The Online Mental Health Company Surged To A $48 Billion Valuation After It Started Dispensing Adhd Medication But Staffers Grew Concerned That It Was Pushing The Drugs Too Aggressively
Online mental-health startup Cerebral Inc. was just getting off the ground in early 2020 when it detected a potential problem in its business model.
The company was focused on treating people experiencing depression and anxiety, charging a monthly fee to see a nurse practitioner online for prescription antidepressants. But patients tended to cancel their subscriptions after only a few months, making it more difficult for the company to recoup advertising and other costs, according to documents reviewed by The Wall Street Journal and people familiar with the matter.
Hope came from the federal government, which was concerned that people wouldnt be able to see their physicians during Covid-19 lockdowns. It had just granted online providers the ability to prescribe so-called schedule 2 controlled substances, drugs such as OxyContin and Vicodin, which are often abused and would normally require an in-person doctor visit.
Cerebral saw an opportunity in one such drug, Adderall, a powerful stimulant used to treat attention-deficit hyperactivity disorder, or ADHD. In a February 2021 presentation to attract new investors, Cerebral said a pilot project showed that it was half as costly to advertise for ADHD patients than for those with depression and anxiety because each ad dollar yielded more customers. Treating ADHD could expand its market by 30%, the presentation suggested.
Study: Adhd Drugs Don’t Lead To Better Grades
Many parents and kids dealing with symptoms of ADHD believe that drugs like Ritalin and Adderall lead to better grades in school. However, a recent study that examined the grades and school performances of nearly 4000 kids with ADHD in Quebec over an 11 year period found no significant benefit in school performance for kids who took ADHD drugs compared to those who didn’t. An article from The Wall Street Journal shared the following:
“A June study looked at medication usage and educational outcomes of nearly 4,000 students in Quebec over an average of 11 years and found that boys who took ADHD drugs actually performed worse in school than those with a similar number of symptoms who didn’t. Girls taking the medicine reported more emotional problems, according to a working paper published on the website of the National Bureau of Economic Research, a nonprofit economics research firm.
‘The possibility that won’t help them needs to be acknowledged and needs to be closely monitored,’ says economics professor Janet Currie, an author on the paper and director of the Center for Health & Wellbeing, a health policy institute at Princeton University. Kids may not get the right dose to see sustained benefits, or they may stop taking the medication because side effects or other drawbacks outweigh the benefits, she says.”
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Walmart Cvs And Others Blocking Adhd Drug Prescriptions From Online Startups
Pharmacies across the country are blocking or delaying prescriptions from clinicians working for telehealth startups to treat ADHD, The Wall Street Journal reported April 27.
Pharmacies across the country have expressed concerns that these startups’ clinicians are writing too many prescriptions for Adderall and other stimulants, which are highly addictive.
In May, former Cerebral employees toldBloomberg the company could be fueling a new addiction crisis because providers are pressured to prescribe medications after short video visits.
Walmart told The Wall Street Journal it has blocked some Done Healths clinicians so its pharmacists cannot fill their prescriptions. Individual locations of CVS and Walgreens, as well as some grocery store chains’ pharmacies, have done the same. CVS has interviewed at least two Done Health clinicians over prescription concerns, according to the report.
“There have been incidents where prescriptions have been temporarily delayed by pharmacies due to confusion around today’s telehealth policies,” Cerebral told The Wall Street Journal. “This is an industrywide issue that weve seen and experienced with pharmacies across the country.” Done Health declined to provide comments to The Wall Street Journal.
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Goal Is To Prevent A Backlash Against Stimulant Medications: We Dont Want A Repeat Of What Happened With Opioids
A group of specialists in attention-deficit hyperactivity disorder plan to create the first U.S. guidelines for diagnosing and treating the condition in adults, partly due to the proliferation of telehealth companies that they worry
Led by the American Professional Society of ADHD and Related Disorders, the effort is motivated in part by growing demand for ADHD treatment and medication, particularly during the pandemic when more mental-health care has been taking place online, members say.
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Digital Companies Such As Cerebral And Done Seized On Looser Pandemic Rules For Prescribing Adhd Drugs Like Adderall Some Workers Said They Felt Pressure To Provide The Medications
Cris Wibby joined online mental-health company Cerebral Inc. as a nurse practitioner last spring, looking for the flexibility to work from home while helping new patients.
She began treating adults with attention deficit hyperactivity disorder and offering prescriptions for powerful stimulants such as Adderall. She could do so because the federal government relaxed a rule requiring an in-person visit before such substances can be provided, and nurse practitioners are allowed to prescribe controlled substances in many states. Ms. Wibby said patients clamored for the medication, and she said she sometimes struggled to diagnose ADHD during 30-minute video calls that she said sometimes felt could be too brief.
All day every day, people were demanding Adderall, she said, adding that you cant diagnose people in a half hour. Cerebral said it encourages proper treatment and its clinicians arent required to reach a diagnosis in a half hour. We simply want to make the right diagnosis and develop the right treatment plan for the safety and quality of care for each patient, it said.
All day, every day people were demanding Adderall, said Cris Wibby, a nurse practitioner who treated ADHD patients and left Cerebral in January.
Cerebral said its clinicians can schedule an unlimited number of appointments. Done said systems and software help complete its initial consultations within 30 minutes.
30 minutes
Lets get em in
The clinical quality team
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Stimulant Medications For Adhd
Stimulants are the most common type of medication prescribed for attention deficit disorder. They have the longest track record for treating ADHD and the most research to back up their effectiveness. The stimulant class of medication includes widely used drugs such as Ritalin, Adderall, Focalin, and Dexedrine.
Stimulants are believed to work by increasing dopamine levels in the brain. Dopamine is a neurotransmitter associated with motivation, pleasure, attention, and movement. For many people with ADHD, stimulant medications boost concentration and focus while reducing hyperactive and impulsive behaviors.
An Explosion In Demand
ADHD is a neurodevelopmental condition marked by inattentiveness, impulsivity and/or hyperactivity that is severe enough to interfere with school, work and other aspects of life. The Centers for Disease Control and Prevention estimates, based on data from 2016 to 2019, that approximately 10% of children are diagnosed with it, with boys more likely to receive a diagnosis.
Adderall and other stimulant drugs are a common and effective way of managing ADHD symptoms.
However, Adderall has the potential to be abused if taken improperly or without a prescription. Telehealth startups such as Cerebral and Done Health, which gained footing during the pandemic and prescribe stimulants, raised questions among pharmacies about whether Adderall was being overprescribed. Former and current employees of those companies told The Wall Street Journal that they felt pressured to prescribe medication without adequate time to make a diagnosis.
In May, Walmart and CVS announced they would stop filling prescriptions for controlled substances from those telehealth firms.
Demand for Adderall is higher than ever: Prescriptions dispensed in the U.S. spiked to 41.4 million last year, up 10.4% from 2020, according to IQVIA, an analytics provider for the life sciences industry.
But that doesnt mean that all ADHD diagnoses made during the pandemic were illegitimate, said Dr. David W. Goodman, an assistant professor of psychiatry and behavioral sciences at Johns Hopkins School of Medicine.
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Adderall Shortages Impacting Adhd Patients
Widespread shortages of Adderall and other versions of the drug used for treating attention-deficit hyperactivity disorder are deepening in the U.S., causing desperation in patients who rely on the medication to focus.
The largest Adderall manufacturer in the U.S., Teva Pharmaceuticals Industries Ltd., said last month that a labor shortage from earlier in the year disrupted production, The Wall Street Journal reported.
A Teva spokesperson said at the time that the company expects shortages at the retail level to be resolved in coming weeks, but pharmacies are now reporting shortages of the ADHD treatment from an array of other drugmakers.
The American Society of Health-System Pharmacists reported shortages of several versions of the amphetamine from numerous manufacturers this week, as reports sprout up nationwide of the impact that low supplies are having on patients who are unable to fill their prescriptions.
“It frightens people,” Dr. Robert Shulman, a psychiatrist at Rush University Medical Center, told FOX 32 in Chicago. “It frightens parents who have kids who are starting school right now. It frightens adults who are reliant on the medicine to get them through the work day. Patients can’t get their medicines, and we get a lot of phone calls, so it’s a lot of extra work, and the patients have to call around to pharmacies to look and see where there is a supply.”
Psychiatrists And Even Internists Are Often Far Too Eager To Prescribe Pills
Listen to article
Youve probably heard that anxiety and depression are brain disorders that must be treated with psychotropic medication. Thats closer to a pharmacological marketing slogan than settled science. These conditions, along with ADHD and addiction, result from trauma, loss, psychosocial stressors and failed relationships. Even when there is a genetic proclivity to severe mental illness, such as bipolar disorder and schizophrenia, the environment plays a central part in triggering the disease.
Roland Kuhn, the Swiss psychiatrist who discovered one of the first antidepressants, imipramine, in 1956, later warned that many doctors would be incapable of using antidepressants properly because they largely or entirely neglect the patients own experiences. He was right. As a psychoanalyst, I often see patients who come to me after medication prescribed by psychiatristsand even internists, who have no specialization in psychotropic drugshas failed.
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One Telehealth Company Has Now Decided To Stop Prescribing Adderall
On May 4, Cerebral confirmed that it would soon be pulling the plug on Adderall prescriptions. According to an announcement from the company, Cerebral will no longer allow its clinicians to prescribe controlled substances such as Adderall and Ritalin as an ADHD treatment for new patients, starting May 9. Existing patients “will continue receiving their clinically appropriate, prescribed medications,” however. This decision came after Truepill, Cerebral’s preferred online pharmacy, said it would also be temporarily halting prescriptions for Adderall and other controlled substances used to treat ADHD, The Wall Street Journal reported.ae0fcc31ae342fd3a1346ebb1f342fcb
“It is regrettable that a helpful class of medication that is considered a first-line treatment option has become so stigmatized,” David Mou, MD, the chief medical officer and president at Cerebral, said in a statement. “We hope this will change as a population of people with clinical needs are no longer able to access care with us.”
Questions To Ask Yourself Before Putting Your Kid On Adhd Medication
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- The Collapse of Parenting
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American kids are now much more likely to be diagnosed and treated for ADHD than kids in any other country. For example, a teenager in the United States is now nearly 14 times more likely to be on medication for ADHD than a teenager in the United Kingdom. In my book The Collapse of Parenting, I explore some of the reasons why. One is that in the U.S., medication has become the first resort for almost any child who is struggling in school. Outside of North America, medication is usually a last resort. Thats especially of concern because of research showing that these medications for ADHD may affect the developing brain in significant ways.
Here are some questions to ask yourself before your start filling prescriptions for your child:
Am I comfortable with the risks of giving my kid ADHD medication? The most serious potential risk is damage to the nucleus accumbens, the motivational center of the brain. In my own practice, I have seen many children and teensmostly boyswho took these medications for a number of years, and who seemed to lose their motivation and drive as a consequence.
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Adhd Medication Alone Is Not Enough
Treatment for attention deficit disorder isnt just about seeing doctors or taking medication. There are many ways to help yourself or your child tackle the challenges of ADHD and lead a calmer, more productive life. With the right tips and tools, you can manage many of the symptoms of your ADHD on your own. Even if you choose to take medication, healthy lifestyle habits and other self-help strategies may enable you to take a lower dose.
Exercise regularly. Exercising is one of the most effective ways to reduce the symptoms of ADHD. Physical activity boosts the brains dopamine, norepinephrine, and serotonin levelsall of which affect focus and attention. Try walking, skateboarding, hiking, dancing or playing a favorite sport. Encourage your child to put down the video games and play outside.
Eat a healthy diet. While diet doesnt cause ADHD, it does have an effect on mood, energy levels, and symptoms. Set regular snack and meal times. Add more omega-3 fatty acids to your diet and make sure youre getting enough zinc, iron, and magnesium.
Get plenty of sleep.Regular quality sleep can lead to vast improvement in the symptoms of ADHD. Simple changes to daytime habits go a long way toward resting well at night. Have a set bedtime and stick to it. Avoid caffeine later in the day.
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Why An Online Telehealth Startup Is Limiting Adderall
The digital startup Cerebral began prescribing ADHD drugs like Adderall over the internet, after federal rules loosened. But recently, there have been concerns from inside and outside the company that Cerebral was not careful enough. Now the company has stopped prescribing Adderall to new patients. WSJ’s Rolfe Winkler reports.
Further Reading:
–Cerebral Receives Subpoena From Federal Prosecutors
Full Transcript
This transcript was prepared by a transcription service. This version may not be in its final form and may be updated.
Kate Linebaugh: All around social media, you may have noticed a lot of content that’s trying to sell you mental health services.
Speaker 2: I want to remind you how important it is to get the high quality mental health care that you deserve.
Speaker 3: If you’re a student, sometimes ADHD looks like not completing your assignments.
Speaker 4: Can I tell you about how many times I’ve been bullied because of my neuro-divergent tendencies?
Speaker 5: I know life hasn’t been easy lately, but know that you are not alone, no matter how lonely it feels. Know that you are deserving of health.
Kate Linebaugh: These videos are from a company called Cerebral. It’s a telehealth startup that focuses on mental health. And one key to its success …
Rolfe Winkler: And their goal was well, you know what? We can do more than therapy, online telehealth right now is a lot of therapy, is psychiatrists seeing people. We want to try to prescribe medication.
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Telehealth Medicine Has Become More Popular Over The Last Few Years
Telehealth services have been around for years, but they became increasingly important to people during the COVID pandemic. A 2021 analysis from McKinsey & Company reported that the use of telehealth had grown more than 38 times higher than it was before 2020. One of the fastest growing areas of this healthcare rise has been online mental health services. Cerebral, an online mental health company, has provided care to more than 200,000 patients since Jan. 2020, according to Fierce Healthcare.
“You can do psychotherapy and mental health care very well if you have a good quality audio-visual connection” Paul Desan, MD, director of the Psychiatric Consultation Service at Yale New Haven Hospital, explained to Yale Medicine. “It’s much easier for people to schedule a visit and they don’t have to drive there and then wait to be seen. I don’t think the mental health system will ever go back to all in-person sessions as long at the insurers keep paying for it.”
Are Adhd Medications Overprescribed
In recent years, the number of children in the U.S. being treated with prescription medication for attention deficit hyperactivity disorder has grown dramatically.
Journal Report
That trend has led to concern among some doctors, parents and child advocates that many children are taking ADHD medication unnecessarily.
These critics suggest that in many cases ADHD is a mistaken diagnosis for children who are simply immature or undisciplined. And even when the diagnosis is correct, they say, many children who are taking medication for ADHD could do as well or better with alternative treatments, including dietary and behavioral therapies, that have fewer side effects.
Others say the critics greatly exaggerate the number of incorrect diagnoses. Heightened awareness of the disorder has fueled the rapid growth of ADHD cases, they say, not a failure to recognize simpler developmental or parental influences on behavior.
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ADHD medications, these proponents say, are safe and more effective than any alternatives.
Sanford Newmark, head of the pediatric integrative neurodevelopmental program at the University of California, San Francisco, makes the case that ADHD drugs are overprescribed. Harold S. Koplewicz, president of the Child Mind Institute in New York, argues that the notions of overdiagnosis and overuse of ADHD drugs aren’t based in fact.
Yes: We Diagnose Too Fast
SANFORD NEWMARK: ‘There are no rigorous studies that prove ADHD medications work over the long term.’
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