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The Drug Enforcement Administration (DEA) has expressed concern that ‘aggressive marketing practices’ by telehealth companies may be contributing to excessive prescriptions for medications used to treat attention deficit hyperactivity disorder (ADHD), according to a letter from the agency. 

While the letter does not mention specific companies, it is believed to refer to telehealth companies such as Cerebral Inc. and Done Global Inc., whose prescribing practices have reportedly been under investigation by the DEA after blitzing social media with online adverts on platforms including Instagram and Facebook. 

This decision follows an increase in Adderall prescriptions of 10.4% in 2021 and 10.9% through October 2022, after a roughly 5% annual increase in the three years prior, according to data from research firm IQVIA. 

Adderall and the amphetamines used to make it are classified as Schedule II controlled substances by the DEA due to their high potential for abuse, along with opioids such as OxyContin and fentanyl. 

Above, the total number of Adderall pills, branded and generic, dispensed last year at US pharmacies. Teva sold the most Adderall in the US in 2021

Adderall prescriptions rose more than 10% in 2021 and through October 2022, after a roughly 5% annual increase in the previous three years 

The DEA is legally required to set production quotas each year for ingredients in Schedule II drugs. 

In December, the DEA announced that it would not permit any increase in the production of pharmaceutical ingredients used to make Adderall and other stimulants for ADHD treatment in 2023. 

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The letter, which was sent to drug manufacturers over the summer but has not previously been reported, was reviewed by The Wall Street Journal. 

The federal government will regulate the production of the ingredients needed to create the ADHD-drug due to the potential for abuse.

The DEA’s decision to limit production, coupled with a rise in prescriptions since the start of the COVID-19 pandemic, has reportedly contributed to a shortage of Adderall, as noted by the U.S. Food and Drug Administration in October. 

Telehealth company Done has run advertisements featuring images of pills and promising quick ADHD diagnoses

Adderall prescriptions have steadily increased over the last 12 years. The figures include prescriptions for both Adderall, brand and generic, in the U.S.

Cerebral and Done have both stated they do not pressure clinicians and provide essential services but the DEA is currently investigating the prescribing practices of the companies. Pictured, a snapshot from a Cerebral video ad that ran in 2021 on Facebook

41 million prescriptions for Adderall were filled last year 

A spokesperson for Teva, the largest maker of Adderall stated: ‘Teva is committed to patients who need access to the products their healthcare providers prescribe while also fully committed to carefully monitoring products controlled by the DEA.’

The letter from the DEA explained how it was looking at manufacturers’ production quota requests due to the ‘the sheer volume of ADHD medications on the market coupled with aggressive marketing practices and non-registrant marketing companies driving quota requests.’

‘DEA must ensure that any quota granted for the manufacturing of controlled substances used to treat ADHD is driven by a legitimate need and not improperly driven purely by profit motive, pressure from marketing firms, or a desire to obtain more market share—all factors that led to an oversupply of opioids during the prescription opioid crisis,’ stated the letter, signed by Kristi O’Malley, an assistant administrator in the DEA’s Diversion Control Division. 

In December, the DEA announced that it would maintain the same production quota for ingredients used in the manufacture of Adderall and other attention deficit hyperactivity disorder (ADHD) drugs in 2023 as it did in 2022. 

According to The Journal, telehealth companies Cerebral and Done have run advertisements featuring images of pills and promising quick ADHD diagnoses.

Some clinicians at these companies have claimed to feel pressured to prescribe stimulants, and internal presentations at Cerebral have reportedly highlighted the higher profitability of clients prescribed stimulants. 

Prescriptions for Adderall surged during the COVID-19 pandemic. In February 2020, just before the virus erupted across America, the drug made up 1.1% of drugs. By September 2022, the figure had more than doubled to 2.31% of all scripts written

Both Cerebral and Done have stated that they do not pressure clinicians and provide essential services but the DEA is currently investigating the prescribing practices of these companies. 

Cerebral has claimed that it has not been accused of violating any laws and is fully cooperating with the investigation, while Done has stated that it is committed to providing high-quality psychiatric care while following all relevant laws and regulations.

The DEA has also announced that it is considering revoking the ability of mail-order pharmacy Truepill to handle controlled substances, alleging that the company has filled unlawful prescriptions for Adderall in the past. 

Truepill has stated that it is cooperating with the DEA and will be able to demonstrate that there was no wrongdoing. 

Both Truepill and Cerebral have also announced that they will stop filling or prescribing stimulants, respectively.

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