For nearly five years, patients with attention deficit/hyperactivity disorder (ADHD) have had the option of receiving stimulant medication prescriptions and renewals through virtual consultations, without having to see a doctor in person. This has been made possible due to relaxed telehealth regulations, which were initially introduced to increase access to care, especially during the COVID-19 pandemic. However, as these rules approach expiration, a new study sheds light on the potential risks of this virtual care, particularly when it comes to the misuse of stimulant medications.
The study, published in Health Affairs by a team from the University of Michigan, reveals that individuals between the ages of 12 and 64 who started their stimulant medications through telehealth were slightly more likely to develop a substance use disorder (SUD) within the next year compared to those who initiated treatment through in-person visits. Specifically, the risk of SUD was 3.7% for those using telehealth, compared to 3.2% for those seeking in-person care.
However, the study also found that when accounting for pre-existing mental health conditions, such as depression, which are known risk factors for substance use, the increased risk of SUD in the telehealth group was no longer significant for the entire study population. The higher risk persisted only among one subgroup: adults between the ages of 26 and 34.
Joanne Constantin, Ph.D., the study’s lead author and postdoctoral research fellow at the Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, noted that the increase in risk among 26- to 34-year-olds could be attributed to the loss of parental insurance coverage after age 26, which may lead to young adults seeking prescriptions without the supervision of a parent. This could potentially increase the risk of misuse. Constantin emphasized the importance of screening and ongoing monitoring for this age group to mitigate the risk of developing a substance use disorder.
The study’s findings suggest that screening for addiction risk and consistent monitoring for signs of SUD should be a key part of future policies concerning telehealth-based ADHD treatment. Such measures would help ensure patient safety while maintaining the benefits of telehealth, which offers greater access to care for those who might otherwise have difficulty obtaining it.
The current federal telehealth rules, which permit behavioral health care via telehealth without an in-person visit, are set to continue until December 31. These rules were made more flexible during the pandemic, but concerns remain about the potential for misuse of stimulant medications, which are classified as controlled substances due to their high potential for abuse.
The U.S. Food and Drug Administration (FDA) has issued a “black box” warning for stimulant medications like Ritalin and Adderall, highlighting the risks not only to patients but also to others who may misuse the medications, such as those to whom the patient might sell or give the drugs. Despite these warnings, there are currently no clear guidelines for screening ADHD patients for SUD risk factors or for regular monitoring after treatment begins.
The study suggests that while telehealth offers a crucial way to access care, there is a need to balance increased access with the safety of patients. Ensuring guidelines for providers that include addiction screening and ongoing follow-up could mitigate the risks associated with stimulant prescriptions given through telehealth platforms.
The research emphasizes the growing need for robust regulations to protect patients while ensuring that virtual care remains an effective tool for managing ADHD. As the telehealth landscape continues to evolve, policymakers will need to strike a balance between accessibility and safety to prevent negative outcomes such as substance use disorders.
As of now, companies providing standalone ADHD care via telehealth have been scrutinized for their role in prescribing controlled substances, with some facing legal proceedings for alleged inadequacies in monitoring the use of these drugs. These concerns further highlight the importance of ongoing oversight in telehealth-based care, particularly when prescribing medications with high misuse potential.
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