Monday, December 14, 2009

Too many overdrugged kids, or the story of a dead-eyed little boy in Chelsea

In Chelsea (a stone's throw from Boston Harbor), there lives a nine-year-old boy with curly black hair whose eyes are dead because he is on drugs, the legal kind. His single mother, who is on welfare and long-term disability (she has serious health problems) can't control her son, so she feeds him a cocktail of powerful psychoactive drugs that include an anti-psychotic (Seroquel), a stimulant for attention deficit disorder (Vyvanse), and a mood stabilizer (Depakote), along with two other drugs. His mouth is purple-black from all the drugs he has to take every day.

I was reminded of this little boy when I read The New York Times article about a new finding that children covered by Medicaid are given anti-psychotics four times as often as children whose parents have private insurance. The study, by researchers at Columbia and Rutgers universities, also found that children on Medicaid are more likely to receive these drugs for less severe conditions than children whose parents are privately insured.

As the NYT reporter noted, these findings, published online in Health Affairs, "are almost certain to add fuel to a long-running debate: Do too many children from poor families receive powerful psychiatric drugs not because they actually need them — but because it is deemed the most efficient and cost-effective way to control problems that may be handled much differently for middle-class children?"

The answer is an unequivocal yes. Children from poor families, whether they live in Chelsea, New York City or rural Appalachia, are much less likely to get the kind of care and attention they need to forestall problems at home and in school. Many of them live in chaotic households headed by single mothers who are overwhelmed and sometimes on drugs (legal and illicit) themselves. The fathers, for the most part, are out of the picture, and even if the mother (as was the case in Chelsea) tries to get her child intensive therapy, Medicaid won't pay for it. So the only other solution is to give such unruly children powerful psychoactive drugs that often have dangerous long-term side effects, such as weight gain and diabetes (in the case of anti-psychotics) and permanent stunted growth (in the case of Ritalin and other stimulants).

Now let me make this crystal-clear: I am not blaming the Chelsea mom for this state of affairs or any single mother who is trying to hold her family together against all odds. I am blaming the system, a system that turns a blind eye to the problems of children in the poorest nooks and crannies of our country, a system that allows pharmaceutical giants to market and sell dangerous drugs as the answer for broken families and inadequate services, a system that favors drug cocktails over the kind of intensive therapy and attention that could really make a difference in some children's lives.

With all this over-prescribing going on, is it any wonder so many American teenagers are lost every day to illegal drugs such as heroin, crack or meth? Big Pharma, after all, got them hooked early on, and how are they to tell the difference between a legal or illegal substance? Indeed, as any forensic expert will tell you, the abuse of legal drugs like Ritalin and Oxycontin are a fast- growing corner of the street market. (According to a fascinating analysis by British researchers, reported in The Boston Globe yesterday, there is evidence that some legal drugs are far more dangerous than some illicit drugs -- like pot -- for the consuming public. It seems our public policy with regard to drug enforcement is also seriously skewed).

But getting back to the little boy in Chelsea, what can we do? These are complex problems and they won't be solved overnight. But we as taxpayers can start demanding our government provide more of the right kind of resources to help poor families and troubled children. And we can push back against a pharmaceutical industry that profits from dead-eyed little boys. In the meantime, if you know of an overstressed family or child in need, refer them to the Children's Emotional Health Link, where the first order of business won't be a hastily written prescription for Depakote.


Dan said...

Unfortunately, I was in jail recently, and Seroquel in particular was the drug of choice for poor inmates to come off of Heroin in particular.

They say they take it for sleep. You sleep, and you don't experience withdrawals.

The jail psychiatrist prescribed this and other anti-psycotics often. They did this to those patients for such off label uses as withdrawals.

Also, methamphetamine addicts who were inmates seemed to take again seroquel in particular in order to sleep.

So if anti-psycotics are this powerful and desired by such people, it frightens me that children are being coerced to take this class of drugs, or any drugs, for that matter.

Sara said...

Today in the NYTimes there's an article about our flawed juvenile justice system and deploring the lack of psychiatrists to "treat" juvenile prisoners while in the same breath describing the abuse by guards etc. These kids don't "need" more meds. They need a whole different juvenile justice system that focuses on building up esteem and self worth instead of assuming all these kids have "untreated mental illness." Who wouldn't be acting out given the life stories these kids undoubtedly have? We need to realize the scope of the problem is much larger than these individual kids.

Anonymous said...

Well, the only thing I'll add is that Depakote is not an antipsychotic. It is an anticonvulsant, also used as a mood stabilizer. Otherwise, great article, and I totally agree.

Unknown said...

It's a lot easier to deal with a roomful of lethargic kids than one of kids who are angry.

UncleKahuna said...

Billing Medicaid for Seroquel given to a 9 year old constitutes Medicaid Fraud. Under the federal False Claims Act anyone with non-public information can sue on behalf of the government to recover for the fraud and share in the recovery. PsychRights has information on this, including a "model" lawsuit.


Jim Gottstein