A wave of startups are using slick TikTok ads and loosened drug regulations to sell prescription medications for ADHD like Adderall and Vyvanse, raising ethical and legal questions from doctors. In a typical spot from San Francisco-based Done, a young woman swallows a pill from an orange prescription bottle while a caption reads “What it’s like to take ADHD medication.” The ad then moves to a shot of the woman typing on a computer while the phrases “Focusing better,” “Better time management” and “Less anxiety” appear above her head. Another shot then encourages users to “Get affordable ADHD treatment” through Done’s website. Dr. Ravi Shah, a psychiatrist at Columbia University, says the ad is “blurring the line between medication for a clinical indication and a supplement to help improve performance” because drugs like Adderall and Vyvanse are often abused on college campuses and in offices. “The ad makes it seem as though this is what will happen if you take ADHD medications, but whether you actually have ADHD is not necessarily relevant,” he said. Combined with other social media posts and sketchy Google search results, the proliferation of drug ads on TikTok can convince kids to diagnose themselves with conditions they may not actually have, according to University of Colorado psychiatrist Dr. C. Neill Epperson. “I hear parents say, you know, my kid comes to me and says, ‘I think I have ADHD, PTSD, bipolar disorder, etc’… they’re like, where is my kid getting this?” Epperson told The Post. “‘Where are these diagnoses coming from when I haven’t taken my child to a mental healthcare provider? We haven’t even spoken to their pediatrician.’” ‘Advertising’ versus ‘bait’ In addition to potentially drawing in users who are misdiagnosing themselves with ADHD, psychiatrists say that the startups run the risk of attracting people who are looking to get high or flip the pills for a profit. A TikTok ad for another San Francisco startup, Ahead, promises users “a simplified treatment” for ADHD in just three steps: “1. Fill Out An Online Form. 2. Prescriptions Delivered. 3. Appointments are online.” Until recently, users who thumbed over to Ahead’s website were greeted with a list of drugs: Ritalin, Adderall, Concerta and Vyvnase — all prescription stimulants that are restricted by the US government due to their potential for addiction and abuse. Dr. Yamalis Diaz, a child and adolescent psychology specialist at New York University’s Grossman School of Medicine, says flaunting names of medications online runs the risk of encouraging would-be patients to pursue specific drugs. “That is a really, really thin line between advertising and almost baiting,” Diaz told The Post. “Especially among younger patients, they have certain names in their mind.” Legal questions Beyond being ethically questionable, Shah added that Ahead’s practice of naming particular medications rather than just advertising generalized treatment for ADHD risks violating the law. “In my capacity running clinics and advising companies, I would not suggest listing the names of controlled substances as part of marketing,” Shah said. The Post asked the Food and Drug Administration for comment on Ahead’s listing of specific ADHD drugs on Wednesday. The following day, Ahead removed the list of drugs from its website, replacing it instead with a shorter line noting that the site offers “Stimulants (e.g. Adderall).” FDA spokesperson Kimberly DiFonzo refused to say whether the agency had contacted Ahead about the issue, saying, “The FDA does not comment on individual services or websites.” Ahead and Done, which does not appear to list names of specific drugs on its site but does offer controlled substances, did not respond to requests for comment. Medication or therapy? Diaz, the NYU psychologist who works with children, also takes issue with what she calls Ahead and Done’s “medication-forward advertising.” “This could mislead people into thinking the treatment for ADHD is medication,” she said. “When in fact the first line treatment for ADHD should be behavioral therapy before you try meds or behavioral therapy combined with meds.” A third startup, Cerebral, offers both therapy and prescription medications for ADHD and other conditions like anxiety and depression. It previously ran TikTok ads that flaunted ADHD meds but appears to have removed many of them ahead of a Bloomberg exposé published on Friday. Current and former employees told the outlet that Cerebral pushed pills too hard, advertised too aggressively and failed to adequately follow up with patents, potentially creating “a new addiction crisis.” Cerebral did not respond to a request for comment from The Post. Diaz said that physicians responsible for evaluating patients through sites like Done and Ahead might feel pressure to write ADHD drug prescriptions for patients who actually have other conditions like anxiety or depression. “Inattention, difficulty focusing — It’s kind of like a fever. You can’t assume it’s related to one particular thing,” she said. “I also hate for these providers to feel pressured to quote-unquote ‘treat’ ADHD and completely miss or overlook that this person is struggling with another disorder altogether.” DEA rules Every doctor interviewed by The Post for this story said that online health services can help increase access to much-needed treatment for many people — but also cautioned that so-called “telemedicine” can be dangerous without restrictions. In 2008, Congress passed a bill called the Ryan Haight Act, which was named after an 18 year old who died from an opiate overdose using Vicodin pills he was prescribed online. The act made it illegal in most situations for doctors to prescribe “scheduled” drugs such as opiates and amphetamines without first seeing patients in person. However, the DEA changed its implementation of the act in 2020 due to the coronavirus, allowing doctors to prescribe “schedule II through V” drugs — a category that includes narcotics like Adderall and Vicodin but excludes marijuana — through the internet. The measure will remain in place until the public health emergency of the coronavirus is over, according to the DEA. It’s unclear how startups like Done and Ahead, which use the convenience and speed of the internet as a key part of their pitches, will adapt if the DEA reverses the rule. But Yann Poncin, a clinical child psychiatry professor at Yale School of Medicine, says that seeing patients in person is an important part of the process before prescribing potentially dangerous and addictive ADHD drugs. “I for one would be rather uncomfortable with offering controlled substances to someone that I literally never saw and no one in my practice ever saw,” he told The Post. “It’s very concerning.” Poncin also said that the intimate nature of drug ads on TikTok — compared to traditional advertising techniques like TV or magazines — can make it difficult for parents or doctors to monitor what drugs children are being told they should take. “When it gets to that level of targeted marketing, then the rest of us don’t necessarily know about it,” he said. “There’s no way for people to know what other people are experiencing.”
