“It’s an evil drug.”
So says Dam Le, who as a boy was prescribed Johnson & Johnson's blockbuster drug Risperdal while in the custody of the Maryland foster care system.
Dam Le is talking about his experiences with that system. His speech is rapid-fire and at times hard to follow. He recalls he had a difficult time adjusting after he was placed in foster care at the age of fourteen. "My life was messed up," he says. "I didn't want to be there. It was too hard to adjust."
Part1: "An evil drug"
Part 2: "The task of childhood"
One day, he said he was going to kill himself. He assures me he was not serious. "I was joking. What teenager doesn't say things like that?" Nonetheless, the adults around him took his threat seriously enough. He was taken to the mental hospital, where he was diagnosed with depression and prescribed antidepressant medication (he doesn't remember what kind).
The results were disastrous. The antidepressants kicked him into a full-blown mania. He was re-hospitalized for six months and prescribed Risperdal, along with lithium and Depakote. The combination left him heavily sedated and unable to remain awake in class.
Fifteen years later, he still is angry about his experience. "Why would you put a child on something like that?" he asks. "We're 14 years old. We're teenagers. We're kids. We're already stuck by being in the system. Why would you make it worse?"
Stories like these may be more common than people realize. Foster children in the state of Maryland are being prescribed large amounts of psychotropic drugs, including powerful antipsychotics. According to a report prepared by the state Department of Health and Mental Hygiene, the proportion of foster children receiving prescriptions for these drugs exceeds that of other children covered by Medicaid and greatly exceeds that of children covered by private insurance.
The report covers the years 2008-2010. During that time, 30 percent of foster children received prescriptions for psychotropic drugs, as opposed to 9 percent of other children covered by Medicaid. For foster children aged 10 through 17, 39 percent were prescribed psychotropic drugs, as opposed to 15 percent of other children covered by Medicaid and 11 percent of privately insured children.
Total spending on health care was for foster children was higher, as well. The annual per child payment for foster children receiving psychotropic drugs was $9,805, as opposed to $3137 for other children covered by Medicaid who were prescribed these drugs.
In addition, a high proportion of Maryland foster children were prescribed drugs from a class known as antipsychotics. 14 percent of Maryland foster children were prescribed antipsychotic drugs, as opposed to 2 percent of other children on Medicaid and less than one percent of privately insured children.
So-called antipsychotic medications that have been approved for use in children include aripiprazole (Abilify), quetiapine (Seroquel), paliperidone (Invega), olanzapine (Zyprexa), and risperidone (Risperdal). Within the last ten years, the manufacturers of these drugs have paid billions of dollars to settle claims of illegal marketing, including off-label marketing to children.
Earlier this year, a jury awarded $70 million to a boy who grew breasts after taking J&J's blockbuster drug Risperdal.
None of this seems to have harmed these companies' profitability. During the period 1996-2012, prescriptions for antipsychotic drugs for children aged 6-17 rose a whopping 600 percent. By 2008, these drugs had edged out proton pump inhibitors and lipid regulators to become the top-selling drug class in America, and for October 2013 through September 2014, Abilify became this country's single best-selling drug, with a whopping $7.5 billion in sales.
Antipsychotic drugs are also known as major tranquilizers or neuroleptics. The latter term literally means "that which seizes the neuron," an apt description of what these drugs do. Antipsychotic drugs cross the blood brain barrier, causing nerve cell death and atrophy of the brain, along with tardive dyskinesia as well as a dizzying array of other toxic effects. The long term use of these drugs is correlated with a drop in life expectancy measured not in years but in decades.
Despite all this, the psychiatric literature continues to tout these drugs for their "neuroprotective" effects.
David Healy is a Professor of Psychiatry at Bangor University and the author of Mania: A Short History of Bipolar Disorder. In a telephone interview Dr. Healy blasted the idea that antipsychotic drugs exert a neuroprotective effect. "That's a complete myth," he told me. "I know of absolutely no basis for this.
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"What we do know is that the antipsychotics cause tardive dyskinesia. Everybody agrees that they do. Everybody has agreed this for half a century. This is brain damage. Tardive dyskinesia stems from brain damage."
The high rate of antipsychotic prescriptions for Maryland foster kids is especially concerning. The report warns "The long-term efficacy and safety of these agents in the pediatric population has not been well established." Nationwide, over half of Medicaid prescriptions of antipsychotics for children are off-label, meaning the safety and effectiveness for children have not been established for a given indication.
Even preschoolers are not exempt. Two percent of Maryland foster children under the age of five are given antipsychotics--more than twenty times the rate for other children the same age covered by Medicaid. The effect of these powerful tranquilizers on developing brains remains largely unknown. Guidelines issued by the American Academy of Child and Adolescent Psychiatry state "There is almost no data about the use of atypical antipsychotic agents in pre-school aged children."
"It's just really shocking," said Joanna Moncrieff, a psychiatrist of 25 years experience and the author of The Bitterest Pills: The Troubling History of Antipsychotic Drugs. "We know the adverse effects of antipsychotics are more severe in younger people. The idea that you're giving them to a two-year-old with a very vulnerable developing brain is just very worrying."
The Maryland Department of Mental Health and Hygiene report did not provide information about dosages, and most of these drugs are prescribed to children off-label, which means that FDA guidelines for dosage levels are not available. Nevertheless, a 2010 report prepared by the US Agency for Healthcare Research and Quality and a consortium of 16 states found that thousands of Medicaid children and adolescents were prescribed antipsychotic dosages in excess of the maximum defined by the Texas Department of State Health Services guidelines for foster children.
In addition, twenty percent of Medicaid children who were prescribed antipsychotics received prescriptions for two or more antipsychotics in the same calendar year. This may be the result of medication switching, but it also may reflect prescriptions for two or more antipsychotic concomitantly, another violation of the Texas guidelines. In addition, thousands of Medicaid children are being prescribed four or more psychiatric medications concomitantly, yet another violation of the Texas guidelines. The state of Maryland was not included in the AHRQ study.
A 2011 report by the United States Government Accounting Office on psychotropic prescriptions for foster children found that Maryland's foster care data was unreliable and could not be analyzed. The same report found that Maryland was not in compliance with the American Academy of Child and Adolescent Psychiatry guidelines for psychotropic drug prescriptions for foster children. Specifically, the investigators found:
No standard form for obtaining written consent for prescriptions
No statewide training on psychotropic drugs for foster parents
No uniform system to monitor adverse drug reactions
No statewide monitoring of psychiatric interventions for foster children
No statewide program to collect and analyze data on psychotropic medication use in foster children
No consultation program administered by child and adolescent psychiatrists for the person consenting to psychotropic treatment
No program for face-to-face evaluation of youths by child and adolescent psychiatrists at the request of state or county agencies
No website to provide ready access to clinicians foster parents, and other caregivers to policies regarding psychotropic medication management
A 2012 report by the US Department of Health and Human Services on psychotropic medication prescriptions for foster kids noted that, all too often, prescription patterns for foster children deviate from established guidelines: too much, too many, and too young. Last year another HHS report confirmed this and added that much of the time, recommended metabolic monitoring is not performed for Medicaid children prescribed antipsychotics.
"It's hard to find a word for how appalling this is," Dr. Healy opined. "The polypharmacy is in particular truly appalling.
"These drugs are not going to relieve the emotional distress," he added. "They're just going to straightjacket it."
Peter Breggin, a psychiatrist of 48 years experience and the author of Psychiatric Drug Withdrawal, concurred. "These drugs are in fact potent neurotoxins," he stated. "We're poisoning these children and preventing their normal development. It's a catastrophe."
Next: Part 2: "The task of childhood"List of Sources
