May 5, 2022 - Health

The trouble with telehealth prescriptions

Illustration: Brendan Lynch/Axios

Mental telehealth startups such as Cerebral and Done Health are coming under increased scrutiny for the way they prescribe drugs with a high potential for abuse like Adderall.

Driving the news: Cerebral announced quality and safety changes on Wednesday, telling clinicians it will stop prescribing Adderall and other controlled substances to treat attention deficit hyperactivity disorder for new patients.

  • The decision came after Cerebral's preferred pharmacy, Truepill, said it would halt prescriptions for Adderall and other controlled substances.
  • Large pharmacies like CVS and Walmart blocked or delayed prescriptions from Cerebral over concerns that they were writing "too many prescriptions for Adderall and other stimulants" to new patients, per the Wall Street Journal.

The big picture: Relaxed telehealth rules during the pandemic fueled a telehealth boom — including in behavioral health — and have been widely lauded for improving access to care during a crisis.

  • But the Drug Enforcement Agency's pandemic-era waiver of the Ryan Haight Act, which blocked companies from prescribing controlled substances online, raised the specter of companies becoming "Adderall mills," sources recently told Axios' Erin Brodwin.

In other words: "We want to avoid an opioid crisis part two," University of Michigan clinical assistant professor Erik Gordon told STAT News about the industry moves.

What to watch: The DEA rules are expected to last only until the end of the public health emergency which is currently set to expire July 15.

  • The DEA is developing a special registration process to allow telehealth prescribing of controlled substances.
  • The American Psychiatric Association and the American Telemedicine Association are among 70 organizations — including Cerebral — pushing to permanently remove the prior in-person requirement and restrictions on the location of the patient being treated.
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