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Sunday 10 June 2012

FOSTER CARE CHILDREN :Senate investigates differential drug rates - psychotropic drug use in foster care system under investigation

Psychotropic Drug Use in Foster Care System Under Investigation

The US Senate Subcommittee on Federal Financial Management has asked the Government Accountability Office (GAO) to investigate the prevalence of prescribed psychotropic medications for children in foster care.  The estimated cost of prescribed medications, often used in the treatment of emotional and behavioural problems, may run to hundreds of millions of dollars each year in the United States alone.  To date, only limited reports are available to determine the actual prevalence of psychotropic medication in foster children.  Experts suggest that foster children are four times more likely to be prescribed antipsychotic or antidepressant medication than other children covered under Medicaid.  One 2003 study of foster children in Florida indicated that 55 percent of children in the foster care system are being administered psychotropic medication although forty percent of those medicated had no history of a psychiatric evaluation..  Another study has indicated that anti-psychotic medication used has increased 528 from 2000 to 2005.  A Texas study from 2004 showed that 34.7 percent of foster children were prescribed at least one psychotropic drug with some children taking five or more. 
Prescribing psychotropic medication for children is especially troubling given the potential risks associated with some types of antidepressant and antipsychotic medication which are believed to increase the risk of suicidal behaviour in adolescents.  The GAO investigation has focused on antidepressants which are often prescribed "off-label" to address symptoms for which the medication has not been approved by the Food and Drug Administration (FDA).     Although Congress has established formal guidelines for medications that qualify for Medicaid reimbursement, the potential for severe side-effects (and even death) remains high.  Medications that are commonly prescribed to children include Prozac, Phenobarbitol, Cymbalta, Mellaril, Effexor, Respiridal, Paxil, and many others.   Doctors prescribing medications to children tend to focus on behavioural problems although case histories are often unavailable when the children are being assessed.
Pharmaceutical companies have been implicated in the widespread use of psychotropic medication in foster children.  Drug companies engage in aggressive marketing campaigns which highlight the potential benefits of certain types of medication while minimizing potential risks for children.  The Law Project for Psychiatric Rights has launched several lawsuits aimed at calling drug companies to account for their marketing practices.  In one example, AstraZeneca has recently paid over $520 million in lawsuits over illegal promotion of off-label use of Seroquel (quetiapine).  A recent Justice Department action against Pfizer led to a $2.3 billion settlement (the largest in Justice Department history) although Pfizer maintains that it did not break the law.
There are no easy fixes for the complex problems that have led to the proliferation of prescription drug misuse in foster care.  Despite recent attempts at passing legislation to oversee the prescribing of medication, the ongoing use of psychotropic medications to control unruly behaviour in foster children seems likely to continue for the foreseeable future.  The long-term consequences of drugging children rather than providing more effective support services seem dire.

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