Their excuse is that they aren’t “overruling the doctor”, they just aren’t going to pay for it. Never mind that in the US it’s functionally the same thing.
They will just say “you do what you think is best for the patient doc. We just disagree and aren’t going to cover it.” It forces doctors, hospitals, rehabs, and nursing homes into situations where they either have to provide care for free, or not at all. I’ll never understand how we allowed things to get this bad.
I live this every day. I’ve had a United Medical Director tell me that being able to feed yourself was “not an essential skill” worthy of rehab because it could be performed by staff or a family member.
This man tried to tell me that my patient in their late 60s was unworthy of a rehab stint for strengthening their upper arms to be able to feed themselves because someone else could do it for them for the rest of their lives.
Stay the hell away from Medicare Advantage plans. No matter what they promise, it’s irrelevant because they won’t actually provide it when the time comes.
tl;dr They probably aren’t discriminating against you because of autism, you may have accidentally made your situation worse, but you can fix it by being proactive
So I’m saying this to help you. You just sent the largest red flag imaginable to every provider in that practice to not prescribe you controlled substances.
Immediately bailing and demanding a new provider when asked to submit to a urine drug screen screams “I’m going to fail that test.” It doesn’t matter what the truth is, or what your intentions were - that is the message you just sent.
I say all of this as a physician who has been practicing for the better part of a decade. They are more than likely NOT persecuting you for having an autism spectrum disorder.
Vyvanse is a Schedule 2 drug, with the same restrictions as Dilaudid, Oxycodone, and Fentanyl. You admitted to using a federally illegal substance at a federally funded institution, while asking for a highly controlled substance and then bailed the instant they mentioned getting drug tested. That sends a massively negative message that I guarantee other providers in that practice will be aware of.
Some other information you should know is that while there may not be legal requirements for testing, there may be practice level requirements that the psychiatrist has no control over (and every other provider at that VA will be bound to as well). For example, my old practice expressly prohibited provision of medical marijuana prescriptions until the patient had been with the practice for 90 days, had at least two visits, and had a urine drug screening. I could do precisely zero to change that, and this was in a state where medical marijuana was legal.
Lastly, patients lie. All. The. Time. I’ve had patients lie straight to my face about things I literally caught them doing on camera (in an inpatient setting). Patients with substance use disorder can lie and manipulate and fabricate ridiculous things in the all consuming pursuit of feeding their disease. They will say whatever they need to, to get what they want. I don’t hold it against them, because it is the disease doing it, not them.
Still, if I had a dollar for every patient that claimed they only used weed, but later admitted to using fentanyl every day, I wouldn’t need to work as a physician.
Your best bet is to reach back out to the psychiatrist to ask if you can stay with her, and agree to the drug test. This is the fastest, simplest, and quickest way to get the medication you need.
If you truly feel like your trust with this provider is fractured and you absolutely cannot work with her further, then you need to be very proactive and upfront with the next provider as to why you asked to switch, and be enthusiastic about submitting to a drug test if they want one.
At the end of the day, as frustrating as it is, whether you think Vyvanse being a Schedule 2 drug is right or wrong, it’s irrelevant. You just performed the equivalent of walking into a brand new doctor’s office, asking for a prescription for Dilaudid, and then becoming irate when they ask for a drug test.
The psychiatrist may be making assumptions about you, may be demonstrating biases, or may be profiling you - I wasn’t there, so I don’t know. However, if it went down pretty much how you described, then it’s likely you misconstrued what was being asked of you, and are likely unnecessarily making your situation more challenging. Healthcare can be incredibly frustrating to navigate, and the VA doubly so. I’ve worked in the VA system, and I know first hand how these types of situations can be handled on the back end. I don’t want you mislabeled as a “drug seeker” or “doctor shopper” based on a misunderstanding.
Best of luck, and I hope you get the care you require with a provider you trust and respect.