The Drug Enforcement Administration (DEA) has raised concerns that “aggressive marketing practices” by telemedicine companies could contribute to overprescribing of drugs used to treat attention-deficit hyperactivity disorder (ADHD), the agency said in a letter.
Although the letter doesn’t mention specific companies, it is believed to be referring to telemedicine companies like Cerebral Inc. and Done Global Inc., whose prescribing practices were reportedly under investigation by the DEA after flooding social media with online advertisements like Instagram and Facebook.
The decision follows a more than doubling in Adderall prescriptions by more than 10% per year in 2021 through October 2022, after an annual increase of about 5% in the previous three years, according to data from research firm IQVIA.
Adderall and the amphetamines used in its manufacture are classified by the DEA as Schedule II controlled substances because of their high potential for abuse, along with opioids such as OxyContin and fentanyl.
Above is the total number of Adderall pills, branded and generic, dispensed at US pharmacies last year. Teva sold the most Adderall in the US in 2021
Adderall prescriptions rose more than 10% in 2021 and through October 2022, after an annual increase of about 5% for the previous three years
Telehealth company Done ran ads with images of pills and promising quick ADHD diagnoses
The DEA is required by law to set production quotas for Schedule II drug ingredients each year.
In December, the DEA announced that it would not allow ramp-up production of pharmaceutical ingredients used to manufacture Adderall and other stimulants used to treat ADHD in 2023.
The letter, which was sent to drugmakers over the summer but had not previously been reported, was reviewed by the Wall Street Journal.
The federal government will regulate the manufacturing of the ingredients needed to manufacture the ADHD drug due to the potential for abuse.
The DEA’s decision to curb production, coupled with a surge in prescriptions since the COVID-19 pandemic began, has reportedly contributed to a shortage of Adderall, the U.S. Food and Drug Administration found in October.
Adderall prescriptions have steadily increased over the past 12 years. Numbers include prescriptions for Adderall, both brand and generic, in the US
Cerebral and Done have both said they do not pressure doctors and provide essential services, but the DEA is currently investigating the companies’ prescribing practices. Pictured is a snapshot from a Cerebral video ad that ran on Facebook in 2021
A spokesman for Teva, Adderall’s largest manufacturer, said: “Teva is committed to serving patients who need access to the products their healthcare providers prescribe, while also committing to carefully monitor DEA-controlled products.”
The DEA’s letter explained how it viewed manufacturers’ requests for production quotas due to the “sheer volume of ADHD drugs on the market, coupled with aggressive marketing practices and unregistered marketing companies driving quota requests.”
41 million prescriptions for Adderall were written last year
“The DEA must ensure that any quota granted for the manufacture of controlled substances for the treatment of ADHD is driven by a legitimate need and not improperly driven purely by profit motives, pressure from marketing companies, or a desire to gain more market share , are all factors that have contributed to the opioid glut during the prescription opioid crisis,” read the letter, signed by Kristi O’Malley, associate administrator in the DEA’s Diversion Control Division .
In December, the DEA announced that in 2023 it would maintain the same production quota for ingredients used in the manufacture of Adderall and other attention-deficit hyperactivity disorder (ADHD) drugs as it did in 2022.
According to The Journal, telemedicine companies Cerebral and Done ran ads with pictures 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 greater profitability of clients prescribed stimulants.
Adderall prescriptions surged during the COVID-19 pandemic. In February 2020, just before the virus broke out across America, the drug made up 1.1% of medications. By September 2022, the number had more than doubled to 2.31% of all screenplays written
Both Cerebral and Done have said they do not pressure doctors and provide essential services, but the DEA is currently investigating these companies’ prescribing practices.
Cerebral has maintained that it has not been charged with violating any law and is fully cooperating with the investigation, while Done has stated that it is committed to providing quality mental health care while complying with all relevant laws and regulations.
The DEA has also announced that it is considering removing the ability for mail-order pharmacy Truepill to handle controlled substances, alleging that the company has a history of dispensing unlawful prescriptions for Adderall.
Truepill has stated that it is working with the DEA and can demonstrate no wrongdoing.
Both Truepill and Cerebral have also announced that they will stop injecting and prescribing stimulants.
What is Adderall?
Adderall is an amphetamine drug used to help people focus and avoid unwanted behavior.
When it launched in 1996, it was heralded as a “game changer.”
Who takes the drug?
The drug is prescribed to people who have been diagnosed with ADHD.
But addiction centers say many otherwise healthy people take the drug to help with their work or social life.
How does it work?
It works by increasing levels of the “feel good” hormones dopamine and norephinephrine in the brain.
This helps ADHD sufferers to concentrate better and prevent behavioral problems.
How is it taken?
It is available as a fast-acting pill that is taken two to three times a day.
Or it can be taken as a duration pill once a day.
These start at $12.68 per 30 tablets, or about 42 cents per pill.
What is it like to come off the drug?
People who stop taking the drug are in a state of heightened excitement.
They also have slowed brain and body movements, an increased appetite, and unusual levels of tiredness.