As per June 13th, 2022 article by Verywellmind – key discussion was around the ethical concerns at play when mental healthcare in the digital space is now so commonplace, and what effects can (alleged) poor or improper treatment have on patients?
Much of the coverage surrounding possible over-prescription has focused on drugs like Xanax and Adderall in relation to conditions like ADHD. Dr. Benjamin Cheyette (MD, PhD), a professor Emeritus at the University of California-San Francisco and current director of ADHD services at Mindful Health Solutions, says that traditional barriers to mental healthcare are heightened for those with ADHD.
“We don’t have enough providers. The ones that we do have aren’t available everywhere. And so there are a lot of patients who need mental health care who can’t get it because they don’t have access… That’s true across the entire mental healthcare landscape. It is further exacerbated in the case of ADHD because ADHD has traditionally, especially in adults, not been well recognized or a subject of much training for medical providers.”
Alongside issues already facing the patient population, Cheyette points to the relaxing of restrictions contained in the Ryan Haight Online Pharmacy Consumer Protection Act of 2008.
This action, taken in early 2020, was made to allow more flexibility for drugs—like Adderall, which falls under the purview of the DEA as a controlled substance—to be prescribed to patients via telehealth. That decision meant, as Cheyette puts it, that “the genie was out of the bottle,” as much as some in the field may wish to return to previous norms two year late.
Alongside those possible side effects—as Cheyette says, “there’s no free lunch” when it comes to medications—is a real concern that when the appointments don’t have a fully formed patient-practitioner relationship attached to them, certain warning signs may be missed.
Without that in-person element tests related to blood pressure, EKG’s, and other tools meant to check for other drugs in a patient’s system, are likely to go by the wayside. Despite these concerns, Cheyette believes that a portion of the dialogue around these platforms is absent.
“They’re meeting a need. There is a real value that they’re adding by providing access to patients who can’t get it, and that is getting a little bit lost in this conversation, perhaps. Why did this happen? Well, it’s because there are patients out there who need help, who weren’t getting it before.”
Cheyette believes that the responsibility now falls on broader organizations that oversee medical practitioners to formalize a set of standards for the online delivery of mental healthcare.
“What should be appropriate standards of care, and management of patients on a virtual platform? That is a general medical question that I think all of American medicine and worldwide medicine has to now grapple with.”
1 Baney L, Brady J, Stevenson SL. The Future of Telehealth and the Ryan Haight Act Post-Pandemic. National Association of Boards of Pharmacy. Published April 22, 2021.