Antipsychotics and Maryland foster children

Part 2: “The task of childhood”

By —— Bio and Archives--December 2, 2016

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In an attempt to ensure psychotropic medications are being appropriately prescribed to children, the Maryland Medicaid Pharmacy Program has established the Peer Review Program for Mental Health, in collaboration with the Behavioral Health Administration, the University of Maryland Division of Child and Adolescent Psychiatry and School of Pharmacy, and the Johns Hopkins University School of Medicine. Any prescription for antipsychotic medication to any child under 18 is automatically referred to the program.

Part1: “An evil drug
Part 2: “The task of childhood

Dr. Albert Zachik is the Deputy Director, Child and Adolescent Services for the Behavioral Health Administration at the Maryland Department of Health and Mental Hygiene, as well as a member of the clinical faculty in Psychiatry at Johns Hopkins University, Georgetown University, and the University of Maryland. On the last day of October he discussed the ins and outs of the Peer Review Program in a conference call with Dr. Susan dos Reis and Dr. Raymond Love, both of the University of Maryland School of Pharmacy.

“We really want children to not just be medicated but to be in some form of outpatient treatment or therapy in addition to the medicine, and the numbers have been good,” Dr. Zachik explained. “There’s been a decrease in the use of antipsychotic medications in this population over the last several years, since the initiation of this program.

“It really was a quality improvement program,” he added. “The main goal wasn’t whether prescriptions went up or down, it was to be monitoring the care of these young people.”

Dr. Love stated “One of the important things the program entails is regular monitoring of these children. So, if there are side effects, they’re picked up quickly. We want to make sure the drug is employed in a safe manner and that other evidence-based treatments that are non-pharmacological are also in place.”

Asked why so many children in foster care are being prescribed antipsychotics, Dr. dos Reis replied “There are youth in foster care that have had early exposure to trauma.” She added that some of these children can exhibit behaviors that may be harmful to themselves or others, and sometimes the only other alternative is institutionalization. “I think we have to put into context that clinicians are trying to provide the best possible care for these children.”

Is getting down to zero antipsychotic prescriptions a desirable goal? Dr. Zachik declared “I would not say it’s at all desirable, because these medicines can be very helpful—more than helpful sometimes—life-changing for certain children and adolescents. The use of medication should be only one piece of the overall plan for a child, but sometimes certain medicines do need to be used.”

The other experts consulted for the article had a different take on matters. Dr. Healy indicated that while he could not completely rule out the idea that antipsychotic drugs might be beneficial to juveniles under certain circumstances, he asserted that if such circumstances exist, they must be rare. “I don’t think I have ever prescribed antipsychotics to anyone under the age of sixteen,” he said. “Probably not under the age of eighteen, except possibly terribly briefly.”

Dr. Moncrieff noted that she does not treat children in her own practice. She did allow that these drugs might be beneficial to young people caught in the grip of a psychotic episode. “That’s the only legitimate indication I would see,” she said.

“The task of childhood is to learn how to manage unpleasant emotions,” she added. “We need to help children learn techniques to manage their emotions, not just squash them with drugs”

Continued below...

Dr. Breggin was the most blunt in his assessment. “Children should never be given these drugs,” he declared. “It is a shortcut to avoid meeting the real needs of the children. Instead of delivering the services that the family would need to overcome the family dysfunction and the effects of poverty, poor schooling, bad neighborhoods, and bad diet, we drug the children.”

Via email, Athos Alexandrou, Director of the Maryland Medicaid Pharmacy Peer Review Program, indicated that the program does not specifically track the prescribing of antipsychotic medications to foster children, so he was not able to state whether patterns of antipsychotic prescriptions for these children have changed since the DHMH issued its 2012 report.

In another email, a DHMH spokesperson indicated that internal data show a decrease in the number of Maryland Medicaid youth receiving antipsychotics, but was unable to provide further characterization of the data.

On 19 November, the journal Drug Safety published a review of key studies of antipsychotic drugs by Thomas J Moore and Curt Furberg of the Institute for Safe Medication Practices, who summed up matters thusly:

“Antipsychotic drugs impair multiple body systems, including the extrapyramidal motor system, glycemic metabolism, vascular control, and sexual function.

“When beneficial effects on psychosis are measured, the mean improvements in psychosis are minimal, on the order of 20%, accomplished only with co-administration of other psychotropic medications, and rarely sustained over time.

“The findings of substantial harm are robust, and seen in studies of short and long duration, with first- and second-generation agents, and with rigid protocols, and those providing treatment flexibility.”

As for Dam Le: at the age of 19, a blood test revealed abnormal levels of liver enzymes and thyroid hormones, both well-known toxic effects of the drugs he was given. With medical supervision, he was tapered off all the drugs he was taking. Asked if he suffers any lasting effects from the medications, he replies candidly, “I don’t know. I don’t know what the lasting effects would be.”

In the years that followed, he drifted through half a dozen colleges and universities without completing a degree but at the age of 29 seems finally to have gotten his life on track. He is working as a restaurant host and an instructional assistant at a public school while finishing his bachelor’s degree in Organizational Leadership at the Johns Hopkins University. When he graduates, he hopes to work in the foster care system as an analyst.

I ask him why he thinks so many foster kids in Maryland and elsewhere are given powerful antipsychotics like Risperdal. The reason seems obvious to him: “The doctors and the pharmaceutical companies—the more drugs they give out, the more money they make.”

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Patrick D Hahn -- Bio and Archives | Comments

Patrick D Hahn is an Affiliate Professor of Biology at Loyola University Maryland and a free-lance writer. His writing has also appeared in Biology-Online, Loyola Magazine,Popular Archaeology, Natural News,Canada Free Press, and the Baltimore Sun.

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