US Inspector General Report: Antipsychotic Drug Hazards

Antipsychotics are used primarily as chemical restraints to control behavior– not for any therapeutic, medically justifiable reason.. The claimed benefit for patients has never been supported by independent scientific evidence.

The life-shortening hazards of Antipsychotic drugs– for adults and children — have been documented and verified by the National Institute of Mental Health .  Indeed, antipsychotics  carry a  black box warning label about sudden deaths in the elderly. This is not to say, that they are less dangerous for children for whom they are also widely misprescribed.

The reason antipsychotics have become blockbusters–cash cows for the drug industry–is that they are prescribed overwhelmingly for patients whose medical care is paid for by taxpayers. 

The IG  audit found that: 83% of antipsychotic prescriptions for elderly nursing home residents were for uses not approved by federal drug regulators, and 88% were to treat patients with dementia — for whom the drugs can be lethal.

More than half of the antipsychotics paid for by the federal Medicare program in the first half of 2007 were “erroneous,” in other words for unapproved uses. They cost the program $116 million for those six months.

We strongly disagree with Dr. Daniel Carlat who is quoted in The New York Times report (below) repeating the often heard absurd defense that psychiatrists offer when confronted with the harm produced by their prescribing practices. Dr. Carlat makes the absurd claim  that toxic antipsychotic drugs that are known to shorten life, "maximize quality of life" for patients.

That specious claim won’t wash! 

Antipsychotics are NOT a way to "maiximize quality of life" –they are an inhumane way of shortening life.

It is the height of hubris for psychiatrists to claim that doctors have a right to decide to prescribe a drug "even if that means the patient will die a bit sooner."

Clearly, the government needs to step in by cutting public funds for antipsychotic drugs. That has the potential of both improving patients’ quality of life– and  saving taxpayers hundreds of millions of dollars.

 

THE NEW YORK TIMES

May 9, 2011

Antipsychotic Drugs Called Hazardous for the Elderly

By GARDINER HARRIS

Nearly one in seven elderly nursing home residents, nearly all of them with dementia, are given powerful atypical antipsychotic drugs even though the medicines increase the risks of death and are not approved for such treatments, a government audit found.

More than half of the antipsychotics paid for by the federal Medicare program in the first half of 2007 were “erroneous,” the audit found, costing the program $116 million for those six months.

“Government, taxpayers, nursing home residents as well as their families and caregivers should be outraged and seek solutions,” Daniel R. Levinson, inspector general of the Department of Health and Human Servicesw, wrote in announcing the audit results.

Mr. Levinson noted that such drugs — which include Risperdal, Zyprexa, Seroquel, Abilify and Geodon — are “potentially lethal” to many of the patients getting them and that some drug manufacturers illegally marketed their medicines for these uses “putting profits before safety.”

The audit is an unusual assessment by the government of whether doctors are treating Medicare patients appropriately in nursing homes. Mr. Levinson suggested that the government should collect information on the diagnoses given Medicare patients so that the government can assess whether the drugs prescribed to them are appropriate.

While common in the private sector, such basic oversight is unheard of in the Medicare program and would almost certainly be opposed by doctors’ groups and many in Congress who view government intrusions into the doctor-patient relationship as inappropriate. In response to the audit, the Centers for Medicare and Medicaid Services said that some of the inappropriate use of antipsychotics in elderly nursing home patients is a result of drug makers’ paying kickbacks to nursing homes to increase prescriptions for the medicines.

Omnicare Inc., a pharmacy chain for nursing homes, paid $98 million in November 2009 to settle accusations that it received kickbacks from Johnson & Johnson and other drug makers for antipsychotic prescriptions.

Medicare officials said that diagnosis information is not generally included with prescriptions so the government cannot assess in real time whether prescription payments are appropriate.

While the Food and Drug Administration has warned doctors that using antipsychotic drugs in elderly patients with dementia increases their risks of death, doctors continue the practice because they have few other good choices, said Dr. Daniel J. Carlat, editor in chief of The Carlat Psychiatry Report, a medical education newsletter for psychiatrists “Doctors want to maximize quality of life by treating the patient’s agitation even if that means the patient will die a bit sooner,” Dr. Carlat said.

The government auditors found that of the 2.1 million elderly patients in nursing homes during the first six months of 2007, 304,983 had at least one Medicare claim for an antipsychotic medicine. Nursing home residents received 20 percent of the 8.5 million claims for antipsychotic medicines for all Medicare beneficiaries at a cost of $309 million during those six months.

The auditors found that 83 percent of antipsychotic prescriptions for elderly nursing home residents were for uses not approved by federal drug regulators, and 88 percent were to treat patients with dementia — for whom the drugs can be lethal.

“These results are alarming,” said Senator Charles E. Grassley, Republican of Iowa, who asked for the audit. “Medicare officials need to pay attention.”

Federal rules require that any drugs that are paid for by the government be given only for uses that are approved either by the government or one of three independent drug usage encyclopedias. Auditors found that 51 percent, or 726,000 of 1.4 million claims, for antipsychotic medicines did not meet this criterion and were thus paid for by the government improperly.

Government rules also ban drugs that are used in excessive doses or duration, even if patients are found to have a condition for which the drug is appropriate. Auditors found that 22 percent, or 317,971 of 1.4 million claims, for antipsychotic medicines failed this standard.