Responsibility After the ADHD Prescription
Timothy Lesaca MD
10-4-2026
Last month, I started seeing five new patients who were already taking stimulants. I had not met any of them before. Each came with a diagnosis, an active Schedule II prescription, and a telehealth chart note that made it hard for me to piece together their assessment. It felt like I was continuing someone else’s treatment, but what bothered me most was not knowing who had been caring for these patients or exactly what I was now responsible for.
The federal prosecution of clinicians and executives associated with Done Global gives that concern a disturbing context. On October 2, 2026, the Justice Department announced that a Michigan jury had convicted physician Jonathan Decker of conspiracy to distribute controlled substances and six distribution counts. According to the department, Decker distributed more than two million stimulant pills through Done's ADHD platform and received more than $1 million for his prescribing. He became the eleventh defendant convicted in the broader case.1
These details show problems that go well beyond missing paperwork. Prosecutors said Decker gave methamphetamine to a patient who already had a substance use disorder. He also kept prescribing Adderall to a patient with schizophrenia, even after her mother said the medicine made her symptoms worse. The department said Done providers kept prescribing stimulants to keep paying subscribers, even when there were warnings about patients’ mental health getting worse. The Justice Department described a $100 million scheme that involved more than 37 million Adderall pills and over $40 million spent on social media ads. According to their report, the business encouraged people to see attention and mood problems as ADHD and then made it easy to get medication.
Obviously, I do not think that a poor handoff is the same as criminal behavior. This case also does not show how often regular telehealth care fails. Still, it reminds us to ask an important question that remains after the trial: what responsibility comes with a prescription after the first appointment is over?
ADHD is a real condition, and people need to get the assessment and treatment they need. Telehealth can help people who live far from specialists, lack child care, or cannot leave work easily. Patients who looked for help online should not be treated with suspicion just because a company or clinician broke their trust. Prescription data show why this responsibility now affects so many clinics. In a 2024 JAMA Psychiatry study, Grace Chai examined new prescriptions issued from April 2018 to March 2022. These were for people who had not had a prescription in the same drug class for at least a year. During the pandemic, prescriptions for stimulants and nonstimulant ADHD medications went up a lot, but there were no significant changes for antidepressants and benzodiazepines.2
These findings do not prove that telehealth caused the increase or that the extra prescriptions were wrong. More awareness of ADHD and unmet needs may have played a role. Prescription records also do not show whether a doctor took a full history, considered other possible causes, or arranged follow-up care. More prescriptions do not indicate the quality or continuity of care.2
Missing information is relevant because of clinical standards. The UK's National Institute for Health and Care Excellence (NICE) says there should be a full clinical and psychosocial assessment, a developmental and psychiatric history, and evidence of problems across settings. Rating scales can help with assessment but cannot make the diagnosis on their own. Ongoing treatment means monitoring how well it works and for side effects, such as changes in blood pressure, pulse, weight, and growth in children. A diagnosis in a chart does not tell the next doctor if these things were done.3
Longer treatment means more responsibility. A Swedish study by Le Zhang and others, published in JAMA Psychiatry in 2024, found that using ADHD medication over time was linked to higher rates of cardiovascular disease, especially high blood pressure and artery disease. Each extra year of use raised the adjusted odds by about 4% during the study. The risk went up more in the first three years, then leveled off. This study does not prove that the medication caused these problems or predict what will happen to any one patient. It does show the need for careful talks about benefits and risks, and for ongoing monitoring as long as treatment continues.4
Federal policy makes things even less certain. The fourth temporary extension for telehealth prescribing of controlled medications lasts until December 31, 2026. This allows qualifying prescriptions without a prior in-person visit while permanent rules are being made. These rules still require a real medical reason and compliance with the law. But the repeated deadlines make it hard to plan long-term care, especially when patients already have to switch between doctors.5
There should be a clear plan for ongoing care from the start of treatment. Every patient starting a stimulant should know who is in charge of their follow-up, how to contact that person, and when their next check-in will be. Clinics should decide how to review concerning symptoms and who will help if the usual doctor is not available. Just naming a clinician is not enough if they do not have the time and support to do the job.
Transfers should be just as clear. A good handoff should include the reasons for the diagnosis, important history, medication trials, how the patient responded, any side effects, and recent monitoring. The new clinician should clearly accept responsibility and figure out what still needs to be checked. Patients should not have to piece together their own records or manage communication between different clinics. Reassessment should make sure patients keep getting the right care while clearing up any questions about their diagnosis or treatment.
A key question is what to do while waiting for records. A patient might need help before all the details are sorted out. The new clinic should explain how it will assess the patient, set up a timely review, and share a clear short-term plan based on clinical judgment. Responsibility should be clear during this time, so the patient knows who to contact, and both clinics know who is in charge.
Platforms and health systems should be evaluated by what happens after a patient signs up. I would want to know how often follow-ups happen, whether abnormal results lead to action, and whether patients who leave a service can see another doctor. Payment systems should support the time needed to review a diagnosis or change a treatment plan. If a system rewards keeping patients, it should include safeguards to protect sound clinical judgment when it is time to stop prescribing.
Better evidence would help us spot problems before patients show up at a new clinic with missing records. Registries and long-term studies could link starting treatment with continued use, stopping, outcomes, and side effects. This research should protect privacy and look at both access and safety. Otherwise, fewer prescriptions might seem like a win, even if it means patients are losing helpful treatment.
The Done convictions show that people can be held accountable for their actions. My five new patients remind me of the everyday responsibility that comes with this work. Before I continue a prescription, I need to know why it was started, if it is helping, and what needs to be watched now. Our systems should make these answers easy to find. As we expand access to ADHD treatment, we also take on the duty to maintain good care, including a clear handoff when responsibility changes.