🎧 Listen: In part 2 of our series “Uncontrolled Substances,” RolfeWinkler probes how the tightly regulated medication Adderall became crucial to the business of telehealth startup Cerebral, and employees describe feeling pressure to prescribe it
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Rolfe Winkler: Cerebral is listing controlled substances in its pitch deck for investors. It has a slide and a presentation that we reviewed. They have a little pill bottle there, a little capsule right underneath it, and controlled substances leading to an arrow that says, "Now is the time to capture growth."
Rolfe Winkler: "Forgot to ask, totally unrelated, but is Adderall in Cerebral pipeline? Was talking to a supplement company today related to stimulants that said a couple Adderall startups were doing well early innings." Kyle responded, Yep. We're already doing it in some states and it's growing like crazy." And the board member replies, "Awesome.
Shelly Balkey: When I heard that ADHD was rolling out, I said, "Hey, can we talk about what we need to change in order to make sure that we're doing this in a responsible way?" And I was told, "This is happening." It was already written. I as being the, I've already told you, like at that time, the person in the company that was the highest that had a medical license, I didn't write that policy. I didn't sign off on it.
Shelly Balkey: If you look at the questions, they're fairly easy to figure out on how to answer as to whether or not you have ADHD. So in all of medicine, there is a great deal of trusting the patient, right? Their pain is what they say it is. They say that they're not suicidal, then they're not suicidal.
Shelly Balkey: Qualified? Yes. Had the tools to do it properly? No. And that was problematic to me. As we started to accept more complicated patients, this would've been a good point to reevaluate, were they an appropriate candidate for telemedicine? And that piece was missing. Rolfe Winkler: He was certainly fired up. The people we know who were around him say he was very excited by the growth opportunities that the company was pursuing. They also said he was laser focused on patient retention. This idea that, "We want to bring customers, once we bring them in through the ads, we want to keep them as long as possible, and we want to make sure that we're doing things that will keep them subscribing to our service as long as possible.
Shelly Balkey: And Kyle said, "Well, why didn't they get their controlled substance?" And I said, "Because the provider didn't feel like it was warranted." And that was the end of discussion. Like that to me, if a provider said that something was not medically indicated, that's the end of the line.Shelly Balkey: It irritated me, honestly.
Rolfe Winkler: Signing up the biggest possible spokesperson for mental health, and she certainly was, was quite a coup for Kyle Robertson and Cerebral. Kate Linebaugh: Those ads catapulted Cerebral into the mainstream, but they were a small part of a much bigger marketing push.Speaker 10: They have prescribers that can give you a medication in case you need it.Speaker 11: Yeah.
Kate Linebaugh: Ashley told Rolfe that some of her patients were expecting an Adderall prescription. They would tell her after seeing ads online describing the symptoms of ADHD, they'd become convinced they had the condition. This was unnerving for Ashley. Kate Linebaugh: Ashley says she tried to explain to him that before she could prescribe Xanax, she needed to take his medical history and ask some questions. That's when he threatened to cancel his subscription.
Kate Linebaugh: Cerebral says only half of its patients with ADHD concerns are ultimately diagnosed with the disorder. And a, "single digit percentage of its patients were given a controlled substance to treat ADHD." Earlier this year, Ashley says the pressure she was feeling to prescribe Adderall ramped up. Cerebral had brought in a new Chief Medical Officer, Dr. David Mou. Mou was taking over from Ho Anh, Cerebral's co-founder, who had recently left the company.
Kate Linebaugh: Ashley says she talked with the patient about the benefits of Adderall, but she also warned about the risks, including the risk that Adderall can be addictive. Rolfe Winkler: Cerebral says, when we ask them about this, that nurse practitioners, clinicians, who are prescribing medication, they exercise independent judgment. The company doesn't pressure them or never did.
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