The Dangerous Side Effects of the Booming Telehealth Industry
Image Source: The Economist
As a consequence of the COVID-19 pandemic-induced restrictions which trapped people indoors unable to socialize, the mental health of America’s youth was significantly compromised. Predictably, this resulted in a surge in demand for mental health treatment.
Though this phenomenon was seen worldwide, America produced a great market response, with firms increasingly introducing “telehealth” services to address these alarming mental health issues while curbing the challenges posed by social distancing regulations. Telehealth, or telemedicine, involves the delivery of healthcare services via remote technologies rather than in-person visits with healthcare professionals. Firms such as Cerebral (a venture-capital-funded health startup), BetterHelp, and Done Health, are now offering various forms of online treatment. Instead of making appointments with a doctor without guarantee of a timely appointment, these firms offer easily accessible, over-video consultations. Rather than finding a pharmacy to acquire prescriptions, they deliver prescription drugs in the post.
While increasing the accessibility of vital mental health services, many worry that wider access to medicine implies laxer regulation on consumption. Various mental health conditions, such as ADHD, require treatment in the form of medicinal stimulants. Stimulants, such as Adderall, though counteracting symptoms, are highly addictive. Prior to the pandemic, visitation with a doctor in person was necessary to get a prescription. But, due to social distancing, these rules were relaxed to enable prescriptions to be given post virtual visits. This is extremely worrying. Many doctors fear that venture capital-backed firms have strong incentives to overprescribe due to their profit-driven motives.
Easier access to such medicines creates the conditions for dependency and addiction over time, which can lead to more severe consequences, including major anxiety, depression, sleep apnea, and heart problems. Worryingly, this has resulted in exponential increases in Adderall prescriptions. Particularly for patients aged 22 to 44, patient volumes and Adderall prescriptions both increased in 2020 and 2021 compared to pre-pandemic years. The number of patients with Adderall prescriptions increased by 7.4% from 2019 to 2020, followed by a further increase of 15.1% from 2020 to 2021. Moreover, while prescriptions have risen, the Drug Enforcement Agency (DEA), which controls the manufacturing levels of Adderall, has not lifted its annual quota, resulting in shortages. In fact, according to a survey by the National Community Pharmacists Association, 64% of pharmacies are struggling to obtain enough Adderall.
However, this issue of overprescription may soon be addressed. In April of this year Matthew Truebe, a former Cerebral executive, sued the company claiming they “put profits before patient safety” by overprescribing medications and encouraging employees to prescribe stimulants to 100% of new patients. Post this lawsuit, the firm stopped prescribing stimulants as its pharmacy partner cut them off. Additionally, the pandemic rules about online prescription of medicines are expected to be revisited next month with the intention of clamping down on overprescription.
Yet, striking a balance between overprescribing and underdiagnosing is difficult. Though a clampdown on prescriptions may prevent dependency and addiction, it could also prevent people in need of medication from access. Thus, saving some at the cost of hurting others.
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