On October 1, 2010, John Kelly reported on an investigation by Youth Today that found atypical antipsychotics were prescribed to many incarcerated youths in juvenile facilities in the US without a diagnosis of schizophrenia or bipolar disorder, the only FDA-approved indications for use with juveniles.
A wide variety of diagnoses were listed for the prescribing of the drugs including general mood disorders, intermittent explosive disorder, oppositional defiant disorder, PSTD and ADHD.
However, Kelly reports that critics believe most of these diagnoses are simply a cover for the fact that prisons now use drugs as a substitute for the banned physical restraints that were once used on juveniles who aggressively acted out.
"Fifty years ago, we were tying kids up with leather straps, but now that offends people, so instead we drug them," Robert Jacobs, a former Florida psychologist and lawyer who now practices psychology in Australia, told Kelly.
"We cover it up with some justification that there is some medical reason, which there is not," he said.
The atypical drugs include Bristol-Myer Squibb's Abilify, Pfizer's Geodon, Seroquel from AstraZeneca, Eli Lilly's Zyprexa, and Risperdal and Invega from Johnson & Johnson.
Youth Today has been working for over a year to find out how much money individual states have been spending on the drugs for incarcerated youth, and for what reason. Medicaid records would not contain the relevant information because federal Medicaid money cannot be used to fund medical care for anyone incarcerated for a crime, whether adult or juvenile, Kelly reports.
Because funds for medications prescribed to juvenile inmates must come from state sources, each state's juvenile justice agency was asked how much was spent, in the most recent year available, on five drugs - Abilify, Geodon, Risperdal, Seroquel, and Zyprexa - and to provide the diagnosis listed for the prescriptions.
Only 14 states provided some information on the amount spent in either 2008 or 2009, with wide variations. For instance, New Jersey and Minnesota reported spending less than $100,000 a year, while Texas, Florida and Virginia each spent over $1 million.
Only five states were able to provide a comprehensive list of diagnoses along with the amounts. The total number of prescriptions for those five states combined was 5,299, with an off-label condition listed as the diagnosis for 3,709, or 70 percent.
In Texas, nearly 4,000 atypical prescriptions were written in 2008, for a total juvenile population in state facilities of between 1,600 and 1,900, with only 29 percent diagnosed with schizophrenia or bipolar disorder and no diagnosis listed for nearly 25 percent of the prescriptions.
Because Seroquel accounted for so many prescriptions with no diagnosis, Texas officials feared that it had become the "sleeping pill of choice" for agency clinicians, Kelly reports. Seroquel was prescribed 2,553 times in 2008, almost twice as often as the other four atypicals combined.