## Telehealth, ADHD, and Controlled Substances: A Journey Toward Accessible and Secure Care

The current state of telehealth in the United States, specifically regarding behavioral health and Attention Deficit Hyperactivity Disorder (ADHD) management, stands at a critical juncture. With the temporary prescription waivers for telehealth, first introduced during the COVID-19 pandemic, now facing potential expiration, the consequences for millions of Americans needing ADHD treatment are extensive.

This situation underscores the balance between ensuring the safety of patients and providing accessible medical care to underserved communities. In this light, the expertise of physician executive Dr. Mikkel Hansen and his efforts to enhance ADHD care through technology and data present a promising perspective for the future of telehealth.

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### **The Telehealth Environment and the Impact of Waivers**

The telehealth waivers established by the U.S. Drug Enforcement Administration (DEA) during the pandemic temporarily removed the requirement for in-person visits when prescribing controlled substances like ADHD medications. These waivers enabled millions of Americans to receive vital behavioral health care services remotely. However, as the expiration date approaches, significant apprehensions have emerged regarding a reinstatement of in-person requirements.

The in-person visit mandate—set forth by the 2008 Ryan Haight Act prior to these waivers—plays an important role in regulating prescriptions of controlled substances such as stimulants for ADHD. Yet, for countless individuals in the U.S., especially those residing in mental health care deserts, face-to-face appointments present a major obstacle. This issue is further complicated by the ratio of around 350 patients for each mental health provider, leading to a mismatch between the demand for in-person services and the availability of clinicians.

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### **The Surge in ADHD Diagnoses and the Self-Diagnosis Epidemic**

ADHD diagnoses throughout the U.S. have seen a notable increase, spurred by a rise in societal awareness often linked to platforms like TikTok. While this increased awareness can improve identification and treatment, it has also led to a rise in self-diagnosis and misinformation. This can result in inappropriate treatments, making it harder for clinicians to distinguish between legitimate diagnoses and unsupported self-reported assessments.

This trend heightens the urgency to refine ADHD diagnostic procedures and ensure that patients truly in need of care receive appropriate treatment, while also addressing potential misprescribing or misuse of stimulant medications.

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### **The Argument for Objective Measures in ADHD Diagnosis and Monitoring**

Diagnosis of ADHD is largely a subjective process, often based on self-reported symptoms, clinician evaluation, and questionnaires. However, Dr. Mikkel Hansen posits that the incorporation of objective measures facilitated by technology could transform the ADHD diagnostic process, treatment monitoring, and secure prescribing practices.

Dr. Hansen’s company, QB Tech, has developed FDA-cleared tools that integrate objective testing into ADHD care. These assessments quantify the core symptoms of ADHD—hyperactivity, impulsivity, and inattention—through rigorous, data-driven evaluations. Here’s how it works:
– Patients perform a task necessitating sustained attention for 15-20 minutes while their movements and response times are captured in real-time.
– The resulting metrics are then compared to a database of same-age and gender peers, offering clinicians a standardized and objective assessment of the patient’s performance.
– This technology can objectively track treatment advancements, such as improvements from stimulant medications like methylphenidate, within hours or via long-term monitoring.

By providing consistent and quantifiable information, such tools are instrumental in reducing errors arising from subjective accounts, whether they originate from patients or clinicians. They also empower clinicians to determine whether prescribed ADHD medications effectively alleviate a patient’s symptoms, thereby minimizing the risk of unnecessary or ineffective treatments.

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### **Challenges of a Face-to-Face Requirement**

Mandating in-person evaluations as a condition for controlled-substance prescriptions often worsens access disparities. Many individuals exhibiting symptoms of ADHD already encounter difficulties related to disorganization and planning—central symptoms of the disorder—which can make scheduling and attending in-person appointments challenging. These challenges are even more pronounced for those living far from mental health providers, who may find travel and logistics to be significant deterrents.

The withdrawal of telehealth waivers could disproportionately impact already vulnerable groups, including individuals in low-resource, rural, or underserved urban areas.

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### **A Vision for Lasting Solutions**

To protect the future of ADHD care while ensuring continued access to telehealth, Dr. Hansen and other authorities advocate for the following essential solutions:
1. **Centralized Prescription Monitoring Systems:**
A national prescription database could enhance transparency and deter patients from engaging in “doctor shopping” for controlled substances. This system would furnish clinicians with a full history of patient prescriptions, safeguarding against medication misuse.

2. **Incorporation of Objective Testing in ADHD Care:**
By standardizing validated, objective tools within ADHD diagnosis and treatment monitoring, clinicians can make informed, data-driven decisions that promote accuracy and safety in prescribing practices.

3. **Hybrid Telehealth and In-Person Models:**
While some patients may profit from occasional face-to-face evaluations, telehealth platforms should retain a