The Drug Enforcement Administration (DEA) has expressed concern that ‘aggressive marketing practices’ by telehealth companies may be contributing to overprescribing of drugs used to treat attention deficit hyperactivity disorder (ADHD), according to a agency letter.
While the letter does not name specific companies, it is believed to refer to telehealth companies such as Cerebral Inc. and Facebook.
This decision follows an increase in Adderall prescriptions of 10.4% in 2021 and 10.9% through October 2022, after an annual increase of approximately 5% over the previous three years, according to data from research firm IQVIA.
Adderall and the amphetamines used to produce it are classified as Schedule II controlled substances by the DEA due to their high abuse potential, along with opioids such as OxyContin and fentanyl.
Above is the total number of Adderall pills, brand-name and generic, dispensed last year in US pharmacies. Teva sold more Adderall in the US in 2021
Adderall prescriptions increased by more than 10% in 2021 and through October 2022, after an annual increase of approximately 5% over the previous three years
Telehealth company Done ran ads with pictures of pills promising quick ADHD diagnoses
The DEA is legally required to establish production quotas each year for Schedule II drug ingredients.
In December, the DEA announced that it would not allow any increase in production of pharmaceutical ingredients used to make Adderall and other stimulants to treat ADHD in 2023.
The letter, which was sent to drugmakers over the summer but was not previously reported, was reviewed by The Wall Street Journal.
The federal government will regulate the production of the ingredients needed to create the ADHD drug because of the potential for abuse.
The DEA’s decision to limit production, coupled with an increase in prescriptions since the start of the COVID-19 pandemic, would have contributed to the Adderall shortage, as noted by the US Food and Drug Administration in October.
Adderall prescriptions have steadily increased over the past 12 years. Numbers include prescriptions for Adderall, brand and generic, in the US
Cerebral and Done have stated that they do not pressure doctors and provide essential services, but the DEA is investigating the companies’ prescribing practices. Pictured is a snapshot of a Cerebral video ad running in 2021 on Facebook
A spokesperson for Teva, the largest manufacturer of Adderall, said: ‘Teva is committed to patients who need access to products prescribed by their healthcare professionals and is fully committed to carefully monitoring DEA controlled products.’
The DEA’s letter explained how it was reviewing requests for production quotas from manufacturers due to “the sheer volume of ADHD drugs on the market, coupled with aggressive marketing practices and unregistered marketing companies conducting quota requests.”
41 million Adderall prescriptions were filled last year
‘The DEA must ensure that any quota awarded for the manufacture of controlled substances used to treat ADHD is motivated by a legitimate need and not unduly motivated purely by profit motive, pressure from marketing companies or a desire to gain more market share – all the factors that led to an opioid oversupply during the prescription opioid crisis,” said the letter, signed by Kristi O’Malley, assistant administrator for the DEA’s Diversion Control Division.
In December, the DEA announced that it would maintain the same production quota for ingredients used to make Adderall and other attention-deficit hyperactivity disorder (ADHD) drugs in 2023 and 2022.
According to The Journal, telehealth companies Cerebral and Done ran ads with pictures of pills and promising quick ADHD diagnoses.
Some physicians at these companies said they felt pressured to prescribe stimulants, and internal presentations at Cerebral highlighted the greater profitability of prescribing stimulants to clients.
Adderall prescriptions increased during the COVID-19 pandemic. In February 2020, just before the virus broke out in America, the drug accounted for 1.1% of drugs. As of September 2022, the number has more than doubled to 2.31% of all screenplays written.
Both Cerebral and Done have stated that they do not pressure doctors and provide essential services, but the DEA is currently investigating these companies’ prescribing practices.
Cerebral claimed that it has not been accused of violating any law and is cooperating fully with the investigation, while Done stated that it is committed to providing high quality psychiatric care, following all relevant laws and regulations.
The DEA also announced that it is considering revoking mail order pharmacy Truepill’s ability to handle controlled substances, alleging that the company has filled illegal prescriptions for Adderall in the past.
Truepill said it is cooperating with the DEA and will be able to demonstrate that there have been no wrongdoings.
Both Truepill and Cerebral have also announced that they will stop filling or prescribing stimulants, respectively.
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