Telehealth Stimulant Prescribing and Substance Misuse Risk: What the Evidence Really Says

This article reviews two large studies from The American Journal of Psychiatry that evaluated whether telehealth prescribing of stimulants for attention-deficit/hyperactivity disorder (ADHD) increases substance misuse risk. Findings suggest that while overall risk of developing a substance use disorder was not higher with telehealth, patients starting stimulants via telehealth appeared more likely to develop a stimulant use disorder—likely reflecting underlying patient characteristics rather than the telehealth encounter itself.

Telehealth can offer significant benefits in managing patients with ADHD. A recent scoping review reported that telehealth interventions enhance ADHD assessment, treatment adherence, parental education, access to care, and the overall experience for both patients and families.¹ While these findings are promising, they do not address a key concern: whether telehealth prescribing affects the risk of stimulant medication misuse or abuse. This concern is especially relevant because stimulants are controlled substances,² requiring a balance between expanding access and minimizing the risk of misuse when prescribed inappropriately. 

Unpacking the Relationship Between Telehealth and Substance Use Disorders

Two studies published in The American Journal of Psychiatry examined the association between telehealth prescribing of controlled substances and the subsequent risk of developing substance use disorders (SUDs). The first study analyzed electronic health records from 7944 patients aged 12 years and older who received an initial ADHD stimulant prescription between March 2020 and August 2023.³ Approximately half of these patients initiated treatment through telehealth. After adjusting for covariates, researchers found that having a purely telehealth-based relationship, compared with any in-person care, did not significantly affect the risk of developing an SUD (adjusted odds ratio [AOR], 0.85; 95% confidence interval [CI], 0.60–1.20) or stimulant use disorder (stimUD) (AOR, 1.28; 95% CI, 0.34–4.85).³ 

Likewise, a telehealth versus in-person initial appointment for stimulant prescribing was not significantly associated with increased risk of subsequent SUD (AOR, 1.15; 95% CI, 0.92–1.44); however, this comparison did reveal a significantly greater risk of developing stimUD when the initial stimulant prescription was issued during a telehealth appointment (AOR, 6.18; 95% CI, 1.34–28.46).³ According to investigators, the receipt of a stimulant prescription via telehealth may itself indicate an elevated risk for stimUD.³ However, this may not reflect a direct causal effect of telehealth prescribing; rather, it may reflect unmeasured patient characteristics that both increase the likelihood of using telehealth and predispose individuals to stimulant misuse—for example, difficulties accessing consistent in-person care.⁴  

A second study supported these findings through a nationally representative survey of 63 795 adults who had at least 1 health care visit in the 2021-2022 National Survey of Drug Use and Health. In unadjusted analyses, respondents who reported using telehealth had a 25% to 46% higher odds of misusing prescription opioids, benzodiazepines, or stimulants. However, this increased risk was no longer evident after adjusting for prior history of misuse.^4,5 According to the investigators, this suggests that the apparent risks associated with telehealth prescribing are primarily attributable to pre-existing patient vulnerabilities, not to telehealth use itself.

The Bottom Line

Collectively, these findings suggest that telehealth prescribing of stimulants for ADHD does not significantly increase the overall risk of SUDs. Although some subgroups may demonstrate increased stimulant misuse risk, these differences are likely explained by underlying patient characteristics. These findings underscore the need to balance expanded access to ADHD care via telehealth with vigilant monitoring of patients at increased risk for substance misuse.⁴ 

References

1. Susmarini D, Shin H, Choi S. Telehealth implementation for children with attention deficit hyperactivity disorder: a scoping review. Child Health Nurs Res. 2024;30(4):227-244. doi:10.4094/chnr.2024.026
2. Drug Enforcement Administration. Controlled Substances: Alphabetical Order. US Department of Justice, DEA website. Published August 2025. Accessed August 27, 2025. https://www.deadiversion.usdoj.gov/schedules/orangebook/c_cs_alpha.pdf
3. Rao V, Lanni S, Yule AM, et al. Telehealth prescribing of stimulants for ADHD and associated risk for later stimulant and substance use disorders. Am J Psychiatry. 2025;182(8):779-788. doi:10.1176/appi.ajp.20240346
4. Stimulant Prescription Via Telehealth Does Not Increase Substance Misuse Risk, Studies Find. Psychiatric News Alert. June 13, 2025. https://alert.psychnews.org/stimulant-prescription-via-telehealth-does-not-increase-substance-misuse-risk-studies-find