In 2020, healthcare experienced radical shifts, the most prominent of which was the rise of telehealth. Clinicians across disciplines were granted permission to examine, diagnose, and treat patients via virtual appointments.
Within the mental health field, this adaptation was met with great enthusiasm. Most psychiatric conditions are not diagnosed through physical exams, and we learned that we could provide patients with the same quality of care virtually as in person. For many of my patients, particularly those with ADHD, the new arrangement wasn’t equal – it was far superior.
As COVID-19 restrictions are behind us, the Drug Enforcement Administration (DEA) continues to debate its position on telemedicine flexibilities, issuing another extension until late 2025. In January, the DEA proposed a new rule limiting clinicians to issuing no more than 50% of their Schedule II controlled substance prescriptions via telehealth. Although this measure aims to curb medication diversion, the policy could have significant unintended consequences, particularly for underserved and rural populations that rely on telepsychiatry for consistent, high-quality mental healthcare.
How Telehealth Facilitates Better Care
The core symptoms of ADHD, including inattentiveness, hyperactivity, and impulsivity, create challenges for patients in scheduling and attending in-person appointments. I have witnessed firsthand how telehealth has improved accessibility for this group of patients. At my clinic, telehealth has decreased missed visits and late cancellations by 72% compared to in-person appointments.
Before telepsychiatry, patients often arrived late for in-person appointments due to forgetfulness or poor time management. Comorbid conditions, such as anxiety or depression, create additional barriers. Many of these challenges are ones we would address during treatment. However, if a patient is unable to reach me, I cannot provide care, which delays treatment.
Since 2021, telehealth has accounted for approximately 5% of medical claims (equating to roughly 75 million claims), with about 70% of these related to mental health conditions. Telehealth eliminates physical barriers to care, greatly enhancing access to a wider range of providers to meet patients’ needs and budgets. Many patients reside several hours away from a clinic or any practitioner who offers mental health treatment. Research from the University of Michigan shows that over 50% of counties in the United States lack a single psychiatrist. More than 75% of my patients live more than two hours away from a central office.
Accessing appropriate care shouldn’t jeopardize one’s livelihood, but for many Americans, an in-person visit may necessitate taking a day off work, resulting in lost income and opportunities. With telehealth, distance from a clinic is no longer an issue. It doesn’t matter if a patient can only spare an hour from work or if agoraphobia makes it difficult to leave home. Everyone receives equal access to care.
The devastating impact of restricting Schedule II prescriptions
The DEA’s proposed rule, which requires that no more than 50% of a clinician’s total Schedule II prescriptions be issued via telehealth, is a catastrophic blow to ADHD care. While intended to limit predatory prescribing behaviors of large corporations, the fallout will unjustly restrict independent telehealth psychiatry clinics like mine from launching, depriving thousands of rural adolescents and adults with ADHD of their trusted providers and further undermining access to mental health care.
The prescription cap is a practice-ending mandate for many providers who cannot afford the high overhead costs associated with a physical office location, further deepening the gaps in behavioral health care in the U.S. ADHD impairs executive function, planning, and organization, and disruption of care risks relapse, symptom exacerbation, and significant harm to patients.
Ultimately, my concerns, along with those of many providers, regarding the proposed rule stem from the DEA’s fundamental misunderstanding of ADHD assessment and treatment.
ADHD is the most treatable mental health disorder in psychiatry. Stimulants are heavily researched, with findings consistently pointing to reduced ADHD symptoms and improved life outcomes. They are not optional; they are the standard of care for ADHD and are recognized as such by the American Psychiatric Association (APA). Early stimulant-based ADHD treatment is even linked to a lower incidence of substance abuse.
Furthermore, embracing available technology could alleviate concerns about misdiagnoses and medication diversion. Objective ADHD assessments are widely used among clinicians abroad and are gaining traction in the U.S. (my practice uses QbCheck). These tests measure the three core symptoms, providing clinicians with hard data to complement traditional subjective ADHD screenings and support a diagnosis.
Research demonstrates the effectiveness of objective testing in guiding treatment decisions, remote monitoring of ADHD medication, tracking symptom regulation, and optimizing treatment outcomes for individuals with ADHD. Regardless of a patient’s preferred treatment method—stimulants, non-stimulants, or other modalities—objective measurements provide a clear understanding of how a patient responds, prompting any necessary adjustments. For certain treatments, such as stimulants, this can be achieved within hours of administering medication, ensuring patients receive optimal care quickly and efficiently. Evidence-based tools enhance the clinical interview and pathway, providing additional safeguards for clinicians and patients in managing and monitoring ADHD treatment to prevent misuse.
Simply put, virtual care ensures people of all backgrounds can access care. Stimulants are not the enemy, and digital technology does not cloud psychiatrists’ professional judgment, especially when data-driven assessments are utilized. In-person treatment is suitable for some individuals, but telehealth is the only accessible option for others. Without the freedom to personalize care, we risk undermining a fundamental requirement for delivering effective, patient-centered care.
Dr. Griffith Jones DMSc, MPAS, PA-C
Diagnosed with ADHD at 8, Dr. Jones has dedicated over a decade to the field of psychiatry, positively impacting thousands of lives through his work in clinical settings, education, and research. As the founder and lead psychiatry provider of Fox Fern ADHD Clinic in Bellevue, Washington, Dr. Jones excels in treating a broad spectrum of psychiatric conditions with a compassionate focus on patients with intersecting neurodivergence.
