Mental Tele-health Startup Facing Investigation for a Potential Violation of the Controlled Substances Act

The pandemic has had a substantial effect on people’s mental health. Different surveys report more than a quarter of the US population has shown anxiety or depression symptoms after the pandemic kicked in, and more than 10% of those surveyed had seriously considered suicide.^[1] 

Another consequence of the pandemic was the expansion of tele-health. Considering the substantial decline in people’s mental health, it did not take too long to see the emergence of companies specializing in mental tele-health. And while these companies may bring considerable benefits to society, their business model also entails considerable risks, such as the improper prescription of controlled substances.

A typical Silicon Valley strategy is being followed by digital health businesses that provide diagnostics and drugs for ADHD online: They’re utilizing software and the internet to reduce the friction that comes with a high-demand service. Cerebral and Done Health are two of the most notable new suppliers of these services for ADHD sufferers, with tens of thousands of patients treated online and well-known backers from venture capital and sports.

Last week, Federal prosecutors subpoenaed Cerebral Inc. as part of an investigation into suspected violations of the Controlled Substances Act. Cerebral Medical Group, the company it uses to contract with physicians and offer healthcare services, was served with the subpoena. The company stated that it wants to comply with the investigation and stressed that no regulatory or law-enforcement authority has accused it of violating any law.

Only a few months ago, some Cerebral nurse practitioners told the Wall Street Journal that they felt pressured by the company to prescribe stimulants, and that the company’s 30-minute patient evaluations weren’t long enough to accurately diagnose ADHD. The company claimed at the time that it did not force therapists to prescribe stimulants and that it was offering an important service in the United States, where demand for mental-health care significantly outnumbered supply.

According to the Wall Street Journal, several pharmacists have banned or delayed some prescriptions from Cerebral prescribers due to worries that the firm was writing too many stimulant prescriptions. Truepill Inc., Cerebral’s preferred pharmacy partner, has stopped filling all stimulant prescriptions. Prescription delays, according to Cerebral, were caused by a misunderstanding of telehealth policies.

A complaint was also filed by a former Cerebral executive, saying that the firm prioritized expansion over patient safety. The firm has stated that the lawsuit’s allegations are untrue and that it will vigorously defend itself. Its officials informed its clinicians that the firm would stop prescribing controlled medicines to treat ADHD in new patients, including Adderall and other stimulants. According to the Wall Street Journal, Cerebral’s chief medical officer wrote to clinicians saying the business would continue to prescribe controlled medicines for other mental-health issues and continue to treat existing ADHD patients with stimulants.

Mental health should be a priority for policymakers. Startups that help expand the supply of mental health are valuable and socially desirable. Yet the improper prescription of stimulants can have serious negative consequences on people’s health.

^[1]See, for instance, CDC, Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020. Available at: https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm