Confirming proper use of medication: more than one way.

Dr Philip G. Winkelaar raises the issue of drug diversion by the father of a child being prescribed methylphenidate. He correctly advises that assessment of the child’s condition is one method of confirming proper use of the medication. A more reliable method would be to randomly test the child’s urine, with parental consent, for the presence of methylphenidate. Absence of the drug in the child’s urine sample would confirm that the child was not taking it and would strongly suggest improper use. Parental refusal to consent to random urine testing might constitute a reason to discontinue prescribing methylphenidate. Finally, a written agreement or drug contract made with the parents before initiation of methylphenidate could have established random urine testing as a condition of treatment. —Philip B. Berger, MD, FCFP Toronto, Ont by e-mail