Many States Trying to Slow Antipsychotic Prescribing to Children

Rob Wipond
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Thirty-one US states have implemented some kind of “prior authorization” policies to try to rein in the unnecessary prescribing of antipsychotic medications to children, according to a research letter in JAMA. However, the impacts of those policies should be studied, because they could be backfiring, stated the researchers.

Over the past two decades, antipsychotic prescribing to children and youth has increased about seven-fold, from an estimated 0.16 percent in 1993-1998 to 1.07 percent in 2005-2009, according to a JAMA press release about the study. “Antipsychotic use is also 5-fold greater in Medicaid-insured youth than in privately insured youth, and occurs mostly for indications not approved by the U.S. Food and Drug Administration.”

Governments have made efforts to rein in the trend. “Such efforts have included age­-restricted prior authorization policies, which require clinicians to obtain pre-approval from Medicaid agencies to prescribe atypical antipsychotics to children younger than a certain age as a condition for coverage,” stated the press release. Sometimes, the policies may even require peer review of specific cases.

Led by University of Maryland researchers, the team reviewed all of the prior authorization policies.

“The researchers found that 31 states have implemented prior authorization policies for atypical antipsychotic prescribing to children, mostly within the past 5 years,” stated the press release. “Most states apply their policies to children younger than 5, 6, or 7 years of age. Only 7 states (Alabama, Kentucky, Maryland, Nevada, North Carolina, Pennsylvania, Tennessee) apply their policies to Medicaid-insured youth up to age 18 years. Seven other states (California, Colorado, Georgia, Mississippi, Nebraska, New York, Washington) have age-restriction criteria that vary by drug entity.”

The authors suggested that the effect of the policies should be examined. “(The) potential unintended consequences of these restrictive policies include inadequate treatment, substitution of potentially inappropriate, off-label psychotropic medication classes such as anticonvulsant mood stabilizers and antidepressants, and administrative burden on prescribers,” stated the press release.

The researchers also argued that more could be done to improve practices. “Medicaid oversight programs should be concerned not only with unnecessary antipsychotic use, but also should ensure adherence to appropriate cardiometabolic monitoring practices at baseline and during antipsychotic treatment, and support access to alternative evidence-based nonpharmacological treatments.”

Examination of prior authorization policies for antipsychotic prescribing to children (JAMA press release on ScienceDaily, March 3, 2015)

Schmid I, Burcu M, Zito JM. Medicaid Prior Authorization Policies for Pediatric Use of Antipsychotic Medications. JAMA. 2015;313(9):966-968. doi:10.1001/jama.2015.0763. (Excerpt)

8 COMMENTS

  1. “the unnecessary prescribing of antipsychotic medications to children, ”

    But there in lies the problem. There is no NECESSARY prescribing of neuroleptic drugs to children. No child in the history of the world ever dropped dead or became sick because they didn’t have one of those brain damaging glorified sedatives in their blood stream. This is why these policies don’t work; because what constitutes “necessary” and “unnecessary” is completely arbitrary and any parent or healthcare professional can argue their case and it’ll be no more or less valid than any other.

    • “There is no NECESSARY prescribing of neuroleptic drugs to” adults, either. These drugs don’t cure or prevent anything, they’re major tranquilizers used to control other human beings. But they can actually create the symptoms of schizophrenia in people too, from drugs.com:

      “… neuroleptics … may result in … the anticholinergic intoxication syndrome … Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures.”

      It’s quite odd that the neuroleptics are known as torture drugs worldwide, and when Russia used them on their political dissidents, this is confessed to be wrong by our country and the APA. But when our government psychiatrists are drugging millions of innocent children on them, it’s A-OK. Those in charge have lost their minds.

      • Someone Else,

        I totally agree with your post. The late and unlamented Soviet Union used psychiatry and psychiatric drugs against dissidents. An individual brave enough to speak truth to power was at risk of being labeled, drugged and abused. But I do not believe that what is going on here (e.g., in the U.S.) is the same; I believe that drugging — especially of children — for profit is much, much worse. The dissidents understood the risk they were taking; they had some choice in the matter (not to speak out). Not much of a choice, but some measure of choice. The children, their parents, and all those who put their trust in institutions that betrayed them (mainstream psychiatry, the FDA, NAMI) have no choice at all. And I say this as someone who is generally right of center, politically speaking.

        • GetItRight,

          I agree the deception is worse – the neuroleptics are fraudulently being marketed as “medicines” in this country, when they are not; they are torture drugs / chemical restraints, and have been known to be just this for decades. And the massive drugging of children is resulting in harm on an almost unfathomable scale in this country.

          The complete betrayal of the American people by mainstream psychiatry, the pharmaceutical industry, the FDA (our own government), NAMI, and the entire mainstream medical community is simply staggering.

          Dante warned the hypocrites would land in the lowest depths of hell, the hypocrites working within these industries and organizations (and even the religions that currently advocate belief in the psychiatric services) wouldn’t likely be written in the book of life, if there is a Jesus, and He chose to pull off judgement day on faith alone today. But us Christians who aren’t profiting from this fraud, and are heartbroken by it instead, do think now would be a good time for this.

          Personally, I’m confused by the “delusions of grandeur” of all these hypocrites. Forcing children onto psychoactive drugs is not acceptable human behavior, forcing any human onto psychoactive drugs is not acceptable human behavior. “For the love of money is a root of all kinds of evil.”

  2. Prior authorization policies vary. Some can come near to prohibiting a drug entirely. Others can be window-dressing, presenting the appearance of regulation to appease people like Mad in America’s readers while doing nothing to interfere with the flood of pharmaceutical profits. The devil is in the details. Reform will have a chance when states and/or the federal government make data available so that researchers can determine which prior authorization policies are effective and which are illusory.