Venture-backed telemental health care companies are creating a new opioid epidemic

The phrase sounds dramatic, maybe even rude enough to spill coffee on a venture capitalist’s Patagonia vest. But the warning is not that online mental health companies are literally causing another opioid crisis pill for pill. The warning is that some venture-backed telemental health care companies have repeated the same dangerous pattern that helped fuel earlier prescription-drug disasters: rapid growth, weak oversight, aggressive marketing, pressure on clinicians, and a business model that can reward prescriptions more than patient care.

Telehealth itself is not the villain. In fact, virtual behavioral health care can be a lifeline for people in rural communities, patients with disabilities, parents who cannot leave work, and anyone who has ever tried to find an in-network psychiatrist before the sun burns out. The problem begins when care is redesigned as a subscription funnel, diagnosis becomes a conversion event, and controlled substances become a retention strategy.

In the United States, the concern has centered especially on prescription stimulants such as Adderall, benzodiazepines for anxiety, and other controlled medications that require careful evaluation and follow-up. These are legitimate medicines when prescribed appropriately. They are also drugs with real risks of misuse, dependence, diversion, and harm. That is why the comparison to the opioid epidemic matters: not because the drugs are identical, but because the incentive structure can look uncomfortably familiar.

What “the new opioid epidemic” really means

The opioid epidemic was not created by one bad actor, one bad doctor, or one bad pill bottle. It emerged from a system that normalized overprescribing while downplaying risk. Pharmaceutical marketing, financial incentives, patient satisfaction pressure, fragmented care, and regulatory blind spots all played a part. By the time the public understood the scale of the problem, communities were already buried under addiction, overdose, grief, and lawsuits.

Today’s telemental health boom is different in important ways. Most online mental health providers are not pushing opioids. Many are trying to expand access to therapy, psychiatry, and medication management. However, some high-growth platforms have shown how quickly a digital clinic can become a prescription engine when venture capital demands hockey-stick growth.

The most dangerous version of the model works like this: ads target anxious, distracted, exhausted people; a short online intake promises fast answers; a subscription begins; a clinician is squeezed into a brief appointment; medication becomes the product that makes customers stay; and the company tracks metrics that look suspiciously like sales performance. That is not modern medicine. That is a drive-through with a stethoscope.

Why venture capital changed the mental health waiting room

Mental health care in America has long been slow, expensive, and hard to access. Venture-backed companies saw a giant opening. They promised convenience, lower friction, friendly branding, and care from a phone. For many patients, that promise was attractive because the old system often felt like calling a therapist, leaving a voicemail, and waiting three presidential administrations for a reply.

The pandemic supercharged the shift. Emergency telemedicine rules made it easier for qualified clinicians to prescribe controlled substances without an initial in-person visit. That flexibility helped many patients maintain care during a public health crisis. It also created a market opening for digital clinics that could scale faster than traditional practices.

Investors loved the math. A traditional psychiatric practice grows slowly because clinicians have limited hours. A digital platform can grow through ads, software, centralized operations, and subscription billing. But medicine is not a streaming service. You cannot safely “optimize” diagnosis the same way you optimize a checkout page for wireless earbuds.

The prescription button problem

A core tension in venture-backed telemental health care is simple: patients want relief, clinicians need time, and companies want revenue. In a healthy system, clinical judgment wins. In a broken system, speed wins.

Conditions such as ADHD, anxiety, depression, insomnia, and trauma can overlap. Poor sleep can look like ADHD. Anxiety can look like restlessness. Depression can look like low motivation. Substance use can hide behind symptoms of stress. A good evaluation often requires history, screening, collateral information, follow-up, and careful monitoring. When a platform compresses that process into a quick virtual visit, risk rises.

The issue is not that online diagnosis is always invalid. Telepsychiatry can be clinically appropriate. The issue is that controlled-substance prescribing requires guardrails. Stimulants can improve attention and functioning for patients with ADHD, but they can also be misused or sold. Benzodiazepines can calm panic, but they can also cause dependence and dangerous interactions. Ketamine-based services can help select patients, but they require careful protocols. In short, the medicine cabinet is not a growth hack.

Case study: Cerebral and the danger of prescription metrics

Cerebral became one of the most visible examples of the promise and peril of venture-backed mental health care. The company grew rapidly by offering online access to medication management and therapy. Federal authorities later said the company engaged in business practices that encouraged the unauthorized distribution of controlled substances from 2019 to 2022.

According to the U.S. Department of Justice, Cerebral monitored prescription-related metrics, including how often patients received prescriptions after initial visits and how often certain ADHD patients received stimulant prescriptions. The government said the company had not consulted its clinical advisory board before implementing campaigns intended to improve those metrics. Cerebral eventually entered into a non-prosecution agreement and agreed to pay more than $3.6 million.

The lesson is not “never use online psychiatry.” The lesson is that when a company treats prescribing rates like sales targets, the exam room starts to smell like a quarterly earnings call. That is exactly the kind of blurred incentive that public health systems should fear.

Case study: Done and the Adderall distribution scandal

Done, another digital ADHD company, drew even sharper federal attention. The Justice Department described it as the first criminal drug distribution prosecution involving a digital health company that distributed controlled substances through telemedicine. In 2025, federal prosecutors announced convictions of Done’s founder and clinical president for their roles in a scheme involving illegal distribution of Adderall and health care fraud.

Prosecutors alleged that the company used social media advertising, subscription payments, and short online encounters to drive access to stimulants. The allegations and convictions matter because they show that regulators are no longer treating questionable telehealth prescribing as a quirky side effect of innovation. They are treating it as a controlled-substance enforcement problem.

That shift should send a loud message to digital health founders: if your “care pathway” depends on making addictive or abusable medications unusually easy to obtain, you are not disrupting health care. You are volunteering for a courtroom tour.

The data signals are complicated, but not comforting

The evidence does not support a lazy conclusion that all telehealth stimulant prescribing is reckless. Some research suggests that telehealth initiation of stimulants may not independently increase new substance use disorder diagnoses for most patients after controlling for psychiatric complexity. That nuance matters. Public policy should not punish legitimate patients who benefit from accessible care.

At the same time, prescribing patterns changed dramatically during and after the pandemic. Studies have found increases in new prescriptions for behavioral health medications, including stimulants and nonstimulant ADHD drugs. CDC data also show that millions of U.S. adults report current ADHD diagnoses, with many using telehealth for ADHD-related services. Meanwhile, medication shortages have made life harder for patients who rely on legitimate prescriptions.

The correct conclusion is not panic. The correct conclusion is vigilance. When demand rises, access expands, and profit-driven platforms enter the market, the system needs better monitoringnot a nap with noise-canceling headphones.

Privacy scandals reveal the other growth engine

The prescribing controversy is only half the story. Digital mental health companies also collect some of the most sensitive data a person can share: symptoms, diagnoses, medication history, panic attacks, addiction concerns, sexual health details, family trauma, payment information, and browsing behavior. In a traditional clinical setting, patients assume that information is locked down. Online, the privacy picture has often been messier.

The Federal Trade Commission has taken action against several digital health and mental health companies over alleged misuse or disclosure of sensitive health data. Cerebral, BetterHelp, GoodRx, and Monument have all faced federal scrutiny or settlements related to health information and advertising practices. These cases highlight a disturbing truth: in digital health, user data can become a second product.

That matters for controlled substances because advertising and prescribing can reinforce each other. A platform that knows what symptoms users report can target, retarget, nudge, and convert. The line between patient education and demand generation can get blurry fast. And when the patient is vulnerable, distressed, or desperate for help, that blur is not just a marketing issue. It is an ethical one.

Why patients are vulnerable to the “fast diagnosis” promise

People do not usually seek mental health care because life is going fabulously. They seek help because they cannot focus, cannot sleep, cannot stop worrying, cannot get out of bed, cannot stop drinking, or cannot keep pretending everything is fine. A platform promising quick answers can feel like rescue.

That emotional context makes aggressive marketing risky. A person who has struggled for years with attention problems may click an ADHD ad hoping finally to be understood. A person with panic attacks may want immediate relief. A person with burnout may confuse exhaustion with a disorder that requires stimulants. Good clinicians slow the process down enough to ask the right questions. Bad systems speed it up because friction kills conversion.

The best mental health care does not simply ask, “Which medication can we ship this person toward?” It asks what else is happening: sleep, trauma, work stress, substance use, medical conditions, family history, previous treatment, and safety risks. Sometimes the right answer is medication. Sometimes it is therapy. Sometimes it is both. Sometimes it is a different diagnosis entirely.

Telehealth can be part of the solution

It would be a mistake to respond to these scandals by throwing telehealth into the nearest digital dumpster. Virtual behavioral health care can reduce stigma, shorten travel time, improve continuity, and connect patients to specialists they could not otherwise reach. It can also support treatment for substance use disorders, including access to medications that reduce overdose risk.

The challenge is to separate good telehealth from reckless telehealth. Good telehealth uses licensed clinicians, adequate appointment times, evidence-based screening, state prescription drug monitoring programs, careful follow-up, privacy protection, emergency protocols, and transparent pricing. Reckless telehealth hides behind cute branding while pushing clinicians toward volume, renewals, and prescription-friendly workflows.

The difference is not whether the visit happens on a screen. The difference is whether the company respects medicine more than metrics.

What responsible regulation should look like

Regulators should avoid two extremes. One extreme is a free-for-all where online platforms can prescribe controlled substances with minimal oversight. The other is a rigid crackdown that cuts off legitimate patients from care, especially in underserved areas. Smart policy should protect access while targeting dangerous incentives.

1. Require stronger clinical governance

Digital mental health companies should have independent clinical leadership with real authority, not decorative advisory boards displayed like houseplants. Clinical leaders should be able to stop marketing campaigns, change workflows, and overrule growth teams when patient safety is at stake.

2. Audit prescribing patterns

Regulators, payers, and companies should monitor unusual prescribing rates, rapid dose escalation, high refill volumes, and geographic clusters. Outlier detection should not be used to punish careful clinicians; it should identify systems where prescribing looks more like sales performance than medical judgment.

3. Protect clinician independence

Clinicians should not be rewarded for prescribing more medication, retaining more subscribers, or completing visits at unsafe speeds. Compensation models should support quality, follow-up, documentation, and patient outcomes.

4. Strengthen privacy rules

Mental health data should not be used casually for advertising. Patients should not need a law degree, a magnifying glass, and a backup therapist to understand where their information goes. Consent must be meaningful, not buried under a button that says “continue.”

5. Preserve access for appropriate care

Patients who benefit from telepsychiatry should not be abandoned because some companies behaved badly. The goal should be safer access, not less access. A rural patient with ADHD, depression, or opioid use disorder deserves care that is both reachable and responsible.

Conclusion: innovation without guardrails is just speed with better branding

Venture-backed telemental health care has shown both the best and worst of American health innovation. At its best, it can bring help to people who were locked out of the old system. At its worst, it can turn vulnerability into a customer acquisition strategy and controlled substances into subscription glue.

The warning in the title is intentionally sharp because history is sharp. The opioid epidemic taught the country that prescribing systems can become public health disasters when risk is minimized and revenue is maximized. Today’s digital mental health industry still has time to choose a better path.

The future should not be anti-telehealth. It should be anti-exploitation. Patients need access, but they also need careful diagnosis, privacy, follow-up, and clinicians who are not quietly managed by dashboards. Mental health care can be digital without becoming dangerous. But only if companies remember that the person on the other side of the screen is not a monthly recurring revenue unit. They are a patient. Start there, and the whole business model gets a lot less creepy.

Experience notes from the front lines of digital mental health care

The lived experience around venture-backed telemental health care is rarely simple. Many patients describe online care as the first time they felt someone finally listened. A college student who has spent years losing assignments, missing deadlines, and being called lazy may feel enormous relief after an ADHD evaluation. A single parent with anxiety may prefer a video visit after bedtime because driving across town for therapy is not realistic. For these people, telehealth is not a Silicon Valley toy. It is the only door that opened.

But other experiences reveal why the model worries clinicians, pharmacists, and regulators. Some patients report feeling rushed through intake forms and short appointments, then leaving with medication but little explanation. They may not understand side effects, storage rules, dependence risks, or what to do if symptoms worsen. A prescription can feel validating at first, especially when the patient has been searching for an answer. Later, the same patient may wonder whether anyone truly evaluated the full picture.

Clinicians inside high-growth platforms have faced their own pressure. In a careful psychiatric visit, the provider may need time to ask about sleep, trauma, substance use, heart history, family history, previous diagnoses, and current medications. In a platform built around speed, that time can feel like a luxury. The clinician may be told the company values quality while the dashboard quietly worships volume. Nobody says, “Please prescribe more so our retention improves.” The message can arrive in softer language: improve completion rates, reduce friction, keep patients engaged. Translation: do more, faster, with fewer awkward pauses.

Pharmacists also experience the fallout. When many prescriptions arrive from unfamiliar online clinics, they must decide whether the prescription fits legitimate medical practice. That is not easy. Pharmacists are not trying to ruin anyone’s day; they are legally responsible for spotting red flags. Patients, meanwhile, may feel humiliated or angry when a pharmacy questions a medication they believe they need. The result is a triangle of frustration: the patient wants treatment, the prescriber may be hard to reach, and the pharmacist is stuck playing safety inspector at the end of the conveyor belt.

Families experience the uncertainty too. A parent may be grateful that a teenager can see a clinician online, yet nervous about a stimulant prescription after a brief visit. A partner may notice mood changes, appetite loss, insomnia, or escalating use and wonder whether the platform is monitoring anything beyond the next refill. These are not arguments against medication. They are arguments for care that keeps paying attention after the credit card clears.

The best experiences share a pattern: the clinician takes time, explains options, checks risks, schedules follow-up, coordinates with other providers when needed, and treats medication as one tool rather than the whole toolbox. The worst experiences share a different pattern: ads create urgency, intake feels automated, appointments feel thin, prescriptions arrive quickly, and follow-up becomes a customer-service ticket. That gap is where the next public health crisis could grow if the industry refuses to learn from the last one.