How Done ADHD Turned a COVID Loophole into a Drug Mill

Does the name Ruthia He mean anything to you?

It should.

She is one of the most influential figures in American healthcare in the 2020s — and she’s now a convicted felon.

The founder of Done ADHD — the telehealth startup that promised effortless ADHD diagnoses and next-day stimulant prescriptions (and somehow is still operating?) — was just found guilty of conspiracy to distribute controlled substances. We’re not talking about over-prescribing. I mean a federal drug distribution case.

If you haven’t been following the trial, the basics are simple: according to prosecutors (and anyone with a functioning brain, sorry not sorry), Done built a model that turned ADHD diagnosis and treatment into a high-velocity subscription product. The company “designed its clinical workflows to increase prescription volume,” and prescribers “were financially incentivized to rubber-stamp diagnoses,” the DOJ alleged.

Here’s how Blake Madden of Hospitalogy summarized it in a detailed account of the story last year that I encourage you to read:

“Done was not a telehealth company with operational problems. It was a stimulant distribution scheme with a marketing budget.”

Done denies that characterization, of course.
The jury didn’t agree.

And here’s why this story matters for you:

Done wasn’t a glitch in the system. Done was the system — pushed to its logical conclusion.

This is what happens when you combine:

What follows is an abbreviated version of the story the headlines aren’t telling. It touches a lot of what I’ve written over the past six months — and it explains even more about how we ended up with the current mess in the American pharmacy landscape.

Lock in.

To understand how Done went from a telehealth startup to a criminal case, you have to go back to 2020.

When COVID shut down in-person medical care, the government temporarily suspended the Ryan Haight Act, the law requiring an in-person visit before prescribing any controlled substance. The most highly regulated controlled substances are classified as Schedule II.

Schedule II includes:

These are stimulant medications with proven medical use — but also high potential for abuse and diversion. They sit in the same DEA category as opioids like oxycodone and fentanyl.

Suddenly, all of them were eligible for telehealth-only prescribing.

No office visit.
No physical exam.
No established patient relationship.

Just a WiFi signal and a shipping address.

Telehealth companies called this “access.”
Stimulant manufacturers called it “growth.”
VCs called it “an opportunity.”
Pharmacists called it “a complete disaster.”

Within weeks, stimulant prescribing exploded.

CDC data shows stimulant prescriptions surged across nearly every demographic. ADHD diagnoses rose 40%+ in young adults from 2020 to 2023.

This wasn’t an accident. It was the predictable result of removing the only meaningful friction point in a system built on friction.

In healthcare, barriers for narcotics exist for a reason. They aren’t moral judgments. They’re safety rails.

Telehealth ripped the rails out and turned the road into Talladega Superspeedway.

Done ADHD launched in 2019 — right before the pandemic — with a pitch that felt like the future:

That pitch would have been impossible under the Ryan Haight Act.

But once the law was suspended, Done went from clever to unstoppable.

ADHD was the ideal product category:

Done’s membership model capitalized on all of it.

You paid $79 a month.
You got a virtual visit.
You received stimulants in days.
And each refill kept your subscription active.

Hospitalogy called it “the Netflix of controlled substances.”
The DOJ called it “a drug distribution operation masquerading as telemedicine.”

I remember a period in 2021 when I couldn’t open Instagram or TikTok without being bombarded by ads diagnosing me with ADHD and promising me an instant fix. If you remove your moral compass and look at it purely from a profit perspective, it was the perfect business model.

Here’s the exact quote prosecutors used in court:

“The defendants prioritized growth and speed over medical judgment.”

That sentence could be the tagline for the entire telehealth boom.

One of the most damning parts of the DOJ’s case: Done’s internal systems were engineered to maximize approvals.

According to court documents:

A real ADHD evaluation requires:

Done’s process reportedly boiled that down to an online form and a short video call.

The prescriber wasn’t the clinician. The prescriber was the throughput constraint.

And what do we do with constraints in tech?

We optimize them.

Every pharmacist remembers what happened next.

By late 2022, DEA manufacturing quotas — the limits on how much amphetamine can be produced each year — were wildly out of sync with demand.

The DEA accused manufacturers of under-producing.
Manufacturers accused the DEA of low quotas.
Both were right. Both were wrong.

But the outcome was the same:

The U.S. ran out of Adderall.
Then Vyvanse.
Then Concerta.
Then everything else.

At C.O. Bigelow, we were playing a daily guessing game with wholesalers. We’d order 500+ tablets and be lucky to receive a single bottle. Most days we got nothing.

Patients were frantic.
Doctors were overwhelmed.
Pharmacies were drowning in script changes.

Every controlled prescription became a scavenger hunt.

And Done’s entire business depended on instant gratification.

They actually weren’t dispensing meds — they were selling access to prescribers. Their scripts were being sent to pharmacies like mine to fill. Which meant Done had no control over the shortage they helped create.

When the shouting got loud enough, regulators finally started paying attention.

By early 2023, The Wall Street Journal, DOJ, and DEA were all asking the same question:

How did a single telehealth startup become one of the largest stimulant prescribers in America?

The WSJ found:

“Some Done prescribers approved prescriptions for hundreds of patients a month.”

One prescriber called it “assembly line medicine.”
Another said they felt pressure to “rubber-stamp diagnoses.”

When employees raised concerns, Ruthia He reportedly declared:

“The first person to go to jail because of this gets a Tesla!”

She knew exactly what she was doing.

This wasn’t a rogue clinic cutting corners quietly.
This was scale. Brash, brute scale.

Meanwhile, patients were posting TikToks about:

Influencers made stimulant use trendy.
Startups made it accessible.
Shortages made it chaotic.
Regulators made it easy.

Done wasn’t alone. You may also remember Cerebral, a competitor, quietly backing away from stimulants under federal scrutiny.

When the indictment hit, the charges were unusually severe.

The DOJ charged He and Done’s top doctor, David Brody, with:

This is the statute used for pill mills.

Not lazy telehealth.
Not over-diagnosis.
Not regulatory sloppiness.

Deliberate drug distribution.

Prosecutors said Done’s stimulant pipeline was:

“Not meaningfully different from an illegal drug operation — only with cleaner branding.”

For a founder of a venture-backed startup, that is not something you want read aloud in a courtroom.

What Done did looks shocking in hindsight.

But nothing they built was unusual in the moment.
(Well… except to me and the other pharmacists at C.O. Bigelow.)

Every part of their model already existed — and still exists — in American healthcare:

Done didn’t invent the loophole.
Done industrialized it.

They created the first true “Stimulant SaaS” company.

And while Done might be done, the game is still being played by countless others.

We didn’t learn a thing.

Here’s the part that angers me most.

There are millions of Americans with legitimate ADHD who:

Once the DOJ intervenes in a drug category, the pendulum swings hard in the opposite direction.

Just like with opioids — where legitimate pain patients were collateral damage — ADHD patients are now facing:

The damage Done did to public trust will take a decade to undo.

Let’s be brutally honest.

ADHD care was a disaster long before Done.

Done dropped an atomic bomb into an already broken system.

And for a lot of patients, it worked — until it didn’t.

Telehealth isn’t going away. It shouldn’t.

But this case will (hopefully) trigger a cascade of consequences:

Mandatory in-person evaluations for stimulants are coming back.

The liability exposure is nuclear now.

Independent pharmacies included.
Chains already have corporate-level stimulant restrictions.
If you take ADHD meds, you’ve probably felt this for the past few years.

Not for safety. Don’t kid yourself.

More hoops.
More delays.
More stigma.

Every platform that leaned on the COVID loophole is now on deck.

Done wasn’t the end.
It was the beginning.

As a pharmacist, I believe ADHD is real.
I believe stimulants help people.
I believe access matters.
And I believe telehealth has an important role in lowering barriers.

But I’ve also been doing this long enough to recognize patterns.

This is no different from:

It’s always the same story:

When demand is high, oversight is weak, and money is everywhere, someone eventually takes the model to its logical extreme.

Done was the blueprint.

We all need to open our eyes.

Ruthia He’s conviction closes one chapter.

But it opens another — a much bigger one.

Because now the government has admitted they know what’s happening.
And every telehealth company, pharmacy, prescriber, PBM, and startup knows it too.

This scandal wasn’t about ADHD.
It wasn’t about telehealth.
It wasn’t even about stimulants.

It was about what happens when healthcare chases convenience faster than it can build guardrails.

And it was about how easily good intentions get swallowed by bad incentives.

Sadly, that’s a line I could use to end this newsletter every single week.

This is American healthcare, after all.

Alec Wade Ginsberg, PharmD, RPh
4th-Gen Pharmacist | Owner & COO, C.O. Bigelow
Founder, Drugstore Cowboy