ADHD Drugs Are Convenient to Get Online. Maybe Too Convenient


From Bloomberg Businessweek: “[Nurse practitioner Angela Rasheed] joined [fast-growing telehealth service] Cerebral, Inc. . . . hoping to help address America’s mental health crisis at a company that promised the masses expanded access to care. She found something else, she says: a growth-obsessed startup targeting patients with social media ads and pressuring providers to dispense drugs after too-brief virtual sessions. In time, she says, she was seeing 30 patients a day . . . twice the typical caseload, according to the American Association of Nurse Practitioners.

. . . Hundreds of thousands of people with mental health issues have found solace in a new breed of telehealth companies that don’t just offer talk therapy but also prescribe medications after a brief online appointment. And not just antidepressants. Federal rules that had required in-person examinations before the prescription of addictive drugs—including amphetamines such as Adderall and benzodiazepines like Xanax and Klonopin—were relaxed in response to [COVID-19].

No company in this business has grown faster or bigger than Cerebral, which operates in all 50 states and in two years has registered more than 200,000 patients. In interview after interview, Chief Executive Officer Kyle Robertson has touted a commitment to ‘increasing access to high-quality mental health care.’ But 27 former executives, managers, nurses, and other staff say Cerebral is failing on the ‘high-quality’ part of the goal. In its hunt for explosive growth, they say, it has made appointments too short, set follow-up sessions too infrequently, advertised too aggressively, pushed prescriptions too hard, and paid front-line staff too little. In some ways the company, based in San Francisco and funded by venture capital, follows the classic Silicon Valley playbook: identify opportunities among changing rules, move fast, drive employees hard. In psychiatric telehealth, the stakes are heightened by the prospect of patients in crisis and the risks of addictive drugs.

. . . Demand for ADHD drugs is booming in the U.S. In the second quarter of 2021, amphetamine sales jumped more than they had in almost a decade. In addition to people ‘with clinical ADHD,’ bleary-eyed students and overworked middle-aged professionals have turned to Adderall and similar drugs as a salve. Colleges say abuse of the drug is rampant on campus, where students use it to power through both studying and partying.

. . . Seven former nurses for the company say they worried that Cerebral wasn’t merely meeting a demand but was also, by making access so easy, effectively creating it; they described a fear that they were fueling a new addiction crisis.

. . . In meetings with managers, Chief Medical Officer David Mou has said 95% of people who see a Cerebral nurse should get a prescription, according to two people familiar with his remarks. He was equally emphatic, according to the former employees, that the rate cannot be 100%—saying the company would be a ‘pill mill’ at that rate . . . Cerebral said, through a letter from its lawyer, that it does not set any prescription target for its clinicians.

. . . Getting patients to come to Cerebral is as easy as posting on social media. The company markets on Instagram and TikTok, often with variations on the message, ‘Have you ever thought you might have ADHD?’ Some ads suggest that symptoms as common as difficulty with multitasking, focusing, and stress, as well as poor planning, procrastination, and disorganization can all be symptoms of ADHD . . . In another ad, a woman shakes her leg; restless leg syndrome can be a symptom of ADHD. In a third, a woman is asked: ‘Yo, bro, who got you smiling like that?’ She then begins dancing with a box of prescription pills.

. . . Disconcerted staff can be found at every level of Cerebral’s organization . . . Carlen Zhu joined the company as a coordinator in August, just as Cerebral was retiring the Eileen Davis alter ego. ‘It is pretty bizarre to make people believe they’re talking to someone they’re not talking to, and it was strange to introduce myself to clients acting like I was “taking over” from Eileen when she wasn’t a real person,’ Zhu says. She had a roster of about 1,000 patients and was so overwhelmed on her first day that she cried. On an average day, she estimates, she fielded about 100 inbound messages; in a typical week she heard from at least a few people in crisis.

. . . As a recruiter of prescribers for Cerebral, Stephanie Leonard saw how nurses struggled under the company’s model and, as a member of its headquarters staff, worked closely with Robertson. ‘The company would be much better off outside of his hands,’ says Leonard, who left in June. ‘He just wants to make money. That’s his end goal. Whenever he talks about “providing quality mental health care,” his eyes are dead. He does not care.'”

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