WSJ Article about ADHD Pill Mills

[watto]

You have to be a subscriber to read the full article.

I was pretty shocked at the volume that some of these places (they mention Done and Cerebral specifically) are pushing. This excerpt was pretty damning:

"Yina Cruz-Harris, a nurse practitioner at Done who has a doctorate in nursing practice, said that she manages 2,300 patients for Done. Virtually all have ADHD, and virtually all are on stimulants, she said. Dr. Cruz-Harris said she renews each patient’s prescription each month from her New Jersey home, based mostly on forms patients fill out online, sometimes as fast as two renewals per minute. She said that Done pays her a bit less than $10 per patient, working out to around $20,000 in earnings per month.

She said that Done makes it possible for people struggling with ADHD to get a diagnosis and medication more easily than they could via in-person psychiatrists and that she routinely receives notes from patients who say the medication has helped them keep their job, for instance.

'I just feel I’m able to do more because of the company they built,' she said."

From:

Startups Make It Easier to Get ADHD Drugs. That Made Some Workers Anxious.

Digital companies such as Cerebral and Done seized on looser pandemic rules for prescribing ADHD drugs like Adderall. Some workers said they felt pressure to provide the medication.

www.wsj.com

(subscription required)

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[littlefred]

You have to be a subscriber to read the full article.

I was pretty shocked at the volume that some of these places (they mention Done and Cerebral specifically) are pushing. This excerpt was pretty damning:

"Yina Cruz-Harris, a nurse practitioner at Done who has a doctorate in nursing practice, said that she manages 2,300 patients for Done. Virtually all have ADHD, and virtually all are on stimulants, she said. Dr. Cruz-Harris said she renews each patient’s prescription each month from her New Jersey home, based mostly on forms patients fill out online, sometimes as fast as two renewals per minute. She said that Done pays her a bit less than $10 per patient, working out to around $20,000 in earnings per month.

She said that Done makes it possible for people struggling with ADHD to get a diagnosis and medication more easily than they could via in-person psychiatrists and that she routinely receives notes from patients who say the medication has helped them keep their job, for instance.

'I just feel I’m able to do more because of the company they built,' she said."

From:

Startups Make It Easier to Get ADHD Drugs. That Made Some Workers Anxious.

Digital companies such as Cerebral and Done seized on looser pandemic rules for prescribing ADHD drugs like Adderall. Some workers said they felt pressure to provide the medication.

www.wsj.com

(subscription required)

It's hilarious that they are getting away with murder like this.
The issue is that you can "justify" patients being on these medications. The DEA and/or other agencies are going to have a hard time cracking down on these.

What's needed is re-institution of Ryan Haight act for any scheduled med (except arguably suboxone).

The barrier for entry and receiving medications is so low with these kinds of programs and people wonder what the next crisis will be...?
Stimulants? Benzo's?

 

[watto]

I mean, I can't even write "dexmethylphenidate" twice in less than a minute.
Maybe I should rx more Jornay, it's faster to write.

 

[littlefred]

I mean, I can't even write "dexmethylphenidate" twice in less than a minute.
Maybe I should rx more Jornay, it's faster to write.

Pretty easy with modern EMR's to write refills.
The slow down is the verification application used to verify you are the quack that's supposed to be licensed to practice good medicine.

 

[sloh]

Haha wow. 240k/yr working from home. As an NP.

 

[UTsksk]

2300 patients?!

 

[PikminOC]

Where's the nursing board and dea on this? Drug screen?

 

[splik]

Haha wow. 240k/yr working from home. As an NP.

At $10/patient I don’t see how this is good, even for an NP. It’s outrageous. You’d have to “see” over 12 pts an hour and work 40 clinical hours a week to make that.

 

[calvnandhobbs68]

Haha wow. 240k/yr working from home. As an NP.

I mean you too could do that **** if you had no ethics and I valid DEA license. Just sit down with your coffee and write Adderall refills for 8 hours.

Wonder if her malpractice insurance actually knows what she’s up to.

These companies are also f’ing scams for people who actually have ADHD. For instance, once someone’s stable for me on a stimulant I space them out to q3 months. So you’re only paying to see me 4x a year (we take insurance anyway but even with my self pay patients). These dudes on the other hand make you pay a monthly “subscription” to stay in their system. Like Netflix or something. So if you can’t pay for the subscription anymore, like netflix ya can’t watch movies anymore…or you know get the medication you need to function.
I know a lot of PCPs see stimulant refills monthly but it’s also your PCP so presumably it’d be in network with your insurance.

 

[Psych19]

Just sit down with your Adderall and write Adderall refills for 8 hours.

FTFY

 

[Username2015]

You have to be a subscriber to read the full article.

I was pretty shocked at the volume that some of these places (they mention Done and Cerebral specifically) are pushing. This excerpt was pretty damning:

"Yina Cruz-Harris, a nurse practitioner at Done who has a doctorate in nursing practice, said that she manages 2,300 patients for Done. Virtually all have ADHD, and virtually all are on stimulants, she said. Dr. Cruz-Harris said she renews each patient’s prescription each month from her New Jersey home, based mostly on forms patients fill out online, sometimes as fast as two renewals per minute. She said that Done pays her a bit less than $10 per patient, working out to around $20,000 in earnings per month.

She said that Done makes it possible for people struggling with ADHD to get a diagnosis and medication more easily than they could via in-person psychiatrists and that she routinely receives notes from patients who say the medication has helped them keep their job, for instance.

'I just feel I’m able to do more because of the company they built,' she said."

From:

Startups Make It Easier to Get ADHD Drugs. That Made Some Workers Anxious.

Digital companies such as Cerebral and Done seized on looser pandemic rules for prescribing ADHD drugs like Adderall. Some workers said they felt pressure to provide the medication.

www.wsj.com

(subscription required)

I hope the DEA does something about it.

 

[PsyDr]

At $10/patient I don’t see how this is good, even for an NP. It’s outrageous. You’d have to “see” over 12 pts an hour and work 40 clinical hours a week to make that.

These people are like the corner crack dealers, seeing people in volume. It's just dumb. The entire point of being corrupt is to gain money and influence. There are more lucrative ways to sell your soul. At least the opioid docs made millions.

 

[ObsequiousAplomb]

These people are like the corner crack dealers, seeing people in volume. It's just dumb. The entire point of being corrupt is to gain money and influence. There are more lucrative ways to sell your soul. At least the opioid docs made millions.

Yeah. Based on the online ads Done costs start at $79 a month. I would much prefer to just charge the patient $237 for a 20 minute appointment (if they wanted it to last that long, it is ADHD after all) every 3 months and keep all that for myself instead of making $30 in that time period "seeing" them three times for <30 seconds each month.

The idea of being paid $10 for something the patient is paying $79 for is pretty absurd.

 

[PsyDr]

Yeah. Based on the online ads Done costs start at $79 a month. I would much prefer to just charge the patient $237 for a 20 minute appointment (if they wanted it to last that long, it is ADHD after all) every 3 months and keep all that for myself instead of making $30 in that time period "seeing" them three times for <30 seconds each month.

The idea of being paid $10 for something the patient is paying $79 for is pretty absurd.

It's not just the idea of being low paid. It's the idea of being poorly paid for BS.

No one can perform a psych exam that fast. They know that. But they are choosing to do this work, regardless.

*That company also mails opioids.

 

[nexus73]

This seems like an easy report to board of nursing, assuming that’s how nps are licensed in her state. And this np now has her name out there and I’m sure is easy to find via google. Something like this should just get reported by 100 doctors and nps who read about this egregious practice.

Looks like Christine Wibby is a family nurse practitioner in Utah. Not even a psych np. Possible she works a medical cannabis of Utah as well. Looks like her LinkedIn page has been deleted or made private as you can find it via google but the link doesn’t take you anywhere.

 

[clausewitz2]

It's not just the idea of being low paid. It's the idea of being poorly paid for BS.

No one can perform a psych exam that fast. They know that. But they are choosing to do this work, regardless.

*That company also mails opioids.

It's like a moral injury factory, I imagine impressively efficient for burning people out.

 

[PsyDr]

It's like a moral injury factory, I imagine impressively efficient for burning people out.

I don't know if these providers are concerned with morals.

It's reminiscent of that physician from the documentary, The Pharmacist.

 

[FlowRate]

I mean, I can't even write "dexmethylphenidate" twice in less than a minute.
Maybe I should rx more Jornay, it's faster to write.

Our secure 2FA app takes about 30 seconds to load if I'm lucky. Plus time to review PDMP and click various boxes and type my signature. Typically 45 sec - 120 sec per refill depending how thoroughly I check PDMP and how fast the app and Epic load. It's a major downside to carrying a high stimulant Rx panel. If I had 2000 patients on stims that'd be 4000 minutes per month. That's one and a half work weeks spent refilling stimulants alone.

 

[FlowRate]

These companies are also f’ing scams for people who actually have ADHD. For instance, once someone’s stable for me on a stimulant I space them out to q3 months. So you’re only paying to see me 4x a year (we take insurance anyway but even with my self pay patients).

In private practice yes you need to see people to get income and compensation for the time spent writing their refills. But as an employed doc, my very stable (and reliable/not shady) people are annual. The follow-ups for stable people are the most non-appointments ever.

 

[Jules A]

I guess you don't need 60 minutes for a thorough history or the DSM when there are "advertising algorithms"? Hopefully this article sparks an investigation.

"Terri Squires, a nurse practitioner based in Colorado who has worked for Done for two years, said she has been surprised that most of the roughly 680 patients she sees really do suffer from ADHD, which she attributed to the accuracy of Done’s advertising algorithms.
“They tell me it’s been life-changing,” Ms. Squires said"

 

[VA Hopeful Dr]

In private practice yes you need to see people to get income and compensation for the time spent writing their refills. But as an employed doc, my very stable (and reliable/not shady) people are annual. The follow-ups for stable people are the most non-appointments ever.

You're OK seeing people once/year who are on chronic schedule 2 medications?

 

[clausewitz2]

In private practice yes you need to see people to get income and compensation for the time spent writing their refills. But as an employed doc, my very stable (and reliable/not shady) people are annual. The follow-ups for stable people are the most non-appointments ever.

I try to make a joke out of this by telling people that if they can't think of anything to tell their psychiatrist they are probably winning at life.

 

[FlowRate]

You're OK seeing people once/year who are on chronic schedule 2 medications?

Chronic stimulants, yes. At that point I usually try to repatriate them to their PCP when possible. What function do you get out of seeing them more often than that aside from compensation for your time spent on refills? I review the PDMP to make sure they're not getting multiple Rx or early fills. My nursing staff arranges regular HR, BP, WT, and UDS monitoring.

 

[nexus73]

Chronic stimulants, yes. At that point I usually try to repatriate them to their PCP when possible. What function do you get out of seeing them more often than that aside from compensation for your time spent on refills? I review the PDMP to make sure they're not getting multiple Rx or early fills. My nursing staff arranges regular HR, BP, WT, and UDS monitoring.

But you can’t send in a year of refills. So you have to check PDMP and send in refills every 1-3 months. So you’re doing work but not getting compensated for it. Also not doing drug screens or vitals.

 

[FlowRate]

But you can’t send in a year of refills. So you have to check PDMP and send in refills every 1-3 months. So you’re doing work but not getting compensated for it. Also not doing drug screens or vitals.

Nursing staff arranges the vitals and drug screen separately/automatically and send to me for the final order approval. It doesn't have to happen during an appointment with me. And it's not necessary more than once a year for stable patients anyway.

Nursing staff also pends the stim Rx refills for me and checks that they're caught up on all monitoring requirements. I just have to click the PDMP button, review pdmp, click reviewed, then approve the Rx.

I'm W2. It's slightly more work for myself to see pts annually (~22 minutes max of work outside of an appointment in sum total per year) but I can't justify making someone take half an hour off of work and, if on a HDHP, pay $150+ just to save myself 2 minutes of out-of-appointment work that month. I have 2 hours of paid admin time per day to take care of this sort of thing.

Different story if I was in private practice and doing everything myself and only earning what I bill.

 

[Merovinge]

It's like a moral injury factory, I imagine impressively efficient for burning people out.

The problem here is extrapolating your practice of medicine to expectations of other's practicing medicine. Particularly if you include non MD "prescribers" which seems to be the mainstay of their workforce. I know it's a problem because it's a mistake I make all the time .

Imagine if you will a kid who was a B/C student in high school, gets accepted into a middle tier RN program and works hard, does well and passes their NCLEX. You get to the hospital ward and have a pretty good experience, you are making more than either of your parents at a respectable 80k a year. You start to notice the doctors and administrators seem to wear nicer clothes, drive nicer cars, then you meet some CRNAs who do the same, you think "why not me?". Couple years of night APN school, sign-up to work for a fancy new start-up and soon you think, "man I'm helping way more people than any of these doctors I ever met and making just as much money all from the comfort of my pajamas."

 

[VA Hopeful Dr]

Chronic stimulants, yes. At that point I usually try to repatriate them to their PCP when possible. What function do you get out of seeing them more often than that aside from compensation for your time spent on refills? I review the PDMP to make sure they're not getting multiple Rx or early fills. My nursing staff arranges regular HR, BP, WT, and UDS monitoring.

Quite simply, covering my ass. The DEA limits to 3 months so I see every 3 months. Probably pretty low risk, but as I see all of my other chronic disease patients q6 months it doesn't seem a huge burden.

Plus that's what the majority of the other FPs in town do and I don't want to be the outlier.

 

[FlowRate]

Quite simply, covering my ass. The DEA limits to 3 months so I see every 3 months. Probably pretty low risk, but as I see all of my other chronic disease patients q6 months it doesn't seem a huge burden.

Plus that's what the majority of the other FPs in town do and I don't want to be the outlier.

Makes sense. Other schedule 2's for sure. I usually see someone 6 mo out if they're definitely stable/remission and then annually if they remain that way. All of my colleagues do the same (including for ADHD.) If they're that stable and on relatively simple psychiatric regimen then we're trying to get 'em back with PCP.

 

[Alemo]

These places are disgusting. Not only are patients getting the shaft, but it’s laughing in the faces of all the rest of us “doing due diligence” and “practicing medicine.”

The Cerebral founder Kyle Robertson doesn’t know anything about mental illness. Sure looks cool and trendy though. I don’t know if it’s my fragile ego, but I just keep hearing these people saying “residency and psychiatry are for losers. We’ve found a faster and better way.” Like, my brother in Christ, you graduated from high school in Cincinnati ten years ago. You don’t know anything about anything, sure as hell not behavioral neuroscience! I know I have to step aside though. I’m just a chump doctor who can’t read between the lines and “disrupt markets with valuable diverse synergy of various stakeholders.” Seriously these people will stop at nothing to cheapen every human experience possible if it makes them a buck.

I’m fine with Silicon Valley psychopaths developing app-based platforms with toddler words for names like “Noom” or “Vella” or “Oosha” that help you find live music or pick out rugs or deliver succulents, but it’s a slap in the face when they prey on real people with psychiatric problems, f**k them with drugs they don’t need after a 15 minute evaluation, and then go on television and talk about how they’re helping people.

 

[mistafab]

These places are disgusting. Not only are patients getting the shaft, but it’s laughing in the faces of all the rest of us “doing due diligence” and “practicing medicine.”

The Cerebral founder Kyle Robertson doesn’t know anything about mental illness. Sure looks cool and trendy though. I don’t know if it’s my fragile ego, but I just keep hearing these people saying “residency and psychiatry are for losers. We’ve found a faster and better way.” Like, my brother in Christ, you graduated from high school in Cincinnati ten years ago. You don’t know anything about anything, sure as hell not behavioral neuroscience! I know I have to step aside though. I’m just a chump doctor who can’t read between the lines and “disrupt markets with valuable diverse synergy of various stakeholders.” Seriously these people will stop at nothing to cheapen every human experience possible if it makes them a buck.

I’m fine with Silicon Valley psychopaths developing app-based platforms with toddler words for names like “Noom” or “Vella” or “Oosha” that help you find live music or pick out rugs or deliver succulents, but it’s a slap in the face when they prey on real people with psychiatric problems, f**k them with drugs they don’t need after a 15 minute evaluation, and then go on television and talk about how they’re helping people.

I was about to post this exact sentiment in another thread (related to lifestance).

What a shame how people in suits and monkeys with degrees can cheapen real mental healthcare. Academic places publish "online is non-inferior to in-person," and "NPs provide similar outcomes to MDs" with funding from aforementioned or associated entities thinking they are pushing the literature forward and making a difference. What they are doing is worsening mental health care delivered to patients, bottom line, and causing significant harm. In their vision, psychiatry is a silly app called "psy" on your phone that you can use to text your *mental health practitioner* while waiting in the McDonalds drive through. This is not health care. This is a sham - snake oil wearing the face of accepted medical practice while delivering poorer care.

 

[deleted1100659]

I was about to post this exact sentiment in another thread (related to lifestance).

What a shame how people in suits and monkeys with degrees can cheapen real mental healthcare. Academic places publish "online is non-inferior to in-person," and "NPs provide similar outcomes to MDs" with funding from aforementioned or associated entities thinking they are pushing the literature forward and making a difference. What they are doing is worsening mental health care delivered to patients, bottom line, and causing significant harm. In their vision, psychiatry is a silly app called "psy" on your phone that you can use to text your *mental health practitioner* while waiting in the McDonalds drive through. This is not health care. This is a sham - snake oil wearing the face of accepted medical practice while delivering poorer care.

Ive always thought of the "similiar outcomes between MDs and NPs" along the lines of, driving a 1970s ford escort with 350,000 miles on it vs driving a brand new bentley. Both could get you where you want to go, and you could go with the ford escort, if you don't mind the significantly higher risk of the car imploding on the way there.

A while ago cerebral sent me an email, they are actively recruiting doctors just to sign off on mid levels in states that require it. If you look at their providers they have like four nationwide doctors and like 1,000 nps, lmao.

 

[Merovinge]

Ive always thought of the "similiar outcomes between MDs and NPs" along the lines of, driving a 1970s ford escort with 350,000 miles on it vs driving a brand new bentley. Both could get you where you want to go, and you could go with the ford escort, if you don't mind the significantly higher risk of the car imploding on the way there.

A while ago cerebral sent me an email, they are actively recruiting doctors just to sign off on mid levels in states that require it. If you look at their providers they have like four nationwide doctors and like 1,000 nps, lmao.

Unregulated capitalism being used to guide healthcare, what could go wrong!?

 

[sloh]

If you look at their providers they have like four nationwide doctors and like 1,000 nps, lmao.

Serious?

 

[the5thelement]

Hopefully DEA can revoke their registration like they did in the case of this doctor.

https://www.govinfo.gov/content/pkg/FR-2022-02-11/pdf/2022-02973.pdf

 

[deleted1100659]

Serious?

look at this craziness, their provider list

https://cerebral.com/care-team/prescribers

 

[calvnandhobbs68]

look at this craziness, their provider list

https://cerebral.com/care-team/prescribers

WTF

 

[littlefred]

WTF

I counted 8 MDs. Who wants to count the NP's?

I love how they are just called Cerebral Prescribers. At least they're not hiding that they do just that, prescribe.

 

[deleted1100659]

it legit looks like an army, lol

I counted 8 MDs. Who wants to count the NP's?

I love how they are just called Cerebral Prescribers. At least they're not hiding that they do just that, prescribe.

hmm i went back and counted 6, but one is their CMO and I dont think he prescribes so then 5ish.

But 5 docs...8 docs...vs what 200 nps?

who has the stamina to count all the other "prescribers" lol. This is like that game where theres a huge jar full of jelly beans and you have to guess how many there are...

 

[Bartelby]

I used the browser search function and "cerebral prescriber" is written 1,610 times on that page. If you subtract out the couple of times it is written at the top of the page and the less than 10 MDs I presume that means they have about 1600 NPs listed there.

 

[littlefred]

it legit looks like an army, lol

hmm i went back and counted 6, but one is their CMO and I dont think he prescribes so then 5ish.

But 5 docs...8 docs...vs what 200 nps?

who has the stamina to count all the other "prescribers" lol. This is like that game where theres a huge jar full of jelly beans and you have to guess how many there are...

Counted them using ctrl+f, 1615 prescribers, 8 of them MD's.
Some of the MD's are not in the top, ctrl+f and type in MD.
I looked for DO's found none.

A supervision ratio of 1:200 MD:Midlevel . Sounds about right.

It's hard to crack down on the supervision too as physicians working for these companies have licenses in like 30 states, so fleshing out who is supervising who and in what state can be cumbersome.

I searched one of the MD's in 1 state and only has 2 supervised in the random state I looked at.

Fun exercise.

 

[calvnandhobbs68]

I counted 8 MDs. Who wants to count the NP's?

I love how they are just called Cerebral Prescribers. At least they're not hiding that they do just that, prescribe.

"Our prescribing providers are well-equipped to treat bipolar disorder."
"Our prescribing providers are well-equipped to provide care for alcohol dependence. We offer therapy, counseling services, and medication treatment. Medications we may prescribe for alcohol use disorder include naltrexone, disulfiram, and acamprosate."

Good god.

Uh wtf I also just looked at their FAQ page about payments. So you have to pay an $30/month subscription fee ON TOP of what they're getting from insurance if they're in network with your insurance (including copays). What? So you're paying $360 a year on top of whatever you'd have to pay otherwise to see an NP and possibly whatever random LPC you get to see on there?

 

[the5thelement]

This needs to be reported to state medical boards as well as the DEA. These people are making a mockery of the medical boards / DEA .

Submit a Tip | DEA.gov

www.dea.gov

 

[FlowRate]

look at this craziness, their provider list

https://cerebral.com/care-team/prescribers

I did not expect to learn that I know/knew (acquaintance) their CMO. I knew he was involved in the MH/tech/startup space but didn't think he'd be part of the sleazier side of it.

McLean certainly does state they select for "future leaders of psychiatry" but not sure this is what they had in mind.

Kinda reminds me of "Dr. K" and healthygamer.gg. Dr. K seems somewhat legit but I wonder about the quality of the coaches/coaching his service provides.

 

[littlefred]

This needs to be reported to state medical boards as well as the DEA. These people are making a mockery of the medical boards / DEA .

Submit a Tip | DEA.gov

www.dea.gov

It'll take you easily like 3 months to report all of them.

 

[MacDonaldTriad]

Man asks a woman at a bar "will you sleep with me for a million dollars?"
Woman: "Of course"
Man: "Would you sleep with me for $1?"
Woman: "Of course not, what kind of woman do you think I am?"
Man: "We established that, we are just negotiating price."

This is an example that may be a few standard deviations from the mean, but we should all consider our use of stimulants and our justification for it.

A slight variation on the above joke:

A couple just finished watching "Indecent Proposal" with Robert Redford, Demi Moore, and Woody Haralson.
Husband: "Honey, would you sleep with Robert Redford for a million dollars?"
Wife: "I don't know, a million dollars is a lot of money.....but I think we could come up with it somehow."