Amid growing criticism about the over-prescription of psychotropic medication in foster care, Pennsylvania commissioned PolicyLab to conduct an analysis of the use of psychiatric drugs among all of the state’s Medicaid-enrolled children. The report, released in June, found that the rates of psychotropic prescriptions among youth in Medicaid and foster care are higher than previous estimates.
In an interview with Medscape, the study’s authors discussed their results. “We are concerned that doctors are turning to psychotropic medications because they are more readily available and easier to access than nonpharmacologic interventions,” Kathleen Noonan, codirector of PolicyLab, wrote. “These medications with less evidence behind them are more plentiful than proven therapies.”
To determine the trends of psychotropic medication use in Pennsylvania’s Medicaid program, the researchers analyzed patient data on youth age 3-18 from 2007 to 2012. They examined the records for foster care status, the use of any psychotropic medication, the use of antipsychotics, and the diagnoses of children receiving polypharmacy.
They found that youth in foster care were prescribed psychotropic drugs at nearly three times the rate (43%) of other youth on Medicaid (16%). Those in foster care were also four times more likely to be prescribed an antipsychotic (22% vs. 5%) and four times more likely to receive polypharmacy, the prescription of multiple classes of medications simultaneously (12% vs. 3%).
The researchers point out that the majority of youth prescribed antipsychotics only had a diagnosis of ADHD. A diagnosis for which antipsychotics are neither clinically recommended nor FDA approved. This is also concerning because “antipsychotic medications are associated with serious side effects in youth” and those with an ADHD diagnosis “receive significantly fewer behavioral health visits than youth with more severe behavioral health impairments, and thus, may not be receiving adequate medication monitoring.”
In an interview for Medscape, the authors make varying suggestions about how to bring down these prescription rates.
Noonan, a lawyer, suggests policy reform. While she notes that most states have yet to make such changes, she suggests laws “related to the use of psychotropic medications in children; the use of multiple medications; the use of medications in very young children; or the identification of prescribing red flags, such as the use of antipsychotics for a nonindicated condition.”
David Rubin, a pediatric specialist, disagrees. “We can focus on restricting authorization for antipsychotics,” he writes, “but at the end of the day, we are not going to get ourselves out of this crisis without a serious discussion about trying to provide other therapies for children who have been traumatized.”
Public health researcher Meredith Matone proposes a switch to specific therapies that can be offered instead of prescription drugs. “Evidence-based and trauma-informed nonpharmacologic therapies, such as parent/child interaction therapy, may be a well-suited alternative to medication.”
For the full Medscape interview with the PolicyLab study authors click here →
Matone, M., Sarah Zlotnik, M. S. P. H., Dorothy Miller, J. D., & Kreider, A. (2015). Psychotropic Medication Use by Pennsylvania Children in Foster Care and Enrolled in Medicaid. (Full Text)