Done and Cerebral are the two names everybody remembers from the great pandemic ADHD telehealth boom, and the story of what happened to them is most of the story of what changed in 2023 and 2024 in this corner of medicine. Both clinics, with real differences in degree, were prescribing stimulants to a very high percentage of intake patients after very short evaluations and very loose diagnostic standards, and eventually the DEA (Drug Enforcement Administration, the federal agency that regulates controlled-substance prescribing) and the DOJ (Department of Justice, the federal prosecutors) noticed and the music stopped.
The pandemic loophole that made it possible
Before COVID, controlled substances generally required an in-person visit before a prescriber could write for them, under the Ryan Haight Act of 2008, which was Congress’s response to the early-2000s era of online pharmacies selling Vicodin to anyone with a credit card. The pandemic triggered a federal public health emergency that waived the in-person requirement for telehealth prescribing, including for stimulants. That waiver was the entire reason online stimulant prescribing could exist at scale. It was supposed to be temporary. It got extended. Then extended again. Then partially codified into a longer transition that we’re still partway through.
The clinics that grew up during that window ran on volume. The economics only worked if the visits were short and the conversion rate to a stimulant prescription was high. Done’s published intake-to-Adderall conversion rate was somewhere in the ninety-five percent range, which is a number that doesn’t make clinical sense for any honest evaluation of ADHD, because not even ninety-five percent of patients who come in convinced they have ADHD actually have ADHD. Anyone in the field who looked at that number and didn’t flinch was either not paying attention or pretending not to.
What changed when the music stopped
The DOJ indicted Done’s CEO Ruthia He in 2024 for what they characterized as effectively a drug-trafficking operation dressed up as a medical practice. Whether that’s the right framing is for the lawyers and the eventual verdict, but the operational reality of Done was a stimulant-prescription machine with a medical license stapled to it. Patients filled out a quiz, a contracted prescriber clicked through the form, and Adderall showed up in their mailbox.
Cerebral cleaned up earlier than Done, pulled back from prescribing controlled substances entirely for a stretch, and now operates a different and more conservative model. They got pulled into a federal investigation, paid settlements, lost executives, and currently exist as a much smaller and more cautious thing than they were in 2022. The brand still exists. The business model isn’t really the same one anymore.
The DEA also issued new rules in 2023 and again in 2024 governing telehealth prescribing of controlled substances after the pandemic emergency lapsed. The short version is that for new patients on Schedule II stimulants like Adderall and Vyvanse (the highest-restriction category short of outright illegal), you eventually need an actual in-person evaluation somewhere in the process, with some exceptions and a longer phase-in than originally proposed. The pure-online stimulant pipeline that existed in 2021 is mostly dead, or at least mostly illegal, depending on how it gets enforced.
What still works on telehealth
ADHD evaluation and ongoing management on telehealth is still completely legitimate and still available, if you find a clinic that’s doing it the way actual medicine gets done. The model that works is one where the diagnostic evaluation is a real evaluation, sixty to ninety minutes minimum and often more, ideally with collateral history from somebody who knew you as a kid (a parent, a sibling, an old report card if anyone kept them). There’s a real prescriber attached to your case who knows your name and your numbers, not a different contractor every visit. And if you’re on a Schedule II medication, there’s an in-person piece somewhere in the process, even if most of the follow-ups are virtual.
Most academic medical centers, most established private psychiatry practices, and a handful of legitimate telehealth clinics (Talkiatry for psychiatric care broadly, Brightside for non-controlled medication, some of the smaller regional groups depending on where you live) are running this version of the model. The twelve-minute intake leading to a Vyvanse script in your mailbox is, mostly, a thing of the past.
Some of the clinics that survived the crackdown shifted toward non-stimulant ADHD treatment, which is a legitimate clinical option that’s been historically underused. Strattera (atomoxetine, the original non-stimulant for ADHD), Wellbutrin (bupropion, an antidepressant that helps a meaningful subset of ADHD), Qelbree (viloxazine, a newer non-stimulant), and guanfacine (an old blood-pressure medication that also helps the irritability-and-attention version of ADHD) all have real evidence behind them. Stimulants work better for most adult ADHD, no question. But for guys with hypertension, history of substance use, anxiety that gets worse on stimulants, or who just don’t want to be on a Schedule II medication for whatever personal reason, non-stimulant treatment is real medicine and shouldn’t be treated as the consolation prize.
The cardiac thing nobody’s quite honest about
Stimulants raise heart rate and blood pressure. That’s not a side effect, that’s the mechanism, and any prescriber who tells you stimulants are essentially risk-free in cardiac patients is being a damn liar. For most guys with healthy hearts the risk is small and the medication is worth it. For a guy with hypertension that isn’t well-controlled, a guy on three cardiac medications already, a guy with a history of arrhythmia (irregular heart rhythm) or any structural heart issue, the first-time stimulant conversation is genuinely fraught and shouldn’t get glossed over to keep the appointment short. The honest version is: there’s risk, here’s what we’d watch, here’s the heart workup we’d want first, and here are the non-stimulant options if the workup doesn’t come back clean.
This is one of the things the volume-clinic model couldn’t do, because the volume-clinic model didn’t have the appointment time to do it. A real evaluation includes a real conversation about cardiac risk for any patient who has any cardiac history at all, and skipping that conversation is a corner the field has been quietly cutting for years.
The pattern after the crackdown
The kind of guy who walks in after his Done prescription bounced is usually a guy who genuinely had ADHD and had genuinely been on the right medication, just at a higher dose than he needed and with no real oversight. The Done model wrote prescriptions, but it didn’t titrate, didn’t adjust, didn’t push back when the patient complained about being “still tired” and asked for more. So the typical post-Done arrival is a guy on thirty milligrams of Adderall IR (the immediate-release short-acting version, taken twice daily) who probably should have been on Vyvanse fifty milligrams once a day, sleeping better, with an evening that isn’t agitated.
Say you’ve got a guy like that. A real evaluation, an ASRS questionnaire (the Adult ADHD Self-Report Scale), a structured clinical interview, collateral history from a partner or an old teacher report or report cards from elementary school, and a real conversation about cardiac and substance-use risk. Usually the diagnosis holds. Done had been giving him the right medication, basically. They’d also been giving him a dose that was higher than he needed (the original prescriber had bumped him up after a single complaint of “still tired” and never adjusted again) and had never reassessed. Switching to a single Vyvanse morning dose, lower total daily milligrams, fewer pills to remember, evenings that calm down, sleep that comes back. Same ADHD, fewer side effects, less medication, a wife who’s happier with the evening person. The Done version was real medicine done badly. The current version is real medicine done by somebody actually paying attention.
Wait, can you say “real medicine done badly” about a clinic the founder’s been indicted over? Sure, because that’s roughly what it was… not really a fraud against people who didn’t need stimulants, more a failure to titrate and reassess for people who mostly did. The fraud part is for the courts to sort out, and the clinical part is what whoever picks up the patient afterwards has to clean up.
What’s nice to hear, in case you’re stuck somewhere in this story
If your online ADHD clinic disappeared in 2023 or 2024 and your refill bounced and you’ve been quietly struggling since then, you weren’t the problem. The model was the problem, and the fact that the model collapsed doesn’t make your ADHD less real. Real telehealth ADHD care still exists, you just have to find a clinic that’s doing it properly, which usually means a longer wait and a higher initial fee than the volume-clinic model had. Most adults who actually have ADHD will do fine on a stimulant once they get to a real prescriber, and most of those prescribers don’t mind doing telehealth as long as they get to do one in-person visit a year. The pain in the ass of dealing with the pharmacy every month is real, but it’s not worse than the alternative.
Done’s intake-to-Adderall conversion rate was somewhere in the ninety-five percent range, which is a number that doesn’t make clinical sense for any honest evaluation of ADHD.
Bottom line
The era of the twelve-minute Adderall script is over and most psychiatrists are not sad about it. The era of legitimate ADHD telehealth is alive and reasonable, just slower and more careful than the version that just collapsed. Find a clinic that does a real evaluation, takes the cardiac question seriously, knows your name across visits, and is willing to send patients home empty-handed when ADHD isn’t actually what they have. A clinic willing to say no to the wrong patient is the kind of clinic worth trusting when they say yes to you.
Sources
- Cortese S, Adamo N, Del Giovane C, et al. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder. Lancet Psychiatry. 2018;5(9):727-738. PMID 30097390.
- Drug Enforcement Administration. Telemedicine Prescribing of Controlled Substances When the Practitioner and the Patient Have Not Had a Prior In-Person Medical Evaluation. Federal Register, 2023-2024 rulemaking.
- Mayes R, Bagwell C, Erkulwater JL. The transformation of mental disorders in the 1980s. J Hist Behav Sci. 2008;44(4):344-362.