Over the past two months, digital mental health unicorn Cerebral has found itself under a cloud of intense negative media scrutiny. The spotlight has been focused primarily on the company’s prescribing practices, especially concerning controlled substances used to treat ADHD. This controversy has sparked wider debates about the safety, ethics, and oversight of digital mental health platforms that rely heavily on telehealth and medication management. The Cerebral ADHD prescribing controversy has brought significant attention to the risks and responsibilities involved in online mental health care.
Public Response and Company Leadership Addresses Concerns
At the American Telemedicine Conference in Boston, Cerebral’s Chief Medical Officer Dr. David Mou publicly addressed the recent backlash. In a candid admission, Mou said, “I will say that we have made mistakes. And I’ll also admit that we will continue to make mistakes and learn.” This statement reflects Cerebral’s acknowledgment of challenges and its willingness to engage in ongoing improvement despite the criticisms. This openness is a key aspect of managing the Cerebral ADHD prescribing controversy.
Mou emphasized that the company is actively working to improve its protocols and patient safety measures while navigating the complexities of telehealth delivery for mental health services. He also stressed the importance of transparency and dialogue as the company seeks to regain public trust amidst the ongoing Cerebral ADHD prescribing controversy.
Media Reports Shine a Harsh Light on ADHD Medication Prescribing
In March, a high-profile Bloomberg feature delved into Cerebral’s business model, highlighting concerns that the company’s focus on medication prescribing—particularly stimulants such as Adderall and Ritalin—could create pressure on providers to push these drugs. Both medications are classified by the Drug Enforcement Administration (DEA) as Schedule II controlled substances, the same class that includes cocaine, which heightens regulatory scrutiny.
Following this exposure, Cerebral’s preferred pharmacy partner, Truepill, temporarily ceased fulfilling Cerebral’s Adderall prescriptions. Prior to that, CVS Health had already restricted some Cerebral prescribers from issuing Adderall prescriptions through its pharmacies. These developments marked a significant operational disruption for the startup and intensified the Cerebral ADHD prescribing controversy.
In addition, Cerebral is currently embroiled in a lawsuit from a former VP of product and engineering. The former executive alleges retaliation after raising concerns about the company’s prescribing practices, adding another layer of reputational risk in the ongoing Cerebral ADHD prescribing controversy.
ADHD Treatment Constitutes a Small Slice of Cerebral’s Care Model
Despite the media focus on ADHD medications, Cerebral’s leadership has clarified that ADHD treatment actually represents a small fraction of the company’s overall patient care. Dr. Mou noted that the “vast majority” of Cerebral’s business centers on conditions such as depression, anxiety, post-traumatic stress disorder (PTSD), adjustment disorders, and increasingly, bipolar disorder.
He further explained that many patients who initially seek evaluation for ADHD do not ultimately receive that diagnosis. “Of all the patients who come to us and say, ‘Hey, I have symptoms of ADHD,’ only slightly more than 50% are actually diagnosed with it,” Mou said. “Most of the other patients have anxiety disorders with depression, and they confuse their symptoms of inattention with ADHD.”
This highlights the challenge of differentiating ADHD from other overlapping mental health conditions, particularly in a telehealth environment where traditional diagnostic methods may be limited. Addressing these diagnostic complexities is essential to resolving the Cerebral ADHD prescribing controversy.
Enhanced Safety Measures and Clinical Oversight
In response to concerns, Cerebral has implemented multiple safety protocols designed to ensure appropriate prescribing and patient care. These measures include mandatory depression screening tools, requirements for clinicians to consult state prescription drug monitoring programs before prescribing controlled substances, and advanced clinical decision support systems that guide medication management.
Moreover, Cerebral’s clinicians have access to a “Curbside Consult” feature, which allows them to speak with a licensed psychiatrist within 30 minutes before prescribing any medication. This additional layer of support aims to prevent errors and encourage more cautious prescribing practices.
Dr. Mou emphasized that “the idea here is that you’re getting support the entire time,” indicating the company’s intention to combine technology with human clinical judgment to maintain safety standards — an important aspect in managing the Cerebral ADHD prescribing controversy effectively.
Marketing Controversies and Corrective Actions
Cerebral has also faced criticism for how it markets its services, particularly regarding ADHD medications. The company advertises treatment for several mental health conditions, including insomnia, bipolar disorder, and ADHD. Dr. Mou acknowledged that ADHD tends to attract more attention due to the controlled substance nature of many of its treatments.
He also admitted that in the rush to scale rapidly, Cerebral outsourced some of its marketing efforts. This outsourcing led to promotional materials that were not always reviewed by qualified medical personnel, creating the potential for misleading or inappropriate messaging.
Since then, Cerebral has shifted to a more stringent review process, with the director of quality now responsible for vetting all advertising materials to ensure accuracy and compliance with medical standards. This change aims to address some of the public concerns raised during the Cerebral ADHD prescribing controversy.
Funding Success Amid Growing Industry Challenges
Since its founding in 2019, Cerebral has raised approximately $462 million in venture capital, pushing its valuation to an estimated $4.8 billion. This impressive funding trajectory underscores investor confidence in the digital mental health market, despite the company’s recent setbacks.
However, Cerebral is not alone in facing hurdles related to the digital prescribing of ADHD medications. Other telehealth companies, such as Done, have experienced restrictions on prescribing Adderall at major retail pharmacies. Additionally, the FDA and DEA recently issued warnings to online pharmacies Kubaphram.com and Premiumlightssupplier.com for illegally selling Schedule II stimulants, including Adderall, without prescriptions.
These regulatory actions highlight the challenges digital health companies face when navigating complex controlled substance laws and maintaining compliance, a landscape that forms the backdrop to the Cerebral ADHD prescribing controversy.
Overcoming Telehealth Stigma and Setting New Standards
Dr. Mou pointed out that mental health care, and telehealth specifically, continue to carry societal stigma, which can fuel skepticism. “We’ve been very open with our outcomes data,” he said. “We’ve been sharing it with a lot of people. We end up putting telehealth providers on a higher standard because it’s new.”
This observation suggests that while telehealth offers innovative access to care, it also invites heightened scrutiny, emphasizing the need for robust quality assurance and transparency in digital health — key factors to resolving concerns raised by the Cerebral ADHD prescribing controversy.
Employment Practices and Workforce Controversies
In addition to clinical and regulatory challenges, Cerebral has faced criticism over its employment practices. Earlier this year, the company altered its pay structure for W-2 clinicians, shifting from a salaried model to hourly wages. This change caused concern among staff about job stability and compensation fairness.
Furthermore, reports surfaced in March indicating that Cerebral planned to outsource care coordinator roles to the Philippines. This move sparked debate over the quality and continuity of care, as well as ethical considerations regarding offshore outsourcing of healthcare functions.
Looking Ahead: Challenges and Opportunities for Cerebral and Digital Mental Health
Cerebral’s recent troubles highlight the difficulties digital mental health companies face as they balance rapid growth, patient safety, regulatory compliance, and operational sustainability. The controversy around ADHD medication prescribing underscores the need for careful clinical oversight and clear ethical standards in telehealth.
As the market continues to mature, Cerebral and its peers will need to demonstrate that they can provide high-quality care while adhering to strict regulatory requirements. Transparency, robust safety protocols, and a patient-centered approach will be critical to maintaining trust in this evolving sector.
The path forward may be difficult, but the potential to increase access to mental health treatment via digital platforms remains significant. With lessons learned and reforms underway, Cerebral may yet emerge stronger and better equipped to navigate the complex landscape of behavioral health care delivery and resolve the ongoing Cerebral ADHD prescribing controversy.
