Athletics - UNLV
UNLV Sports Medicine


BANNED STIMULANT MEDICATION REPORTING GUIDELINES FOR ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD) TREATMENT. 2/11/09

Effective August 2009 there will be a stricter application of the NCAA Medical Exception policy and specifically for the use of banned stimulant medications to treat Attention Deficit Hyperactivity Disorder (ADHD). This stricter application will provide more complete information to the medical panel of the Committee on Competitive Safeguards and Medical Aspects of Sports (CSMAS), which reviews requests for a medical exception to a positive drug test for these stimulant medications. This information is necessary to appropriately apply the exceptions policy, so that student-athletes are adequately monitored while using a stimulant medication that can negatively impact health and safety, and so that stimulants are not being used strictly for athletic performance enhancement. Any student-athlete who tests positive from the effective date will need to comply with this stricter application, even if that student-athlete had received an exception for the use of stimulant medication prior to August 2009.

This stricter application will require documentation that demonstrates the student-athlete has undergone a clinical assessment to diagnose ADHD, is being monitored routinely for use of the stimulant medication, and has a current prescription on file, in order to be approved for a medical exception to the banned drug policy. This documentation should be kept on file at the institution and produced in the event the student-athlete tests positive for the banned mediation. All HIPAA requirements should be met for the transmission for this medical information.

CSMAS has reviewed and approved a guideline to assist the membership to meet the requirements of this stricter application of the NCAA Medical Exception Policy. The guideline, with sample physician reporting letters that define what documents the prescribing physician should submit to the institution, is now posted at www.ncaa.org/health-safety.

The NCAA bans classes of drugs because they can harm student-athletes and can create an unfair advantage in competition. Some legitimate medications contain NCAA banned substances, and student-athletes may need to use these medicines to support their academics and their general health. The following guidelines will help institutions ensure adequate medical records are on file for student-athletes diagnosed with ADHD in order to request an exception in the event a student-athlete tests positive during NCAA Drug Testing.

  1. General considerations. Student-athletes diagnosed with ADHD in childhood should provide records of the ADHD assessment and history of treatment. Student-athletes treated since childhood with ADHD stimulant mediation but who do not have records of childhood ADHD assessment, or who are initiating treatment as an adult, must undergo a comprehensive evaluation to establish a diagnosis of ADHD. There are currently no formal guidelines or standards of care for the evaluation and management of adult ADHD. The diagnosis is based on a clinical evaluation. ADHD is a neurobiological disorder that should be assessed by an experienced clinician and managed by a physician to improve the functioning and quality of life of an individual.
    1. Student-athletes should have access to a comprehensive continuum of care including educational, behavioral, psychosocial and pharmacological services provided by licensed practitioners who have experience in the diagnosis and management of ADHD. Student-athletes treated with ADHD stimulant medication should receive, at a minimum, annual clinical evaluations.
    2. Mental health professionals who evaluate and prescribe medical therapy for student-athletes with ADHD should have appropriate training and experience in the diagnosis and management of ADHD and should have access to consultation and referral resources, such as appropriate medical specialists.
    3. Primary care professionals providing mental health services (specifically the prescribing of stimulants) for student-athletes with ADHD should have experience in the diagnosis and management of ADHD and should have access to consultation and referral resources (e.g., qualified mental health professionals as well as other appropriate medical specialists).
  2. Recommended ways to facilitate academic, athletics, occupational and psychosocial success in the college athlete with adult ADHD taking prescribed stimulants include:
    1. Access to practitioners experienced in the diagnosis and management of adult ADHD.
    2. A timely, comprehensive clinical evaluation and appropriate diagnosis using current medical standards.
    3. Access to disability services.
    4. Appropriate medical reporting to athletics departments/sports medicine staff.
    5. Regular mental health/general medical follow-up.
    6. Student-Athlete Document Responsibility. The student-athlete's documentation from the prescribing physician to the athletics departments/sports medicine staff should contain a minimum of the following information to help ensure that ADHD has been diagnosed and is being managed appropriately (see Attachment for physician letter criteria):
    7. Description of the evaluation process which identifies the assessment tools and procedures.
    8. Statement of the Diagnosis, including when it was confirmed.
    9. History of ADHD treatment (previous/ongoing).
    10. Statement that a non-banned ADHD alternative has been considered if a stimulant is currently prescribed.
    11. Statement regarding follow-up and monitoring visits.
  3. Institutional Document Responsibility. The institution should note ADHD treatment in the student-athlete's medical record on file in the athletics department. In order to request a medical exception for ADHD stimulant medication use, it is important for the institution to have on file documentation that an evaluation has been conducted, the student-athlete is undergoing medical care for the condition, and the student-athlete is being treated appropriately. The institution should keep the following on confidential file:
    1. Record of the student-athlete's evaluation.
    2. Statement of the Diagnosis, including when it was confirmed.
    3. History of ADHD treatment (previous/ongoing).
    4. Copy of the most recent prescription (as documented by the prescribing physician).
  4. Requesting an NCAA Medical Exception:
    1. The student-athlete should report the banned medication to the institution upon matriculation or when treatment commences in order for the student-athlete to be eligible for a medical exception in the event of a positive drug test.
    2. A student-athlete's medical records or physician's letter should not be sent to the NCAA, unless requested by the NCAA.
    3. The use of the prescribed stimulant medication does not need to be reported at the time of NCAA drug testing.
    4. Documentation should be submitted by the institution in the event a student-athlete tests positive for the banned stimulant.

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

Criteria for letter from prescribing Physician to provide documentation to the Athletics Department/Sports Medicine staff regarding assessment of student-athletes taking prescribed stimulants for Attention Deficit Hyperactivity Disorder (ADHD), in support of an NCAA Medical Exception request for the use of a banned substance.

The following must be included in supporting documentation:
  • Student-athlete name.
  • Student-athlete date of birth.
  • Date of clinical evaluation.
  • Clinical evaluation components including:
    • Summary of comprehensive clinical evaluation (referencing DSM-IV criteria) - attach supporting documentation.
    • ADHD Rating Scales(s) (e.g., Connors, ASRS, CAARS) scores and report summary - attach supporting documentation.
    • Blood pressure and pulse readings and comments.
    • Note that alternative non-banned medications have been considered, and comments.
    • Diagnosis.
    • Medication(s) and dosage.
    • Follow-up orders.
Additional ADHD evaluations components if available:
  • Report ADHD symptoms by other significant individual(s).
  • Psychological testing results.
  • Physical exam date and results.
  • Laboratory/testing results.
  • Summary of previous ADHD diagnosis.
  • Other comments.
Documentation from prescribing physician must also include the following:
  • Physician name (Printed)
  • Office address and contact information.
  • Specialty.
  • Physician signature and date.
DISCLAIMER: The National Collegiate Athletic Association shall not be liable or responsible, in any way, for any diagnosis or other evaluation made, or exam performed, in connection herewith, or for any subsequent action taken, in whole or in part, in reliance upon the accuracy or veracity of the information provided hereunder.
 
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