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 By Joey Garcia, University Communications and Marketing 

In just one click, almost anything can be delivered to one’s front door. Today’s digital landscape offers countless conveniences through instant items and services, including prescription drugs.

USF Professor recent research, published in the , explores the legal and ethical challenges surrounding the prescribing of stimulants through telehealth services. Her work analyzes two cases brought against telehealth companies while also exploring how prescribing patterns shifted during the COVID-19 pandemic, when temporary federal and state exceptions allowed controlled substances to be prescribed without an in-person exam. These exceptions, which significantly altered telehealth practices, have since been extended through Dec. 31, 2026, as the Drug Enforcement Administration considers making the changes permanent.

Drabiak examines how those legal changes shaped business models, prescribing practices and potential impacts on patients, with a particular focus on stimulant prescribing. student Scotty Mooney and Dr. Sylvia Fogel, psychiatrist at Massachusetts General Hospital and instructor at Harvard Medical School, collaborated with Drabiak on the research.

What questions were you trying to answer about telehealth providers prescribing stimulants?

I was looking at whether clinical providers were following both federal and state law when prescribing controlled substances via telehealth, specifically when it came to stimulants. This included examining the legal layers involved and how business structures influenced whether clinical providers complied with these requirements.

Why were the recent federal enforcement actions against certain telehealth‑based prescribing platforms so significant?

These enforcement actions were extremely significant because criminal penalties in this area are rare and generally reserved for the most egregious violations. The charges brought, such as federal drug‑trafficking conspiracy and fraud, are typically applied to illegal drug distributors, not health care entities. In one case, organizational leaders were convicted, which shows how far outside legal boundaries their operations were. 

In another case, federal regulators required substantial financial penalties and repayment for improperly issued prescriptions. What makes these actions important is that they signal the government viewed the prescribing practices as so inappropriate that they rose to the level of criminal activity rather than routine administrative or civil violations.

How did these companies’ business models contribute to inappropriate prescribing?

Some business structures pushed clinicians to prioritize volume over clinical judgment. Providers were expected to see high numbers of patients and issue large numbers of prescriptions, sometimes facing warnings or termination if they didn’t meet those quotas. In some cases, telehealth visits were brief, checklist‑style encounters that didn’t truly assess clinical symptoms. This created an environment where prescriptions were issued quickly and without meeting the legal standard of a legitimate medical purpose.

Why are stimulant medications especially vulnerable to misuse in telehealth‑only models?

There is strong consumer demand for stimulants for non‑medical reasons, such as increasing productivity, staying awake longer or improving focus. Companies recognized this demand and the ease with which people respond to online advertising. The telehealth‑only model made it simple for consumers to click an ad, go through a minimal symptom‑checker process and quickly obtain a prescription, even when it wasn’t clinically appropriate.

Is there a safe and appropriate way to prescribe stimulants via telehealth‑only platforms?

It may be possible, but only with full acknowledgment of the limitations. Removing in‑person visits eliminates important safety measures, such as heart exams, ruling out precautions and conducting drug screenings. Telehealth can still play a role, but it must be used cautiously, with clinicians dedicating adequate time, thoroughly evaluating symptoms and ensuring patients meet proper diagnostic and legal criteria.

What changes or safeguards would improve safety and accountability in telemedicine prescribing?

Clinicians must recognize the power and influence they have over their patients. Regardless of business pressures or consumer demand, the clinician is responsible for prescribing only when it is clinically and legally appropriate. On the business side, companies must design operational models that prioritize patient well‑being over maximizing prescription volume. Growth shouldn’t come at the expense of safe, ethical clinical practice.