity significant improvement, Disorders, Steering Committee on Quality Improve- behavioral, developmental, prescribe FDA-approved ment and Management. Pediatrics. 2011;128(5): 1007- and physical conditions. 1022.

September 2012