More States Focus on Limiting Psychiatric Drugging of Children

Evelyn Pringle April 7, 2009

The Texas legislature is considering a bill that would require doctors to get prior approval before prescribing atypical antipsychotic drugs like Zyprexa, Risperdal, Invega, Abilify, Seroquel and Geodon to children under 11 who are covered by Medicaid in that state, the Dallas Morning News reported on April 1, 2009.

The reports on Texas foster children in recent years provide evidence to support such a bill. For instance, in 2007, the top five most commonly prescribed psychotropic drugs to Texas foster children were Ritalin, Risperdal, Clonidine, Seroquel, and Adderall. These five alone accounted for half of the $37.9 million spent on psychiatric drugs for foster children in 2007, according to a report in the August 17, 2008 Dallas Morning News.

The atypicals are the most expensive psychiatric drugs on the market and children all across the US have become the target of the off-label marketing campaigns of their makers. The cost of these drugs as of April 2009 at DrugStore.com was:  Abilify 10mg 90 tablets $1230, Geodon 60mg 100 capsules $787, Invega 6mg 100 tablets $1168, Risperdal 2mg 90 tablets $716, Seroquel 200mg 100 tablets $839, and Zyprexa 10mg 90 tablets $1195.

The atypicals are being prescribed more often than antidepressants to children in foster care for everything from ADHD to depression to sleep problems. A report on Texas foster children for the year 2005 has a list of the top ten drugs prescribed to children ages 6 to 12, and Seroquel and Risperdal combined beat out the two antidepressants on the list. There were 1,669 prescriptions for Risperdal and 1,103 for Seroquel, compared to 701 for Zoloft and 712 for Trazodone. In fact, the ADHD drug Ritalin was the only medication prescribed more often than Risperdal. Abilify also made the top ten list with 667 prescriptions.

In the three-year-old toddler age group, Seroquel and Risperdal combined were prescribed 115 times. Risperdal also rated second highest in this age group in 2005.

With infants, age 0 to 2, Risperdal and Seroquel prescriptions had a combined total of 28.

In May 2008, a group of New Hampshire legislators wrote to the state's attorney general asking for a criminal investigation of the atypical makers after learning about the increasingly large amounts of spending by Medicaid for children on the drugs.

Atypical antipsychotic drugging "of children in the Granite state has skyrocketed from under $300,000 in 2000 to nearly $4 million in 2007," the letter states.

"As you are likely aware, antipsychotics are psychiatry’s most powerful medications with very little FDA approval for children and include side effects ranging such as early death, diabetes, heart failure, psychosis, permanent muscle spasms and more," the lawmakers pointed out.

They noted the $515 million civil settlement the DOJ entered into with Bristol-Myers Squibb for illegally marketing Abilify for off-label uses and the settlements between private plaintiffs and Eli Lilly for "causing diabetes in 28,500 people with Zyprexa."

"Any ordinary citizen would minimally be charged with manslaughter or second degree murder for such criminal negligence," the letter advised.

"It is very important to take such criminal actions as the civil actions merely appear to be write-offs as business expenses to drug manufacturers in cases like Vioxx, OxyContin, Neurontin, Paxil and those mentioned above," the lawmakers pointed out.

"A criminal deterrent is needed to protect our children and others placed on powerful medications," they stated.

Last September, attorney Jim Gottstein, the leader of the patient advocacy organization, PsychRights, filed a lawsuit against the state of Alaska seeking to bar the state from paying for off-label prescriptions of all psychiatric drugs to children covered by Medicaid in Alaska.