Sources: health startups Cerebral and Done used looser pandemic rules and pressure on clinicians to prescribe stimulants, often via 30-minute online evaluations
Digital companies such as Cerebral and Done seized on looser pandemic rules for prescribing ADHD drugs like Adderall. Tweets: @cararlombardo and @rolfewinkler Tweets: Cara Lombardo / @cararlombardo : Mind-boggling: A nurse practitioner working for one of the startups makes $20K a month overseeing 2,300 patients. Virtually all are on stimulants and she renews their prescriptions - sometimes two per minute - based mostly on forms patients fill out online. https://twitter.com/... Rolfe Winkler / @rolfewinkler : When Covid hit, the fed gov't relaxed a rule preventing doctors from prescribing controlled substances like Adderall without an in-person visit. Silicon Valley saw an opportunity: diagnosing ADHD online. 🧵 https://www.wsj.com/...
Context & Ripple Effects
When Covid hit, the federal government suspended the in-person visit requirement for prescribing controlled substances, and startups moved fast: this investigation reports Cerebral and Done built ADHD businesses on 30-minute online evaluations, with one nurse practitioner overseeing 2,300 patients and renewing prescriptions at up to two per minute from online forms.
The reporting proved prescient. Federal prosecutors later examined whether Cerebral's social-media-driven growth violated the Controlled Substance Act (social media ads and a federal probe), and by mid-2024 US authorities had arrested Done Global's founder and head doctor over an alleged Adderall prescription scheme (Done founder and head doctor arrested).
First-order effects
- Cerebral and Done face immediate legal exposure: prosecutors scrutinizing possible Controlled Substance Act violations put their prescribing pipelines, clinician staffing model, and ad-driven patient acquisition under direct regulatory threat.
Second-order effects
- Competing telehealth prescribers must tighten evaluation protocols and clinician oversight to avoid being swept into the same enforcement pattern, raising compliance costs across the ADHD telehealth segment.
Third-order effects
- If enforcement keeps escalating — from the ketamine-at-home wave riding the same loosened rules (online ketamine prescribing) to criminal charges against startup leadership — the pandemic-era relaxation of in-person requirements for controlled substances becomes politically untenable, forcing regulators to choose between rolling back access and building real remote-prescribing safeguards.
The trend: Telehealth's pandemic-era expansion into controlled substances is colliding with a federal enforcement backlash that will decide how much of the loosened prescribing regime survives.