For the past five years, people with ADHD have been able to get their stimulant medications prescribed and renewed through telehealth visits, thanks to relaxed rules during the COVID-19 pandemic. However, with these telehealth policies set to expire soon, a new study provides important insights into the safety of virtual ADHD care.
The study, conducted by researchers from the University of Michigan and published in Health Affairs, found a slightly higher risk of substance-use disorder (SUD) among people who started ADHD medication via telehealth compared to those who started in in-person visits.
However, for most age groups, this difference disappeared when adjusting for other factors, such as co-existing mental health conditions.
Key Findings: Slightly Higher SUD Risk in Telehealth Patients
The study analyzed 77,153 patients between ages 12 and 64 who began ADHD stimulant treatment in 2021. Researchers compared those who started their prescription via telehealth (21,000 patients) to those who had an in-person visit.
- Overall, 3.7% of telehealth patients developed a substance-use disorder within a year, compared to 3.2% of in-person patients.
- When adjusting for mental health conditions such as anxiety and depression, the risk difference disappeared for most age groups.
- However, young adults (ages 26-34) who started ADHD medication through telehealth still had a higher risk of SUD, even after accounting for mental health conditions.
Why Might Young Adults Be at Higher Risk?
Lead author Dr. Joanne Constantin suggests that losing parental health insurance at age 26 may play a role.
“Young adults are more independent in obtaining their medications without parental supervision, which highlights the importance of screening and monitoring for this age group,” she explains.
Since ADHD stimulant medications (such as Adderall and Ritalin) are classified as controlled substances, they carry a risk of misuse or being shared with others. This has led to concerns about overprescribing and lack of oversight in telehealth-based ADHD treatment.
Implications for Telehealth ADHD Care
With federal telehealth rules for behavioral health set to expire on December 31, policymakers will need to decide whether to continue allowing virtual ADHD prescriptions without in-person visits.
The study suggests that screening for addiction risk and regular follow-up monitoring should be included in future telehealth policies to ensure safety.
“Telehealth is an essential way to access care, but we need to balance access with safety,” says Constantin.
Challenges in ADHD Medication Oversight
Currently, prescribing ADHD stimulants requires:
- A DEA-licensed clinician
- Checking the state’s prescription drug monitoring program to review the patient’s medication history
- A “black box” FDA warning about misuse risks
However, there are no standard guidelines for screening SUD risk before prescribing stimulants or for long-term monitoring.
The rise of telehealth-only ADHD providers has also raised concerns. Some online ADHD clinics have faced legal scrutiny for allegedly failing to properly assess patients before prescribing stimulants.
Final Takeaways
This study provides important insights for policymakers and doctors as they consider the future of virtual ADHD treatment:
- While most people receiving ADHD medications via telehealth did not develop SUD, young adults ages 26-34 were at higher risk.
- Telehealth increases access to care, but monitoring and screening should be improved to ensure patient safety.
- More research is needed to determine the best ways to balance convenience, oversight, and patient well-being in ADHD treatment.
As the expiration date for current telehealth rules approaches, these findings may help shape future regulations on virtual ADHD care.
For more information about ADHD, please see recent studies about Nutrition’s role in managing ADHD: what you need to know and results showing that Food additives and ADHD: what parents should know.
If you care about ADHD, please read studies about 5 signs you have ADHD, not laziness, and new drug to reduce daydreaming, fatigue, and brain sluggishness in ADHD.
The research findings can be found in Health Affairs.
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