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Florida Medicaid Antipsychotics 2

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Uploaded on Jun 30, 2008

St. Petersburg Times
The 'atypical' dilemma
Skyrocketing numbers of kids are prescribed powerful antipsychotic drugs. Is it safe? Nobody knows.
By ROBERT FARLEY, Times Staff Writer
July 29, 2007

More and more, parents at wit's end are begging doctors to help them calm their aggressive children or control their kids with ADHD. More and more, doctors are prescribing powerful antipsychotic drugs.

In the past seven years, the number of Florida children prescribed such drugs has increased some 250 percent. Last year, more than 18,000 state kids on Medicaid were given prescriptions for antipsychotic drugs.

Even children as young as 3 years old. Last year, 1,100 Medicaid children under 6 were prescribed antipsychotics, a practice so risky that state regulators say it should be used only in extreme cases.

These numbers are just for children on fee-for-service Medicaid, generally the poor and disabled. Thousands more kids on private insurance are also on antipsychotics.

Almost entirely driving this spiraling trend is the rise of a class of antipsychotic drugs called atypicals.

These drugs emerged in the 1990s and replaced the older, "typical" antipsychotics like Haldol or Thorazine, which are often associated with Parkinson-like shakes.

The atypicals were developed to treat schizophrenia and bipolar disorder in adults. But once on the market, doctors are free to prescribe them to children, and for uses not approved by the Food and Drug Administration.

There is almost no research on the long-term effects of such powerful medications on the developing brains of children. The more that researchers learn, the less comfortable many are becoming with atypicals.

Initially billed as wonder drugs with few significant side effects, evidence is mounting that they can cause rapid weight gain, diabetes, even death.

They're also expensive. On average last year, it cost Medicaid nearly $1,800 for each child on atypical antipsychotics. In the last seven years, the cost to taxpayers for atypical antipsychotics prescribed to children in Florida jumped nearly 500 percent, from $4.7-million to $27.5-million.

Medicaid and insurance companies have fed the problem, encouraging the use of psychiatric drugs as they reimburse less and less for labor-intensive psychotherapy and occupational therapy.

Another factor: Doctors have been influenced by pharmaceutical companies, which have aggressively marketed atypicals.

Whatever the reasons for the soaring use of psychiatric drugs in children, things have gotten out of whack, according to Dr. Ronald Brown. Last year he headed an American Psychological Association committee that looked into the issue.

"The bottom line is that the use of psychiatric medications far exceeds the evidence of safety and effectiveness," Brown said.

"What people need to do is what's in the best interest of children instead of what's in the best interest of people's pocketbooks. But children don't vote."

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