Navigating Online ADHD Prescriptions: Medications and Alternatives

Attention Deficit Hyperactivity Disorder (ADHD) is a complex neurodevelopmental condition affecting individuals across various age groups, often continuing into adulthood, causing significant disruptions in daily life [7]. The conventional approach to addressing ADHD symptoms has centered on medications, including stimulants like Adderall XR. However, recent developments have brought to light concerns surrounding online prescription services and inappropriate prescribing or overprescribing [11]. This article explores online ADHD prescriptions and potential alternative treatment using Transcranial Magnetic Stimulation (TMS).

Understanding ADHD: Prevalence and Impact

ADHD, or Attention Deficit Hyperactivity Disorder, is a neurodevelopmental condition that affects people of all ages, often continuing into adulthood. It’s characterized by patterns of inattention, hyperactivity, and impulsivity, which can significantly impact academic performance and social interactions. [7]. Globally, around 85 million people have ADHD. [11]. As a result, researchers have dedicated extensive efforts to unravel the underlying mechanisms of ADHD and explore diverse therapeutic strategies, with a main focus on pharmacological interventions.

Online ADHD Prescriptions: A Growing Concern

The surge in online prescriptions for ADHD medication, especially stimulants like Adderall, has become an alarming issue. A notable case in point is the scrutiny faced by Truepill Pharmacy at the hands of the Drug Enforcement Administration (DEA) over its alleged involvement in the unauthorized distribution of prescription stimulants. Truepill partnered with telehealth firms like Cerebral, aggressively marketing ADHD treatments, particularly Adderall, through online advertisements and social media. Regrettably, the investigation uncovered a significant number of these prescriptions as illegitimate [13]. This situation emphasizes the urgent necessity for regulatory oversight of online prescription services to ensure the safe and responsible dispensation of ADHD medications.

The Downside of Getting ADHD Medication Online

Telehealth visits, which can last as briefly as 30 minutes, are a cause for concern due to the limited evaluation and oversight conducted during these visits. Diagnosing adults with ADHD for the first time is a complex process, as there are many psychiatric disorders that can mimic the symptoms of ADHD, such as anxiety, mood, and psychotic disorders [6]. The COVID-19 pandemic has relaxed regulations that have made remote access to ADHD treatments possible for patients [4]. Nonetheless, this convenience has led to hurried diagnostic assessments and prescription decisions, driven by the pressure to cater to the growing demand for ADHD medication within tight timeframes, potentially jeopardizing patient well-being [4].

Given the substantial increase in privately insured individuals obtaining ADHD prescriptions [4], it becomes imperative to maintain stringent guidelines for organizations to prescribe controlled substances to curtail misuse and overprescribing. The repercussions of overprescribing ADHD medication are extensive, encompassing a heightened likelihood of misuse and diversion, especially among college students seeking cognitive enhancement [12]. This misuse poses substantial public health risks, necessitating vigilant monitoring.

Effects of ADHD Medications

Stimulant medications entail both short-term and long-term side effects, including decreased appetite, insomnia, and growth inhibition in children and adolescents. In cases of adverse effects or intolerance to stimulants, discontinuation and consideration of alternative treatment modalities become necessary [12]. The one-size-fits-all approach may not be suitable for every patient, underscoring the significance of personalized and cautious prescribing practices.

Regulating Prescription Medication

In response to these challenges, regulatory bodies, such as the DEA, have taken significant steps to address the evolving landscape of online ADHD prescriptions, with a primary focus on safeguarding public health. A pivotal milestone in this endeavor is the issuance of an Order to Show Cause to Truepill Pharmacy, signifying a critical move in scrutinizing entities involved in the online distribution of controlled substances. This process aims to determine whether Truepill’s DEA Certificate of Registration should be revoked, potentially disrupting its capacity to handle or distribute controlled substances [13].

The DEA’s warning to Truepill and its unwavering commitment to combat companies profiting from online prescriptions for controlled substances serve as a clear indication of the challenges posed by online pharmacies and telehealth services within the prescription drug landscape [10]. These actions underscore the critical need for unwavering adherence to regulations and standards within the realm of online healthcare services.

Rethinking Online Treatment

As the landscape of online ADHD prescriptions continues to evolve, there is a growing urgency for a thorough reevaluation of existing practices and a renewed focus on patient-centered care. With impending regulatory changes, including the introduction of stricter guidelines for doctors who prescribe stimulant medications to treat symptoms, it becomes imperative for both patients and healthcare providers to take proactive steps to ensure medication continuity. This includes scheduling in-person appointments when necessary and exploring referral options to adapt to the shifting healthcare landscape [5].

Online mental health services like Cerebral have become popular in recent years. However, they need to ensure the safe and effective treatment of conditions like ADHD by balancing convenience with rigorous protocols [4]. In this evolving healthcare landscape, prioritizing patient well-being should always be the topmost concern.

Considerations When Evaluating Stimulant Medications to Treat ADHD

Stimulant medications can be highly effective in managing ADHD symptoms; however, they are not suitable for all people. Several considerations should be made when determining whether stimulant medications are appropriate; these include [12]:

• Misuse and Diversion: Stimulant medications are at times misused, particularly among college students who may seek them for cognitive enhancement rather than medical necessity. This misuse can lead to significant consequences and may be linked to other substance misuse or underlying mental health issues.
• Short-Term Side Effects: Initiating stimulant therapy can result in common short-term side effects, including:
•  Decreased Appetite: Many individuals experience reduced appetite when taking stimulants, which can lead to weight loss, especially in children. Healthcare providers should closely monitor changes in appetite and weight to address this concern effectively.
•  Insomnia: Stimulants can disrupt sleep patterns, causing difficulty falling asleep or staying asleep. Insomnia can lead to daytime drowsiness and negatively impact overall well-being.
•  Long-Term Effects: Prolonged use of stimulant medications, particularly in children and adolescents, raises concerns about potential long-term side effects, such as:
• Growth Impairment: There is a specific concern about the impact of stimulants on the growth of children and adolescents. Extended use may sometimes lead to slower growth rates than expected for their age and developmental stage. Consequently, close monitoring of growth is essential when pediatric patients undergo stimulant therapy.
• Unpredictable and Uncommon Reactions: Some side effects of stimulant medications are unpredictable and rare, meaning they can vary significantly among individuals. These reactions can occur unexpectedly and are challenging to foresee solely based on the drug’s known pharmacological properties. In cases where such uncommon reactions occur, it may be necessary to discontinue the use of the stimulant medication.
• Individual Tolerance: It’s important to recognize that not everyone may tolerate stimulant medications well due to individual variations in response. Patients may have differing reactions influenced by factors like genetics, underlying medical conditions, overall medical history, and concurrent medications. Healthcare providers should closely monitor patients for side effects and assess their response to treatment. When tolerance becomes an issue or side effects are intolerable, adjustments to the medication regimen may be necessary. These adjustments could involve changing the dose, switching to an alternative stimulant, or exploring non-stimulant medications.

While stimulants remain an important cornerstone to treat ADHD, they are not suitable for everyone. Therefore, it is important to speak with a qualified mental health professional and consider non-stimulant ADHD medications or other treatment options.

Exploring Transcranial Magnetic Stimulation (TMS) as an ADHD Treatment

Transcranial Magnetic Stimulation (TMS) is gaining attention as a promising alternative treatment and off-label non-pharmacological approach to treating Attention Deficit Hyperactivity Disorder (ADHD) [8]. TMS is a non-invasive technique that utilizes magnetic fields to stimulate nerve cells in the brain, potentially offering an alternative to traditional medications for managing ADHD symptoms [3].

TMS’s Positive Effects on Attention and Core ADHD Symptoms

Studies have revealed that TMS can have a positive impact on attention in individuals with ADHD. In a randomized controlled pilot study involving adults with ADHD, a single session of high-frequency TMS targeted at the right prefrontal cortex produced a significant improvement in attention within just 10 minutes after the real TMS session, with no notable effects on mood or anxiety [3].

Similarly, a pilot study conducted with adolescents and young adults with ADHD demonstrated symptom improvement over the course of the study, although there was no discernible difference between the active TMS and sham groups. Importantly, this study affirmed the safety of TMS, with no significant adverse events observed, suggesting the need for further exploration in larger controlled trials [14].

Moreover, TMS offers promise as an alternative treatment for ADHD, potentially heralding a brighter future for ADHD management. It has demonstrated its ability to target the core symptoms of ADHD, such as inattention and hyperactivity or impulsivity, by honing in on specific brain regions, particularly the dorsolateral prefrontal cortex (DLPFC) [8].

For instance, a study conducted by Nagy et al. showed significant improvements in ADHD symptoms, especially in inattention and overall symptom severity, in 60 children with ADHD after 15 sessions of TMS over three weeks. These interventions also led to enhancements in the children’s overall functioning [9].

Recent Advances in TMS for ADHD

Recent studies have indicated that repetitive Transcranial Magnetic Stimulation (rTMS) holds promise in improving attention among individuals with ADHD [14]. This represents a significant development, as non-invasive brain stimulation using TMS may offer the potential for long-term relief from ADHD symptoms [1]. Notably, a study focused on adults with ADHD, applying deep TMS to the right prefrontal cortex, demonstrated significant improvements in attention and memory, as evidenced by functional magnetic resonance imaging (fMRI) [2].

While ongoing research continues to investigate the full spectrum of TMS’s potential applications for various mental health conditions, it is crucial to emphasize the optimism surrounding TMS as a compelling alternative for individuals who may not respond well to traditional ADHD medications [8].

Treating ADHD Responsibly

The landscape of ADHD treatment is undergoing significant changes. The challenges associated with online ADHD prescriptions, including concerns about appropriateness and overprescribing, underscore the need for robust regulatory oversight in the digital healthcare realm. While stimulant medications remain a cornerstone in managing ADHD, their potential side effects and misuse risks necessitate careful consideration of alternative treatments like Transcranial Magnetic Stimulation (TMS).

TMS shows promise in targeting core ADHD symptoms, offering hope for individuals who may not respond well to traditional medications. As we navigate these shifts, the paramount concern remains patient well-being and ensuring that treatment choices align with individual needs and circumstances in the ever-evolving ADHD treatment landscape.

Seek Help for ADHD

If you or a loved one are seeking effective ADHD treatment options, don’t hesitate to seek help from a mental health expert. Contact Neuro Wellness Spa today to explore personalized solutions, including Transcranial Magnetic Stimulation (TMS therapy) which targets specific areas of the brain affected by ADHD, in-person and online psychiatry for medication management in adults and adolescents, and talk therapy utilizing a wide range of modalities that have proven to be effective for treating and managing ADHD. Our experienced team is here to help you on your journey towards a better, more focused life. Reach out to us now to start your path toward improved ADHD management and overall well-being. Your brighter future begins with a simple call.

References:

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10. Shelby, L., Blake, D., & Rebecca, T. (2022, December 16). The DEA is alleging Truepill, Cerebral’s former pharmacy partner, broke the law in filling prescriptions for highly regulated drugs. Business Insider. https://www.businessinsider.com/dea-order-truepill-prescriptions-controlled-substances-adderall-illegal-2022-12
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