More kids in the U.S., especially low-income and foster-care children, are on antipsychotics than in any other country. States are just starting to intervene.
By Chris Kardish
Allen Brenzel, a child psychiatrist in Lexington, Ky., can point to the moment he knew his state had a drug problem. A few years ago, Brenzel was working as a consultant for a residential treatment facility for kids under state custody. During his time there, he became acutely aware that many of the children in the program were on prescriptions for psychotropic medications — and lots of them. “It was not uncommon for me to see children as young as 10 or 12 on three or four psych meds,” Brenzel says. “That became more the norm than the exception.” But it was seeing a little boy no older than 5 who was on four different psychotropic drugs that still stands out today in the psychiatrist’s mind. “I remembered thinking you shouldn’t be on more medications than your age.”
Brenzel says he knows that sounds glib, but it drives home a crucial point. Children in the United States are on drugs for longer and more often than kids in any other country. And for children on Medicaid or in foster care, the numbers are far higher. In Kentucky, for example, a child in the Medicaid program is nearly three times as likely to be prescribed a mind-altering psychotropic medication as a kid under private insurance. For a Kentucky foster child, the likelihood is nearly nine times the norm.
Kentucky is hardly alone in overprescribing psychotropics, a class of drugs that ranges from stimulants to antidepressants and antipsychotics. Between 1997 and 2006, American prescriptions for antipsychotics increased somewhere between sevenfold and twelvefold, according to a report by the University of Maryland. And just as in Kentucky, the nationwide numbers for children in foster systems or on Medicaid are startlingly higher than for other children. An average of 4.8 percent of privately insured children are prescribed these drugs every year; among kids on Medicaid, the number is 7.3 percent, according to the most recent study, which looked across 10 states. For children in foster care, it’s a whopping 26.6 percent.
For many physicians and psychiatrists, it’s a situation that’s gotten out of control. “We’ve reached the limits of medicalization,” says Julie Zito, a professor of pharmacy and psychiatry at the University of Maryland. “We’re medicating poverty.”
States have begun to act. Spurred by a series of federal probes and a 2011 directive to begin reporting on the steps they’re taking to reduce prescription rates, state health officials have tried a variety of approaches to address the problem. What they’ve found is that it’s an enormously hard battle to fight. Some places, like Kentucky, are just getting started; others are finding that the efforts they have taken aren’t enough. And it’s not simply about monitoring prescriptions. To make real inroads, states must focus on providing greater access to drug alternatives and on fixing a fragmented system of care. “We know what works,” says Sheila Pires, founder of the Human Service Collaborative, a group specializing in child and family service systems. She points to things like individually tailored pyschiatric therapy programs and family support groups, all connected through people who coordinate the full range of a child’s needs. “The challenge has been getting sufficient service capacity and care coordination across the systems — behavioral health, Medicaid and child welfare.”
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