Informed Consent for Stimulant Medications in Low-Barrier Harm Reduction Clinic
Purpose of This Medication
You are being prescribed a stimulant medication (methylphenidate or amphetamine) to treat attention deficit hyperactivity disorder (ADHD), which can significantly improve your ability to focus, control impulses, and function in daily life. 1, 2 These medications work by increasing dopamine and norepinephrine in your brain, helping to reduce ADHD symptoms that interfere with work, relationships, and overall quality of life. 3
Critical Safety Information: Abuse and Addiction Risk
High Potential for Misuse
Stimulant medications have a high potential for abuse, misuse, and addiction, which can lead to overdose and death. 2 This risk is especially important in our clinic setting where many patients have current or past substance use. 4, 5
Before starting this medication, your provider has assessed your specific risk factors, including: 2
- Current substance use patterns (alcohol, cannabis, cocaine, opiates, other stimulants)
- History of substance use disorder
- Impulsivity levels and psychiatric conditions
- Access to the medication and household members who might misuse it
Throughout treatment, your provider will frequently monitor for signs of misuse, including: 2
- Taking higher doses than prescribed
- Running out of medication early
- Using non-oral routes (snorting, injecting)
- Seeking prescriptions from multiple providers
- Giving or selling medication to others
Safe Storage and Disposal
You must store this medication in a locked, secure location and never share it with anyone else. 2 Unused medication should be disposed of properly through medication take-back programs or by following FDA disposal guidelines. 2
Cardiovascular Risks
Serious Cardiac Disease
Stimulants can cause sudden death in patients with heart problems. 2 Before prescribing, your provider has evaluated you for:
- Structural heart abnormalities
- Cardiomyopathy
- Serious arrhythmias
- Coronary artery disease
- Other serious cardiac conditions 2
Blood Pressure and Heart Rate Monitoring
Stimulants increase blood pressure by 2-4 mmHg and heart rate by 3-6 bpm on average, though some patients experience larger increases. 2 Your blood pressure and pulse will be monitored at every visit. 2
Seek immediate medical attention if you experience: 2
- Chest pain
- Shortness of breath
- Fainting or near-fainting
- Rapid or irregular heartbeat
Psychiatric Risks
Worsening of Existing Mental Health Conditions
Stimulants can worsen psychosis, trigger manic episodes in bipolar disorder, or cause new psychiatric symptoms. 2 Your provider has screened you for:
- History of psychotic symptoms
- Bipolar disorder or family history of bipolar disorder
- Depression or suicidal thoughts
- Family history of suicide 2
New Psychiatric Symptoms
In approximately 0.1% of patients, stimulants can cause hallucinations, delusions, or mania even without prior psychiatric history. 2 If you experience these symptoms, contact your provider immediately—discontinuation may be necessary. 2
Other Serious Risks
Priapism (Prolonged Erections)
Male patients may experience prolonged, painful erections requiring surgical intervention. 2 This can occur after starting medication or after dose increases, and sometimes during medication holidays or discontinuation. 2 Seek immediate medical attention for erections lasting more than 4 hours or that are painful. 2
Peripheral Vasculopathy and Raynaud's Phenomenon
Stimulants can cause blood vessel problems in fingers and toes, including color changes, pain, numbness, and in severe cases, tissue breakdown or ulcers. 2 Report any persistent color changes, coldness, or pain in your extremities. 2
Growth Suppression in Young Adults
If you are under 25 years old, stimulants may affect your growth and weight gain. 2 Your height and weight will be monitored regularly, and treatment may need to be interrupted if growth is not progressing as expected. 2
Eye Problems
Stimulants can increase eye pressure and may worsen glaucoma. 2 If you have significant farsightedness, you should be evaluated by an eye doctor before starting treatment. 2 Patients with open-angle glaucoma or increased eye pressure will be closely monitored. 2
Common Side Effects
You may experience: 2
- Rapid heartbeat or palpitations
- Headache
- Difficulty sleeping
- Anxiety or nervousness
- Increased sweating
- Weight loss and decreased appetite
- Dry mouth
- Nausea and abdominal pain
To manage appetite loss: Take medication with meals and consume high-calorie drinks or snacks in the evening. 6
To manage insomnia: Take your last dose before 2:00 PM and avoid late-day dosing. 6 If insomnia persists, discuss with your provider—you may need dose adjustment or separate sleep treatment. 6
Contraindications: You Cannot Take This Medication If:
The following conditions absolutely prohibit stimulant use: 1, 2
- Known allergy to methylphenidate or amphetamine (including angioedema or anaphylaxis)
- Currently taking or have taken MAO inhibitors in the past 14 days
- Active psychotic disorder
- Symptomatic cardiovascular disease
- Uncontrolled hyperthyroidism
- Uncontrolled hypertension
- Glaucoma (angle-closure type)
- Current illicit stimulant use or abuse (unless in controlled/supervised setting) 1
Special Considerations for Substance Use History
Evidence-Based Approach
Research shows that treating ADHD with stimulants in patients with substance use disorders can be beneficial when done carefully. 3, 5 Studies indicate that proper ADHD treatment may actually reduce substance use risk by improving executive function and reducing impulsivity. 3, 7, 5
Long-Acting Formulations Preferred
You will be prescribed long-acting (extended-release) stimulants rather than immediate-release formulations because they have lower abuse potential and better adherence. 6, 3, 5 Long-acting formulations provide steady medication levels throughout the day, reducing the "high" that contributes to misuse. 6, 3
Integrated Treatment Approach
Your ADHD medication is part of a comprehensive treatment plan that includes: 1, 5
- Ongoing substance use support and harm reduction services
- Psychosocial interventions (motivational interviewing, cognitive-behavioral therapy, skills training) 1, 5
- Frequent monitoring appointments
- Coordination with other providers treating your substance use 5
Specific Substance Interactions
Your provider has considered your specific substance use pattern: 3, 5
- Alcohol: Stimulants do not worsen alcohol use and may improve treatment outcomes when combined with appropriate alcohol treatment 3
- Cannabis: Stimulants can be used safely with appropriate monitoring 3
- Cocaine/Amphetamines: Extra caution is needed; you will be monitored more frequently 3, 5
- Opiates: Stimulants can be used safely in patients on medication-assisted treatment 3
- Nicotine: Stimulants may help reduce smoking 3
Monitoring Requirements
Initial Phase (First Month)
You will be seen weekly or biweekly for: 2, 5
- Blood pressure and heart rate checks
- Assessment of ADHD symptom improvement
- Monitoring for side effects
- Pill counts to ensure appropriate use
- Screening for misuse or diversion
Ongoing Monitoring
After stabilization, you will be seen at least monthly for: 2, 5
- Vital signs (blood pressure, pulse, weight)
- ADHD symptom assessment using standardized scales
- Substance use patterns
- Psychiatric symptom monitoring
- Medication adherence and misuse screening
- Cardiovascular symptom review
Urine Drug Screening
Random urine drug screens may be performed to ensure medication adherence and monitor for other substance use. 5 This is standard practice in harm reduction settings and helps ensure your safety. 5
Dosing and Administration
Starting Dose
You will start with a low dose that will be gradually increased based on your response and tolerability. 1, 2
- Methylphenidate: Typically starting at 5-10 mg once or twice daily, increased by 5-10 mg weekly 2
- Maximum dose: 60 mg daily 2
- Timing: Take 30-45 minutes before meals; last dose before 2:00 PM to avoid insomnia 6, 2
Dose Adjustments
Your provider will adjust your dose based on: 1, 2
- ADHD symptom improvement
- Side effect tolerability
- Cardiovascular response
- Signs of misuse or diversion
If symptoms worsen or severe side effects occur, your dose will be reduced or the medication discontinued. 2
When to Seek Immediate Medical Attention
Go to the emergency room or call 911 if you experience: 2
- Chest pain or pressure
- Severe shortness of breath
- Fainting or loss of consciousness
- Seizures
- Hallucinations or severe confusion
- Thoughts of harming yourself or others
- Erection lasting more than 4 hours (males)
- Signs of allergic reaction (swelling of face/throat, difficulty breathing, severe rash)
- Stroke symptoms (sudden weakness, speech difficulty, facial drooping)
Your Responsibilities
To safely use this medication, you agree to: 2, 5
- Take medication exactly as prescribed—never increase dose on your own
- Store medication in a locked, secure location
- Never share, sell, or give medication to others
- Attend all scheduled monitoring appointments
- Report any side effects or concerns immediately
- Participate in recommended psychosocial treatments
- Be honest about substance use and medication adherence
- Submit to random pill counts and urine drug screens
- Obtain prescriptions from only one provider
- Dispose of unused medication properly
Provider Responsibilities
Your provider commits to: 2, 5
- Thoroughly assess your cardiovascular and psychiatric risk before prescribing
- Start with the lowest effective dose and titrate carefully
- Monitor you frequently for efficacy, side effects, and misuse
- Prescribe long-acting formulations to reduce abuse potential
- Coordinate with your other treatment providers
- Provide integrated care addressing both ADHD and substance use
- Discontinue medication if serious risks emerge or misuse is detected
- Offer alternative treatments if stimulants are not appropriate
Alternative Treatments
If stimulants are not appropriate or effective, alternatives include: 1
- Non-stimulant medications: Atomoxetine, guanfacine, clonidine (though less effective than stimulants) 1
- Psychosocial interventions: Cognitive-behavioral therapy, skills training, parent/family education 1
- Combination approaches: Non-stimulant medication plus therapy 1, 5
Acknowledgment and Consent
I acknowledge that:
- I have read and understood this informed consent document
- My provider has explained the risks, benefits, and alternatives to stimulant treatment
- I have had the opportunity to ask questions and receive answers
- I understand the high potential for abuse and addiction with these medications
- I understand the cardiovascular and psychiatric risks
- I agree to follow all monitoring requirements and safety precautions
- I understand that my prescription may be discontinued if I misuse the medication or fail to comply with monitoring
- I consent to treatment with stimulant medication for ADHD
Patient Signature: _________________________ Date: _________
Provider Signature: _________________________ Date: _________
Witness Signature (if applicable): _________________________ Date: _________