If you’re a child in Medicaid, you already have a more difficult life than average ahead of you. Children in Medicaid programs have nearly twice the number of mental health problems than other children. But now new research suggests it gets even worse for children in Medicaid, according to an article in The New York Times — they are prescribed four times the amount of atypical antipsychotic medications than other children:
New federally financed drug research reveals a stark disparity: children covered by Medicaid are given powerful antipsychotic medicines at a rate four times higher than children whose parents have private insurance. And the Medicaid children are more likely to receive the drugs for less severe conditions than their middle-class counterparts, the data shows.
The problem is simple — there are fewer psychiatrists who take Medicaid payments (which are lower than what private insurance generally pays), so most of these antipsychotic medications are being prescribed by family physicians or pediatricians who simply don’t know better (or think they’re helping when they’re really not). As the article notes, “it is often a pediatrician or family doctor who prescribes an antipsychotic to a Medicaid patient — whether because the parent wants it or the doctor believes there are few other options.”
The worst part? Antipsychotics to treat ADHD? Diagnosing bipolar disorder in children 3 years of age? I feel like I’m in a horror movie that never ends:
The F.D.A. has approved antipsychotic drugs for children specifically to treat schizophrenia, autism and bipolar disorder. But they are more frequently prescribed to children for other, less extreme conditions, including attention deficit hyperactivity disorder, aggression, persistent defiance or other so-called conduct disorders — especially when the children are covered by Medicaid, the new study shows.
You see, once a drug gets pediatric FDA approval for one condition, doctors see that as a green light to prescribe it off-label for any childhood disorder or problem (because, the reasoning goes, it’s been proven “safe”). So while only approved for very serious childhood problems like schizophrenia and bipolar disorder, you’ll see docs turning to it because it’s New and Improved (and hey, covered by Medicaid, so why not?).
Bizarrely, the article notes the “upside” to the over-prescription of atypical antipsychotics for virtually any childhood disorder a doctor feels like:
“Maybe Medicaid kids are getting better treatment,” said Dr. Gabrielle Carlson, a child psychiatrist and professor at the Stony Brook School of Medicine. “If it helps keep them in school, maybe it’s not so bad.”
Really? “Not so bad”?! Does this sound like a researcher who’s received a few grants from pharmaceutical companies over the years? Yeah, if you look at this recent Open Access article, you’ll see the disclosures the New York Times failed to mention to its readers:
Dr. Carlson has received research support or has consulted with the following companies: Abbott Laboratories, Cephalon, Eli Lilly and Company, Janssen, McNeil, Otsuka, and Shire Pharmaceuticals.
Hmmm.
One solution is pretty simple and straightforward — psychiatrists (and related professionals who have prescribing privileges in psychiatry or mental health) are the experts when it comes to choosing the right medication for the right patient. That’s what they’re trained for and that’s what they excel at. When we come to rely on other generalist professionals, we’re bound to get care that — while well-intended — is likely not the best available.
Children, of all people, certainly deserve the best available care, provided by the best professionals to provide it. And children — because their brains are still developing and we have zero long-term studies done on children and these medications — should turn to medications as only one possible solution to these mental health concerns. Psychotherapy is another possible solution and one that should be utilized as much as possible for children, especially for concerns that have a solid empirical research base to support therapeutic interventions (like ADHD).
The Rutgers-Columbia study that found that Medicaid children are prescribed four times the amount of antipsychotic medications compared to non-Medicaid children will be published early next year, in the journal Health Affairs.
Read the full article: Children on Medicaid Found More Likely to Get Antipsychotics
6 comments
How Zyprexa makes you Fat
Study out on Eli Lilly Zyprexa causing diabetes
Anti-Psychotic Drugs (Zyprexa) Change Metabolism
“Based on these findings we concluded that male rats treated with olanzapine experienced an early disruption of energy metabolism.
In the study 18 male rats were randomly assigned to one of three groups: (1) those receiving the conventional antipsychotic drug haloperidol (HA); (2) those receiving the atypical antipsychotic drug olanzapine (OL); or (3) the control (CO) group which did not receive either drug.
The medicines were given in food for a period of six weeks. Female rats were excluded to eliminate bias in the study since antipsychotic-induced weight gain in female rodents is likely related to an interaction of the drugs with estrogens.
Testing after four weeks found that the concentration of blood sugar (as glucose) was higher in OL rats (0.87 g/l) than in CO rats (0.75 g/l) and the levels increased more rapidly after a glucose meal. Testing six weeks later found fasting blood sugar levels continued to rise in OL rats (1.46 g/l vs. 1.25 g/l in CO rats) while the level of lipids (fats) in the blood was similar for both groups.
Although there was no difference in body weight gain or food intake, the proportion of fat stored in the abdominal cavity was higher in OL rats (1.63%) vs. CO rats (1.44%).
The HA rats did not vary in any way with the control group at any time. They exhibited a lower blood sugar level after a glucose meal and a lower proportion of intraabdominal fat store (1.44%) than OL rats.
Senior study author Dominique Hermier said, “Based on these findings we concluded that male rats treated with olanzapine (Zyprexa) experienced an early disruption of energy metabolism. This was a result of the fat tissue we observed and the impairment in blood sugar regulation which are both associated with metabolic syndrome and subsequent risk of diabetes.â€
Source: American Physiological Society
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Daniel Haszard Zyprexa whistle-blower
I can not say that I am suprised, I can say that I am quite alarmed. Physicians who take an oath to care for patients should not allow there inflated egos to allow them to think that they can prescribe and treat mental illness. I have worked in Mental Health a number of years and in many instances it is trial and error with a trained Psychiatrist (as it relates to medication maintenance. How dare a general physician prescribe psychiatric medications? Not to mention that it makes sense that as they have said (Medger Evers); i”if you are not part of the solution, you are part of the problem. If a General Physician has clients with mental illness he should join a network that will best allow him to treat the patients in his care.
I can honestly say this does not suprise me one bit, as someone who has educated over 130,000 kids in six states about the dangers of drugs, and helped thousands overcome addiction, the hardest time I have when it comes to educating people about all drugs and their effects, are some drugs are ” medicines” and when the kids actually start doing worse after taking these ‘meds” it still almost impossible to convince them it could be the drug, as a parent of a child who supposedly had ADHD, was prescribed amphetamines as a result and he became addicted at the age of 7.Later I found out he had a vitamin deficiency and I was able to get him on a nutritional program and he is going great, thanks for the information!
Definitely an interesting and frightening study, but I wonder if it takes into consideration the fact that all children in therapeutic foster care receive services through Medicaid, and that most/all of these kids are obviously on various antipsychotic drugs.
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From what I recall in the study, they also looked at kids with the same diagnosis, ie ADHD It showed that kids with Medicaid were more likely to be prescribed antipsychotics then kids with private insurance, even for the same diagnosis.
Frightening, but not surprising. There is also serious shortage of child and adolescent psychiatrists, especially in areas not near big cities. Although, it’s a great idea to only have children treated by psychiatrists trained in treating children, this isn’t a reasonable expectation in many areas of the country. Even in the big city I live in, many Medicaid children have long waits to see a child psychiatrist or a psychiatrist at all. I think a good interim solution would be to education pediatricians and other pcps about the dangers of these drugs. As well as require more continuing education on mental health issues. (not sponsored by drug companies).
Also, the “black box warnings” on SSRIs are partially to blame because many doctors are more hesitate to prescribe SSRIs for depression but will try an antipsychotic instead because it lacks the warning.
Also, how well can diagnosis of “bipolar disorder” in a 5 year old hold up over the long term? Except in causes of clear psychosis, this whole practice seems a bit bizarre.
How disheartening to review your comments as I am trying to locate a Child Psychiatrist for my daughter. I have worked many jobs to keep a roof over our heads and food on the table and I still cannot afford family health insurance. Therefore people in my position have two options. Do without care and suffer because of it or get care with Medicaid and still suffer for it. Anyone know of a competant Physician that does take Medicaid?
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