Are kids being overdosed?

May 16, 2007

Does Your Toddler Really Need an Anti-Depressant?
Report shows that thousands of Michigan preschoolers
are being prescribed psychiatric drugs



Activist Ben Hansen looks like a regular Traverse City nice guy. He’s handsome with a neatly trimmed gray beard, often dressing in a casual flannel shirt and a Tiger’s ball cap. He lives in a tiny house in Traverse City on the tiniest of incomes.
But don’t let his modest appearance fool you. He is asking big questions of pharmaceutical companies, or pharma, our country’s most powerful industry. And what he wants to know is this: Why are thousands of foster children and poor children on Medicaid — children who are too young for kindergarten — being put on antipsychotics, anti-depressants, anti-hyperactive medicine, as well as pills that eliminate the tremors caused by these medications?
Hansen’s window into this trend is data compiled by the Michigan Department of Community Mental Health (MDCH), which oversees the Medicaid and foster care programs.
For nearly two years, Hansen has been going back and forth with the department with Freedom of Information Act requests. MDCH has given Hansen much of what he wants, but drew the line on giving him the names of drugs (as opposed to the general drug classes such as anti-depressants) that are dispensed to children under the age of five. They also refused to provide the names of drugs for patients of any age who are taking five or more psychiatric drugs, citing patient confidentiality.

DRUG COCKTAILS
Hansen assured the judge he has no interest in confidential information and offered to pay the labor cost of blacking out names. His suit, accompanied by supporting documents by experts in the field, argues that researchers require the data to study the changing prescribing patterns of psychiatric drugs to young children, as well as the increasing number of adults taking “psychiatric drug cocktails.”
Hansen questions, for example, why the number of adults taking three are more psychiatric drugs increased by 68 percent within six months last year (5,544 adults to 9,328). He believes that it’s harmful to the patients and taxpayers alike. But he needs to provide specific drug names to researchers to make his case.
Last week, Judge Beverley Nettles-Nickerson of the Ingham County Circuit Court ruled in favor of the State’s motion to dismiss Hansen’s FOIA request.  The judge also ordered Hansen to pay $3,500 for the state’s legal costs.
Hansen is incensed by the ruling and intends to request a re-hearing. That’s because the Medicaid data that he has been given—some 1,000 pages worth—has raised significant alarms.

TODDLERS AND DRUGS
A key report obtained by Hansen showed that in 2005, some 3,064 psychiatric drug prescriptions were issued to children, ages four and under. They ranged from antidepressants to what are called atypical antipsychotics.
A third were sedative hypnotics/anxiolytics (sleeping pills like Ambien and Lunesta and anxiety reducers), while another third were antidyskinetics (also called antiparkinsonians) typically prescribed for trembling in Parkinson’s patients and for movement disorders such as tics, tremors and restless legs syndrome in children.
The report showed that 46 prescriptions were for ADHD (attention deficit hyperactive disorder), while 875 were mood stabilizers/anti-convulsants. Ninety-four children received medicine to combat depression. These drugs, according to the 2005 report, cost the state $467,343.
The vast majority of these drugs were never approved for use by children and some may carry a ‘black-box’ warning of suicidal thoughts and behavior for children.
Since that 2005 report, the state began lump-ing all children under the age of 18 together, which is one reason why Hansen asked for the “under 5” age breakdown after 2005.

‘PUBLIC HEALTH DISASTER’
Hansen wonders why the number of very young Michigan children on anti-Parkinson drugs has quadrupled in the past two years.  He suspects it may be due to drug-induced movement disorders caused by psychiatric drugs used for the treatment of ADHD, autism, and depression in children. 
“If the increased prescribing of antidyskinetics is the direct result of an increase in the diagnosis and treatment of ‘mental disorders’ in American toddlers, then we could be witnessing a public health disaster of monumental proportions,” Hansen said.
Hansen also worries that the new drugs are being prescribed to children without enough study of their long-term effects on their bodies and brain development.
Doctors do know of potential, near-term side effects. Depakote, used to treat mania and seizures, can cause obesity and diabetes. Those who take Risperdal may suffer from involuntary movements, such as twisting the neck in a birdlike fashion. Zyprexa is linked to obesity and diabetes. Lithium can damage the thyroid and kidneys.

TEEN YEARS
When looking at the number of Michigan children on Medicaid or foster care, 17 and under, the numbers really soar. Nearly 13,000 children last year took Zyprexa or some other atypical antipsychotic at an estimated cost of more than $3 million, according to MDCH data.
These are not just numbers, but real children, Hansen stressed.
“I challenge anyone in the state of Michigan or anyone who works for the Department of Community Health or any doctor to prove me wrong,” Hansen said. “Step forward with the data and tell me, ‘Ben Hansen, what you say is happening is not happening. Our children are not being targeted by the drug companies simply because once they’re on these drugs, they are patients for life.’ Believe me, I’d love to be wrong about this.”
Last week, he was on the phone with a foster care caseworker who told him of a boy, who had acquired a twitch in his neck and was already on at least two prescription drugs. His doctor then prescribed Adderall (an anti-ADHD medicine) to quell the twitch, and the boy suddenly died several days later. His caseworker suspected that drugs played a role, but shied away from the story when a reporter was mentioned.
Hansen said that he would ideally like to see morbidity data — how many children and adults die when given psychiatric drug combinations of three or more.
“I know I’ll eventually get my hands on the data I’m seeking, but how many lives will be destroyed before I do?  When will people wake up to what’s happening? Will it be too late? We’re talking about real lives here.”

MORE BIPOLAR KIDS?
Six years ago, several leading psy-chiatrists reached a consensus that bipolar disorder existed and was diagnosable for pre-pubescent children with the results published in Journal of the American Academy of Child and Adolescent Psychiatry, according to an article recently published in the New Yorker.
But the article also reported that even now, clinicians disagree on whether it’s possible to accurately diagnose bipolar disorder. For one, there’s no consensus on how to define aberrant behavior in children under six, and also many young children can’t adequately explain what they’re experiencing,
Since 1999, the percentage of mentally ill children under the age of 18 diagnosed with bipolar disorder has increased four-fold, the New Yorker article reported.
The frontline treatment for these children are atypical antipsychotic drugs, such as Zyprexa, Risperdal, Seroquel, Abilify, and Geodon.
MSU Professor Bertram Karon wrote in Hansen’s court filing that he is “alarmed” by the over-reliance on psychiatric medications for schizophrenia and other mental disorders.
“These medications, frequently pre-scribed off-label, and mixed in ‘drug cocktail’ combinations, are now being administered to patients at very young ages, a practice virtually unheard of only a couple decades ago.”

THOUSANDS OF KIDS
There are similar concerns throughout
the country. A study of children on Medicaid in Texas was so disturbing—63,118 children, 18 and under, were put on stimulants, anti-depressants, or antipsychotics, with nearly a third taking drugs from at least two of those classes—that Texas established strict guidelines in dispensing drugs to children. Doctors were also warned not to over-prescribe drugs or prescribe drugs for off-labels uses.
The New York Times ran a story just last week on “Industry’s Role in Childrens’ Antipsychotics.” The paper analyzed records in Minnesota, the only state that requires public reports of all drug company marketing payments to doctors.
Those records provide “rare doc-umentation of how financial relationships between doctors and drug makers correspond to the growing use of atypicals in children.
“From 2000 to 2005, drug maker payments to Minnesota psychiatrists rose more than sixfold, to $1.6 million. During those same years, prescriptions of antipsychotics for children in Minnesota’s Medicaid program rose more than ninefold,” the article reported.
The doctors who received the most money from drug makers prescribed the highest number of antipsychotics, the article reported.

DRUG COCKTAILS
Data for adults on Medicaid in Michigan was troubling as well.
One adult, Hansen found, was taking 17 different psychiatric drugs at one time, all paid for with tax dollars. The most recent data showed a 300 percent increase in the adult ADHD category within a six-month period—from five people to 20.
“Growing numbers of patients are now prescribed a dozen or more psychiatric drugs concurrently—a practice in no way supported by scientific evidence,” wrote Bertram Karon, a professor of clinical psychology at Michigan State University in support of Hansen’s FOIA request.
Hansen said he needs specific names of drugs dispensed because the numbers often don’t add up in the reports that were issued. Hansen believes it’s because some drugs overlap different classes.
Assistant Attorney General Thomas Quasarano represented the State of Michigan in the case. He referred comments to spokesman Matt Frendeway, who said the records were confidential and exempt from law, but not specifically why since the information would not be linked to any individual.
The state’s court filing also contended that the Release of Information for Medical Research and Education Act exempts this class of records from FOIA. Hansen would have to qualify as a “review entity” to receive the data.
“After reading and rereading the judge’s decision I do not believe that she made a substantive ruling on the ‘review entity’ issue. Her ruling appears to be more of a procedural decision,” said Alan Kellman, who is handling the FOIA case pro bono for Hansen.
Kellman acknowledged in the suit that MDCH has already provided quite a lot of data. “However, a line is drawn when it comes to simply providing the names of the drugs. This is, to be straightforward, incomprehensible. What purpose is actually served? … Certainly not one of confidentiality. This is arbitrary. It must not be allowed.”

Next week: An article on Ben Hansen and his own brush with the mental health system, and why he now believes our
pill-popping society is losing its mind.