MassHealth: Children overwhelmed with Psychiatric Drugs_Globe

Sun, 9 Mar 2003

The Boston Globe reports that the top official for health and human services in Massachusetts plans to take action to stem the abusive “haphazard” prescribing of psychiatric drugs for children:

“The use of stimulants, antidepressants, and antipsychotics among children has more than tripled in the last 15 years, sparking debate over whether children are being prescribed psychoactive medication too quickly – or whether, as some doctors contend, untreated mental illness remains a bigger problem than overprescription.

Ronald Preston, the state official, was surprised that “there were a few practitioners dispensing a surprising amount of this stuff. It was being prescribed to young, young, young children, and the volume of it.” He plans to issue guidelines to stop the abusive practice.

Dr. Paul Appelbaum, immediate past-president of the American Psychiatric Association (APA), is quoted defending practitioners’ prescribing rights: “We ought to be very cautious about the state developing rules that would constrain prescriptions.”

This demonstrates precisely that the psychiatric establishment–APA–which is totally under the influence of drug company $$$–cares not a bit about the harm being done to children. Psychiatry defends psychiatrists who prescribe powerful psychoactive drugs for helpless children–whether there is any medical justification or not. The problem of “haphazard” prescribing of psychoactive drugs for children is out of control. It has reached epidemic proportions in the U.S.

See: Archives of Pediatric and Adolescent Medicine. Julie Magno Zito, PhD; Daniel J. Safer, MD; Susan dosReis, PhD; James F. Gardner, ScM; Laurence Magder, PhD; Karen Soeken, PhD; Myde Boles, PhD; Frances Lynch, PhD; Mark A. Riddle, MD." Psychotropic Practice Patterns for Youth A 10-Year Perspective"

http://archpedi.ama-assn.org/issues/current/abs/poa20275.html

See also, Editorial "Mirror, Mirror on the Wall Are We Prescribing the Right Psychotropic Medications to the Right Children Using the Right Treatment Plan?" by Michael S. Jellinek, MD http://archpedi.ama-assn.org/issues/current/ffull/ped20022.html

The New York Times

January 14, 2003 A-21

Study Finds More Children Taking Psychiatric Drugs

By ERICA GOODE

http://www.nytimes.com/2003/01/14/health/14DEPR.html?pagewanted=print&positi on=top

More information is freely accessible at the AHRP website: www.ahrp.org

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http://www.boston.com/dailyglobe2/068/metro/Guidelines_pushed_on_child_medic ationP.shtml

Guidelines pushed on child medication

Romney aide questions use of psychiatric drugs in MassHealth program

By Ellen Barry, Globe Staff, 3/9/2003

In one of his first ventures into the quality of medical care in Massachusetts, Governor Mitt Romney’s secretary of the executive office of health and human services, Ronald Preston, last week said doctors have been ”haphazard” in prescribing psychiatric medications to children and that he hopes to develop guidelines for their use.

The use of stimulants, antidepressants, and antipsychotics among children has more than tripled in the last 15 years, sparking debate over whether children are being prescribed psychoactive medication too quickly – or whether, as some doctors contend, untreated mental illness remains a bigger problem than overprescription.

Data gathered in Massachusetts when Preston was associate regional Medicaid administrator showed ”quite extraordinary” prescribing patterns, he said. One in eight teenagers enrolled in MassHealth, the state’s Medicaid program, is taking psychotropic medications, according to the Division of Medical Assistance. For children aged 6 to 12, that number drops to one in nine.

Facing a social service agenda dominated by budget cutting, Preston said he saw this as a medical problem more than a financial one.

When Massachusetts statistics were reviewed, ”there were a few practitioners dispensing a surprising amount of this stuff. It was being prescribed to young, young, young children, and the volume of it” was surprising, he said.

”There is a big interest in getting a handle on what’s going on here.”

Preston said he does not plan to regulate doctors’ use of the drugs, but to make changes by requiring preapproval for some medications and to use his ”bully pulpit” as the governor’s chief health care adviser to generate guidelines. As a model of physician education, he pointed to a pilot program in Worcester that makes child psychopharmacologists available on call to pediatricians faced with medication decisions.

But several clinicians interviewed were wary of the state having any role in medical decisionmaking.

”We ought to be very cautious about the state developing rules that would constrain prescriptions,” said Dr. Paul Appelbaum, a University of Massachusetts psychiatrist who is president of the American Psychiatric Association. ”Informed judgment in the field is probably that we are seeing overprescription and underprescription. … Making it harder to prescribe medications is likely to compound the underprescription problem.”

There is no doubt that the use of psychiatric medications on children has increased, and that the medications are used in younger and younger age groups. In a nationwide study of 900,000 children released in January, University of Maryland researcher Julie Magno Zito found that the number of children taking the drugs had tripled between 1987 and 1996. By 1996, about 6 percent of American children were taking medications such as the stimulant Ritalin, and antidepressants such as Prozac and Risperdal, a medication prescribed for schizophrenia.

According to statistics from the Division of Medical Assistance, Massachusetts children enrolled in MassHealth are receiving medication at a higher rate – 8 percent of children and 13 percent of teenagers overall receive psychiatric medication. Psychiatric medications eat up 47 percent of MassHealth’s drug budget, said Dr. Annette Hanson, medical director of the Division of Medical Assistance, who worked with Preston researching the issue when he was regional Medicaid administrator.

But those increases do not necessarily prove that the drugs are overprescribed, many psychiatrists say. Since children received almost no psychiatric medications 20 years ago, the baseline for growth in prescriptions is deceptively low, Appelbaum said.

And doctors may be prescribing them because their options have narrowed. One reason for the increase, said Dr. Michael Jellinek, is that managed care organizations and the government are unwilling to pay for more time-consuming treatments, such as psychotherapy.

”We used to have more hospital beds for children,” said Jellinek, chief of the child psychiatry service of Massachusetts General Hospital. ”That forces these doctors to use medicines. I believe physicians have been put in a bind.”

The state’s primary strategy is likely to be educational, Preston said. At the pilot program in Worcester, pediatricians – who are responsible for much of the prescribing – have child psychopharmacologists on call to advise them when they make medication decisions. In six months, data will show whether the program results, as planners hope, in fewer emergency room visits and changes in prescribing practices.

”My guess is when [pediatricians] feel more supported … they will be able to not prescribe so much medication,” said Hanson, who has spearheaded research into prescription patterns.

Reforms to the system will aim to ”build a system that doesn’t cost any more but is more responsive,” she said. Hanson added that she would like to see hospitalization rates go down, replaced by more services in the community.

”There need to be other services,” she said. ”If the only answer is hospitalization or medication, that’s no way to run the show. You put a kid in the hospital and pretty soon they become a patient.”

Ellen Barry can be reached at barry@globe.com.

This story ran on page B1 of the Boston Globe on 3/9/2003. © Copyright 2003 Globe Newspaper Company.

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