Recently, the DEA has cracked down on mental health telehealth companies that prescribe controlled substances. It was seen recently with Done, a telehealth startup focused on online treatment for ADHD. However, even before that, another startup called Cerebral found itself under investigation, which led to major changes at the company. Currently, Cerebral is facing public scrutiny after the death of a 17-year-old patient that was treated without his parents’ consent.
The rise of telehealth companies came about during the pandemic when people were in desperate need of medical care but wary of visiting doctor’s offices and hospitals. During that time, the DEA loosened the prescription requirements for controlled medications, so they did not have to be prescribed medication in person. With that change came a revolution in online prescribing and treatment.
But it is not all positive news. While prescribing medication online is certainly convenient and helps promote access to care, there have been problems, such as the allegations that Cerebral treated minors and wrote prescriptions without parental consent.
The Wall Street Journal reported on the situation, detailing a case where Cerebral treated Anthony Kroll, a 17-year-old patient who later took his own life. It mentioned that while the startup uses software to verify customer IDs, it did not check birth dates or other details.
Because of the policy, there have been a few cases of minors being treated without parental consent, with Cerebral eventually identifying 17 minors enrolled in their services from May 2021 to April 2022. According to Cerebral, the case is an outlier, and it has followed state rules every step of the way.
The company also pointed out that it has “provided much-needed care to hundreds of thousands of patients, many of whom would not have had access to critical mental-health support without Cerebral’s telemental health services.”
The Wall Street Journal mentioned a company memo that referred to the software ID check as an “impediment to customer retention.” The company was quickly enrolling tens of thousands of customers during the pandemic, so it chose to use software to capture selfies and had clinicians verify details during 30-minute video chats.
When Anthony Kroll went through the sign-up process, his ID went through the software. He then proceeded to his video chat with a clinician, who he informed of suicidal thoughts. The clinician then prescribed antidepressants, which carried a warning label for adolescents. Anthony later committed suicide.
The medication is not certain to have caused the tragic death, but it is an unnecessary potential factor due to his status as an adolescent. Additionally, because they were not informed, Anthony’s parents were unaware that he was seeking treatment or taking the prescribed medication.
But the allegations concerning the startup prescribing to minors are not the first trouble it has faced. Cerebral announced that it would stop prescribing controlled substances in anticipation of the end of the Public Health Emergency waiver to the Ryan Haight Act as concerns grew about telehealth companies’ prescribing practices. Additionally, the startup tapered existing patients off of controlled substances or transitioned them to providers who could provide in-person care. Cerebral was never accused of any wrongdoing or law violations.
There have also been instances where people expressed their concerns over Cerebral’s quick sessions and the qualifications of its prescribers. In some instances, prescriptions were handed out in as quickly as 15 minutes, and there were cases where patients were prescribed five or more medications. Moreover, many of Cerebral’s prescribers are nurse practitioners and not board-certified psychologists.