The Drug Enforcement Administration (DEA) has expressed concern that “aggressive marketing practices” by telehealth companies may be contributing to overprescriptions for drugs used to treat attention deficit hyperactivity disorder (ADHD), according to the agency’s letter.
Although the letter did not mention specific companies, Cerebral Inc., whose prescribing practices were reportedly investigated by the DEA after blitzing social media with online ads including Instagram and Facebook. and Done Global Inc. is believed to be referring to telehealth companies such as .
The decision comes after Adderall prescriptions rose more than 10% annually from 2021 to October 2022, after an annual increase of about 5% over the previous three years, 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 brand-name and generic Adderall pills dispensed at U.S. 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 about 5% annual growth in the previous three years.
The telehealth company Done ran ads featuring pictures of pills and promising rapid ADHD diagnoses.
The DEA is legally required to set annual production quotas for Schedule II drug ingredients.
In December, the DEA announced that in 2023 it would not allow increased production of pharmaceutical components used to make Adderall and other stimulants for the treatment of ADHD.
The letter, sent to drugmakers over the summer but previously undisclosed, was reviewed by The Wall Street Journal.
The federal government will regulate the production of the ingredients needed to make an ADHD drug because of the potential for abuse.
The DEA’s decision to limit production, along with an increase in prescriptions since the start of the COVID-19 pandemic, has contributed to the Adderall shortage, as the U.S. Food and Drug Administration noted in October.
Adderall prescriptions have increased steadily over the past 12 years. The figures include prescriptions for both brand-name and generic Adderall in the United States
Cerebral and Done both said they do not pressure clinicians or provide essential services, but the DEA is currently investigating the companies’ prescribing practices. Pictured is an image from the Cerebral video ad that aired on Facebook in 2021
A spokesperson for Teva, the largest maker of Adderall, noted: “Teva is committed to patients who need access to products prescribed by their healthcare providers, while also being fully committed to closely monitoring products controlled by the DEA.”
The DEA’s letter explains how manufacturers view production quota requests because of the “large volume of ADHD drugs on the market, aggressive marketing practices, and unregistered marketing companies handling quota requests.”
Last year, 41 million prescriptions were filled for Adderall
‘The DEA must ensure that any quotas for the production of controlled substances used to treat ADHD are driven by legitimate need and are not mismanaged by a profit motive, pressure from marketing firms, or a desire to gain more market share – all factors It has led to an oversupply of opioids 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 in 2023 as it did in 2022 for substances used in the production of Adderall and other attention-deficit hyperactivity disorder (ADHD) drugs.
According to The Journal, telehealth companies Cerebral and Done aired ads featuring images of pills and prospective ADHD diagnoses.
Some clinicians at these companies claimed they felt pressured to prescribe stimulants, and internal presentations at Cerebral cited the higher profitability of clients prescribed stimulants, according to reports.
Prescriptions for Adderall have increased during the COVID-19 pandemic. In February 2020, before the virus spread across America, the drug accounted for 1.1% of prescriptions. By September 2022, this number had more than doubled to 2.31% of all scripts written.
Both Cerebral and Done have said they do not pressure clinicians or provide essential services, but the DEA is currently investigating the companies’ prescribing practices.
Cerebral has not been charged with any wrongdoing and is cooperating fully with the investigation, while Done is committed to providing high-quality psychiatric care in compliance with all applicable laws and regulations.
The DEA also announced that it is considering revoking mail order pharmacy Truepill’s ability to handle controlled substances, alleging the company filled illegal prescriptions for Adderall in the past.
Truepill said it is cooperating with the DEA and can demonstrate no wrongdoing.
Both Truepill and Cerebral have announced that they will stop filling or prescribing the stimulants, respectively.