The release in late March of an alarming new report by federal investigators has confirmed in shocking new detail what has been known for years: Poor and foster care kids covered by Medicaid are being prescribed too many dangerous antipsychotic drugs at young ages for far too long -- mostly without any medical justification at all. The report by the U.S. Department of Health and Human Services (HHS) Inspector General examined in depth nearly 700 claims filed in 2011 in five of the biggest prescribing states -- California, Florida, Illinois, Texas and New York -- and discovered that two thirds of all the prescribing with these popular and costly "second generation antipsychotics" (SGAs) raised high-risk "quality of care" concerns.
The new report noted several disturbing examples, just a few months after an overmedicated teen in foster care, Steven Unangst, died in Antioch, California. The report cited a 10-old-year with ADHD given an antipsychotic -- without any medical documentation -- mixed in with other psych drugs; a 4-year-old on four psychotropic drugs, including two antipsychotics; and a 16-year-old with bipolar disorder on six psychiatric medications, including variously three antipsychotics. Among the side effects of this polypharmacy assault: "This child experienced paranoia, hostility, unstable mood, hallucinations, and suicidal thoughts. This child also experienced significant side effects potentially resulting from the prescribed drugs, including a 22-pound weight gain, insomnia, and edema (swelling) of hands and feet."
Perhaps even more damning, the report found, 92 percent of all kids on Medicaid receiving antipsychotics don't have any of the limited "medically accepted pediatric conditions" supposedly justifying their use. These "accepted conditions" include the authority to use antipsychotics even for autistic children as young as 5 for such dubious FDA-approved conditions as "irritability."
So just how far outside the bounds of sensible prescribing must a doctor be that government approval to provide antipsychotics to a 5-year-old child is somehow considered too limiting? Yet that's precisely the sort of free-fire-zone prescribing underway now for 92 percent of those kids receiving antipsychotics in foster care and the broader Medicaid program.
The Inspector General's report also noted that over half of kids receiving antipsychotics are victimized by "poor monitoring" of the drugs' risky health side effects -- which can include breast growth in boys, cardiac arrest, extreme weight gain and diabetes.
But the report and most of the few mainstream media accounts ignored altogether an even more fundamental example of failed oversight: the federal government's lax monitoring of state Medicaid programs dispensing these potentially life-threatening medications to children.
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Art Levine is a contributing editor of The Washington Monthly, and a former Fellow with the Progressive Policy Insititute. He has also written for The American Prospect, The New Republic, The Atlantic, Slate, Salon and numerous other publications. He is the author of 2005's PPI report, Parity-Plus: A Third Way Approach to Fix America's Mental Health System, and is currently researching a book on mental health issues.
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