Oregon Preschoolers Rx ‘adult’ psychotropic drugs_Portland Tribune

In both cases the incentives, thanks to pharmaceutical industry influence, reimbursement schedules favor
drugs and drugs only:
“The way our mental health policy and reimbursement is organized right now, there just are not incentives to work with children
in impoverished conditions.”

Below, The Portland Tribune reports that a study examining Oregon’s Medicaid plan found that 246 preschool children are being drugged with toxic
antipsychotics and / or antidepressants.  The drugs are unapproved for use in children under 18, and they carry black box warnings of lethal risks.
However, parents never see those warnings.

When confronted with the evidence-essentially medical malpractice- mental health “authorities” are squirming under the light being shined on them:

The author of the Oregon study, psychiatry professor David Pollack, acknowledges:
“I know enough about clinical practice to know that it’s really hard to make diagnoses in children, and there’s a lot of pressure.”

He said he understands that “at first glance, the prospect of children age 5 and under receiving psychiatric medication intended for adults can be
startling.” While conceding, “There’s an element of alarm,” he claims, “It doesn’t mean it’s inappropriate.”

And Dr. Joan Luby, a leading proponent of diagnosing preschool children with bipolar disorder-an aberration in medicine applied exclusively to U.S. children despite the acknowledgement by Dr. Pollack: “it’s really hard to make diagnoses in children.” On the other hand, by labeling children bipolar psychiatrists provide the appearance of legitimacy for prescribing antipsychotic drugs for children off-label, without FDA approval.

Dr.Luby feigns ignorance about the widely reported incontrovertible findings about the hazards of these drugs.  “There’s just not much known. That
doesn’t mean these drugs aren’t effective. We just don’t have the studies to show whether they are safe and effective.”

Has she not kept abreast of the incontrovertible findings of government sponsored research (CATIE study) conducted by leading psychiatrists who
acknowledged that antipsychotic drugs pose severe risks and their efficacy is undemonstrated.

“the side effect outcomes are staggering in their magnitude and extent and demonstrate the significant medication burden for persons with
schizophrenia.. Sky-high drug discontinuation rates were seen, suggesting rampant drug dissatisfaction and inefficacy.”
[See: Dr. Carol Tamminga, “Practical Treatment Information for Schizophrenia” Editorial, American Journal of Psychiatry, April, 2006, vol.
163:563-565.]

In light of the evidence Dr. Luby’s statement is worse than disingenuous.

McNight’s Long-Term Care Assisted Living News reports that a long-range study shows nursing home residents are being killed by overdoses of
prescribed drugs at a rate increase of 179% in 10 years.  “Opioid pain relievers, including codeine, morphine and Demerol caused the majority of
prescription drug overdose deaths….Nursing home residents typically use multiple different prescription drugs at one time.”

Contact: Vera Hassner Sharav
veracare@ahrp.org

http://www.portlandtribune.com/archview.cgi?id=34841
The Tribune
Preschoolers put on ‘adult’ medication
Study: 246 kids in Oregon Health Plan use drugs not tested for children
By PETER KORN     Issue date: Fri, Apr 14, 2006

A new study directed by an Oregon Health & Science University professor
has found that 246 preschool children covered by the state-sponsored Oregon
Health Plan are receiving antipsychotic or antidepressant medications that
have never been studied for use in children.

And while the study’s lead researcher admits the figure might seem
alarming, mental health experts caution that the prescriptions might have
been justified and may be a result of Oregon’s insufficient mental health
resources.

The study, a collaboration between the state’s department of human
services, its Medicaid program and the Oregon State University College of
Pharmacy, was headed by OHSU psychiatry professor David Pollack. Pollack
said he understands that at first glance, the prospect of children age 5 and
under receiving psychiatric medication intended for adults can be startling.

“There’s an element of alarm,” he said. “But it leads us to say we need
to answer more questions. It doesn’t mean it’s inappropriate.”

Pollack noted that the 246 children represent less than one-half of 1
percent of the 86,828 Oregon Health Plan children whose records were
reviewed. The Oregon Health Plan is an insurance program for low-income
Oregonians funded through Medicaid.

“The problem is there’s very little data to direct the use of
pharmacological agents in preschool children,” said Joan Luby, associate
professor of child psychiatry at Washington University School of Medicine in
St. Louis. “There’s just not much known. That doesn’t mean these drugs
aren’t effective. We just don’t have the studies to show whether they are
safe and effective.”

Still, Luby, who has spent a decade studying children under 6 years of
age, said that mental illnesses such as depression occur in the very young
more frequently than most people realize. “I wouldn’t say I’m surprised, but
the public is surprised,” she said. “Depression is a disorder that’s a good
example of a combination of biological and psychological risk factors. It’s
a complicated equation.”

   A third of kids were abused

The Oregon study, first reported in a monthly publication called Oregon
Health News, looked at Medicaid pharmacy prescription records from Oregon
Health Plan claims. Among its findings: 41 percent of the children given
psychiatric medication had an attention deficit disorder (though the
prescribed medications were not those usually recommended for children with
the disorder), and 33 percent were diagnosed victims of child abuse.

But the study, Pollack said, poses as many questions as answers. Among
them: Whether the children were adequately assessed before being medicated,
and whether the prescriptions were accompanied by appropriate therapy.
Pollack said he thinks data showing 82 of the 246 children given the drugs
had suffered some form of abuse might be particularly revealing.

“I know enough about clinical practice to know that it’s really hard to
make diagnoses in children, and there’s a lot of pressure,” Pollack said.
“You have some very complex cases where children might have some combination
of illnesses, developmental disabilities and autism.”

   ‘You’re out on the front line’

One of the questions Pollack would like answered, but which pharmacy
records don’t address, is: “How much pressure was the prescriber
experiencing from whomever?”

“A lot of cases are where they’re trying to keep the child from being
placed outside the home,” he said. “This was a study of Medicaid children. A
lot of these kids may have had some involvement with child protective
services or some other protective services agency.”

Sometimes, Pollack said, medication may be seen as the only way to keep a
child with behavioral problems in the home.

Luby agreed that the Medicaid status of the children in Pollack’s study
could play a role in the prescriptions: “You’re out on the front line and
you have kids coming into your office with serious psychiatric symptoms,
even that young, and you often have restrictions of care to the extent that
it’s not feasible or affordable for nonmedication therapy to be done.”
Ideally, Luby said, therapy takes place for children before medication is
considered. “Psychotherapy is the first option,” she said. “With Medicaid
kids, there’s no resources. There aren’t providers who will take Medicaid.

If there are providers who will take Medicaid, they often have very
overburdened caseloads. It’s not possible to get psychotherapy on Medicaid,
or it’s extremely difficult. And you need clinicians with expertise treating
young children.

“For people who have limited resources, sometimes medication might be
offered first for kids with disruptive problems, even if psychotherapy might
be the more appropriate treatment,” she said.

   Incentives go missing

Christopher Thomas, director of child and adolescent psychiatry at the
University of Texas medical branch at Galveston, said that economic status
might play two roles in the lives of children receiving psychiatric
medication. “The way our mental health policy and reimbursement is organized
right now, there just are not incentives to work with children in
impoverished conditions,” Thomas said. “And we know that poverty increases
the risk for mental illness in children.”

Lynn DeBar, a Portland psychologist with Kaiser Permanente’s Center for
Health Research, who studied preschoolers as part of a study three years
ago, said most of the preschool children she found who had received
psychiatric medication truly needed the help.

“Kids who were medicated – they were kids that were highly aggressive,
that were engaged in behavior that was dangerous to themselves and to other
people,” DeBar said. “The concerns really were that not having some kind of
treatment would put them in more jeopardy.”

Email peter korn
<http://www.portlandtribune.com/continfo.cgi?to=33%20peterkorn%2066>

http://www.mcknightsonline.com/content/index.php?id=24&tx_ttnews[tt_news]=29
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Study: Prescription drug overdoses surpass deaths from illegal drugs
April 25 2006

The death rate from accidental overdoses involving prescription medications
jumped 179% in 10 years. It now tops the rate of deaths caused by overdoes
of illegal drugs such as cocaine and heroin, according to a new long-range
study.
Opioid pain relievers, including codeine, morphine and Demerol caused the
majority of prescription drug overdose deaths, according to a 10-year study.
The results indicate that greater overdose prevention efforts should be
targeted at this group of drugs, said lead researcher Mark Mueller, an
epidemiologist with the U.S. Centers for Disease Control and Prevention.

Nursing home residents typically use multiple different prescription drugs
at one time.

Between 1994 and 2003, accidental prescription drug overdoses increased from
1.9 out of 100,000 deaths to 5.3 per 100,000 deaths. Unintentional overdose
deaths caused by illegal drugs increased 121% over the 10-year period.
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