“On Tuesday and Wednesday, federal agents fanned out across three South Florida counties, arresting a total of 42 Medicare fraud offenders. Three others charged are believed to be in Florida. The sweep came almost one year after the indictment of Miami-based American Therapeutic Corp., with seven regional clinics. A total of 24 defendants, including senior executives, psychiatrists and counselors, were charged, netting several guilty pleas and one trial conviction. That case alone accounted for $200 million in fraudulent Medicare claims during the past decade. ”

But once they arrived, with their valuable Medicare cards in hand, they would be squeezed into rundown assisted-living facilities and steered to purported mental-health programs — at a multimillion-dollar cost to taxpayers, authorities say. If they dropped out of the group therapy sessions, the ALF owners would toss the patients out into the street.

“They were down on their luck,” U.S. Attorney Wifredo Ferrer said, explaining how the latest Medicare scam would target patients from the Southeast. “Come on down, have a fresh start in Miami. But there was a catch.”

On Wednesday, Ferrer announced that federal agents arrested 42 suspects on Medicare fraud charges in South Florida, including the owners of Biscayne Milieu Health Center, a Fort Lauderdale psychiatrist who referred patients to the Miami Gardens clinic, patient recruiters and ALF landlords. Other defendants were operators of home healthcare agencies, HIV-therapy clinics and medical equipment businesses.

Collectively, they’re accused of submitting $160 million in false claims to Medicare for services that were either not needed or provided to patients. In turn, Medicare paid out more than $90 million, according to authorities.

The various South Florida indictments were unveiled as part of a Justice Department crackdown on Medicare fraud in hot spots such as Brooklyn, Detroit and Los Angeles, resulting in a total of 91 defendants being charged with $295 million in bogus billing.

The federal program, which caters to more than 40 million elderly and disabled patients, has been bleeding billions of dollars a year because of waste, fraud and abuse, according to healthcare experts and law enforcement.

Medicare officials recently unveiled new computer software weapons to screen prospective Medicare operators, including criminal background checks, and to scrutinize claims, which are regularly paid within 14 days. But the FBI’s special agent in charge of the Miami regional office said the massive healthcare agency needs to be far more aggressive to prevent the fraud up front.

“The FBI, Health and Human Services-Office of Inspector General and the U.S. attorney’s office devote vast resources to investigate, catch and prosecute those committing healthcare fraud,” said John Gillies, the FBI’s top South Florida agent. “But that’s addressing the problem after the fact. By then, the criminals have squandered away the money they stole.”

On Tuesday and Wednesday, federal agentsfanned out across three South Florida counties, arresting a total of 42 Medicare fraud offenders. Three others charged are believed to be in Florida.

The sweep came almost one year after the indictment of Miami-based American Therapeutic Corp., with seven regional clinics. A total of 24 defendants, including senior executives, psychiatrists and counselors, were charged, netting several guilty pleas and one trial conviction. That case alone accounted for $200 million in fraudulent Medicare claims during the past decade. The agency paid out $83 million.

This week, 10 more patient recruiters and others were charged as part of the conspiracy.

But the biggest case was the new indictment of Biscayne Milieu and 23 defendants, including the family owners, a psychiatrist, Dr. Gary Kushner, patient recruiters and ALF operators. The clinic owners are accused of paying recruiters and landlords to lure out-of-state patients into the scheme.

Among those charged: Antonio and Jorge Macli, the father and son who owned the clinic in an office park off the Palmetto Expressway. Since 2007, authorities say, Biscayne Milieu submitted $50 million in fraudulent Medicare bills, resulting in $11 million in payments.

Read the rest of the article here:  http://www.miamiherald.com/2011/09/07/2394354/dozens-arrested-in-medicare-mental.html#ixzz1XNnx5ZoS

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Coakley alleges Janssen illegally marketed drug

By Jessica M. Karmasek – LegalNewsLine.com

August 2, 2011

BOSTON (Legal Newsline) — Drug manufacturer Ortho-McNeil-Janssen is being sued by Attorney General Martha Coakley for illegally marketing Risperdal, an atypical antipsychotic medication.

Coakley’s lawsuit alleges that Janssen promoted the drug to treat elderly dementia and a number of uses in children and adolescents when these uses had not been shown to be safe and effective and had not been approved by the U.S. Food and Drug Administration.

The complaint, filed this week in Suffolk Superior Court, further alleges that Janssen failed to disclose serious risks associated with Risperdal’s use, including the risk of excessive weight gain, diabetes and, for elderly dementia patients, an increased risk of death.

“Manufacturers should not promote uses of their pharmaceutical products that have not been established to be safe and effective,” Coakley said in a statement Monday.

“Janssen put profits ahead of patient safety by promoting Risperdal for uses that had not been approved and by failing to disclose serious risks associated with Risperdal’s use.”

According to the attorney general’s lawsuit, Janssen’s unfair and deceptive practices included:

* Omitting and/or concealing material facts regarding Risperdal’s efficacy and safety in its communications with Massachusetts health care providers and consumers;

* Concealing, omitting or minimizing the side effects and risks associated with Risperdal’s use;

* Promoting Risperdal to treat elderly dementia without disclosing to prescribers the serious risks associated with Risperdal’s use in dementia patients, including an increased risk of death;

* Promoting Risperdal to treat elderly dementia without disclosing to prescribers that the U.S. Food & Drug Administration had rejected the company’s request to market Risperdal for this use because of unaddressed safety concerns;

* Promoting Risperdal’s use as safe and effective to treat conduct disorder and other conditions in children for more than a decade before receiving FDA approval to market Risperdal to treat any conditions in children;

* Making misleading and deceptive statements to prescribers about Risperdal’s safety, particularly with respect to weight gain and the risk of developing diabetes;

* Paying physicians to participate in sham consulting programs that were, in fact, thinly disguised marketing programs touting unapproved uses; and

* Targeting its sales and marketing efforts to prescribers who rarely, if ever, prescribe Risperdal for its FDA-approved uses, primarily the treatment of schizophrenia and bipolar mood disorder.

According to the attorney general’s complaint, Janssen’s illegal marketing and sales tactics helped the company generate hundreds of millions of dollars in sales in the state.

Citing company documents, Coakley’s lawsuit notes that these illegal tactics helped make Risperdal a market leader in both the children and adolescent and elderly market segments.

http://www.legalnewsline.com/news/233450-coakley-alleges-janssen-illegally-marketed-drug

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The Telegraph – July 22, 2011

By Martni Beckford, Health Correspondent

Five dementia sufferers die each day after being wrongly prescribed “chemical cosh” drugs, the Department of Health has warned.

Click image to read: The Psychiatric Abuse of Our Elderly

Many more hospital patients and care home residents suffer strokes triggered by the antipsychotic medications they are given to keep them sedated.

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Business Insider – July 20, 2011

by Robert Johnson

Image: wikipedia commons

Outselling even common drugs to treat high blood pressure and acid reflux, antipsychotic medications are the single top-selling prescription drug in the United States.

Once reserved for hard-core, One Flew Over The Cuckoo’s Nest type of mental illnesses to treat hallucinations, delusions or major thought disorders; today, the drugs are handed out to unruly kids and absent minded elderly.

A recent story in Al Jazeera by James Ridgeway of Mother Jones illuminates the efforts by major pharmaceutical companies to get doctors prescribing medicines like Zyprexa, Seroquel, and Abilify to patients for whom the drugs were never intended.

Focusing on psychiatrists because they rely on subjective diagnoses, the drug reps have been so successful that they’ve changed the criteria for mental illness and disability payments. Ridgeway quotes former New England Journal of Medicine editor Marcia Angell.

“[T]he tally of those who are so disabled by mental disorders that they qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) increased nearly two and a half times between 1987 and 2007 – from one in 184 Americans to one in seventy-six. For children, the rise is even more startling – a thirty-five-fold increase in the same two decades. Mental illness is now the leading cause of disability in children.” Under the tutelage of Big Pharma, we are “simply expanding the criteria for mental illness so that nearly everyone has one.” Fugh-Berman agrees: In the age of aggressive drug marketing, she says, “Psychiatric diagnoses have expanded to include many perfectly normal people.”

Particularly vulnerable because medication decisions are often out of their hands the old and the young suffer most.

For kids: the number diagnosed with bi-polar disorder rose 40-fold between 1994 and 2003 and one in five comes away from a psychiatrist with a prescription for an antipsychotic.

Dosing the elderly at nursing homes has become so common that sales reps have coined the term “five at five” — meaning 5 milligrams of Zyprexa at 5 pm to sedate difficult residents.

For all their nefarious wrangling, in 2009, Lily agreed to pay $1.4 billion, including a $515 million criminal fine. The largest ever in a health care case and the largest criminal fine on any corporation in the U.S.

That year, Lilly sold $1.8 billion of Zyprexa alone.

http://www.businessinsider.com/zyprexa-antipsycotics-top-selling-drugs-in-us-2011-7

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Modern Medicine – July 16, 2011

Long-term-care (LTC) facilities are overusing antipsychotic drugs. One of every 7 elderly nursing home residents is receiving at least 1 atypical antipsychotic; in 83% of these cases, the drug is associated with a dementia diagnosis, yet the use of atypical antipsychotics in dementia increases the risk of death and is not approved by FDA, according to a report from the Office of the Inspector General (OIG).

Erroneous claims

“Government, taxpayers, nursing home residents, as well as their families and caregivers, should be outraged — and seek solutions,” said Daniel R. Levinson, Inspector General, Department of Health and Human Services (HHS), in a statement. “Despite the fact that it is potentially lethal to prescribe antipsychotics to patients with dementia, there’s ample evidence that some drug companies aggressively marketed their products toward such populations, putting profits before safety.”

OIG analyzed atypical antipsychotic use in LTC at the request of Sen Charles Grassley (R-Iowa). The report, issued in May, evaluated Part B and Part D claims data from January to June 2007. Analysts concluded that 51% of Medicare claims for atypical antipsychotics were erroneous. The claimed drugs were not used for medically accepted indications, not used off label as supported by recognized compendia, or not documented as having been administered to the elderly nursing home resident. The erroneous payments totaled $116 million for the 6 months studied.

Unmet standards

OIG also found that 22% of atypical antipsychotics used in LTC were not administered according to Medicare standards regarding unnecessary drug use in nursing homes. The standards are designed to reduce excessive dosage, excessive duration of therapy, inappropriate use, and lack of appropriate monitoring. Noting that violation of unnecessary drug-use rules may affect nursing homes’ participation in Medicare, OIG recommended that HHS act to reduce unnecessary drug use in LTC.

The report included aripiprazole (Abilify, Bristol-Myers Squibb), clozapine (Clozaril, Novartis), olanzapine (Zyprexa, Eli Lilly), olanzapine/fluoxetine (Symbyax, Eli Lilly), paliperidone (Invega, Janssen), quetiapine (Seroquel, AstraZeneca), risperidone (Risperdal, Janssen), and ziprasidone HCl (Geodon, Pfizer).

http://drugtopics.modernmedicine.com/drugtopics/Modern+Medicine+Now/Antipsychotics-overused-in-LTC-setting-OIG-says/ArticleStandard/Article/detail/730695

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Natural News – June 8, 2011

by Monica G. Young

While sipping drinks from coconut shells, psychiatrists from around the world recently met in Honolulu to discuss more ways to capitalize on human behavior and promote drug dependency. The occasion was the annual meeting of the American Psychiatric Association (APA), held in a Hawaiian convention center lined with mental disorder displays and pharmaceutical booths.

“Hot” topics (potential markets for social control and drug pushing) included:

1) Mental health issues during a woman’s reproductive cycle, such as “treating” pregnant women for bipolar – a disorder said to cause unusual shifts in mood and energy levels. In speaking to Medscape News, an APA committee co-chair, Dr. Don Hilty, called this “a really nice-growing area.”

Yet most every woman experiences mood and energy shifts during pregnancy. Despite this, it is not uncommon for pregnant women to be diagnosed as bipolar and prescribed antipsychotics, some of the most powerful drugs on the market. Even the FDA website alerts doctors to “be aware of the effects of antipsychotic medications on newborns when the medications are used during pregnancy.” The site warns of abnormal muscle movements and withdrawal symptoms, and the FDA’s adverse effects reporting program (Medwatch) includes cerebral hemorrhage, heart malformations and death as documented reactions in newborns. Similarly, studies show birth defects and other serious risks for infants whose mothers took antidepressants while pregnant.

2) Childhood disorders were a particularly popular issue at the convention. But they didn’t stop there – prenatal and newborn genetic screening for mental illness has taken on new emphasis in the psychiatric world. “It’s also trying to understand how genetics predict what medications can be used,” stated APA’s Dr. Hilty.

Having already labeled millions of kids “abnormal” and drenched their brains in toxic substances – a multi-billion dollar business – apparently they aren’t satisfied. They aim to brand children as mental patients and destine them for drug-dependency before they’re even born.

The conference even touched upon electroconvulsive shock therapy (ECT) for children – sending electric volts through their heads. That will teach ‘em to shut up and sit still! It will also cause permanent brain damage.

3) ADHD is usually promoted as a childhood disorder but a team of psychiatrists proposed a new definition to make it easier to diagnose (and drug) older teens and adults. They claim people who tend to miss work deadlines and interrupt others deserve this label.

This would surely lead to millions more on daily meds. Who doesn’t know co-workers who miss deadlines or even friends who interrupt you? Not emphasized however is that, per a study published in The Clinical Neuropsychologist, one in four adults seeking an ADHD diagnosis fake it to obtain stimulant drugs.

4) Capitalizing on America’s service men and women was another hot one: diagnosing and drugging the military for post-traumatic distress disorder, depression and anxiety.

Did they mention that 18 U.S. veterans commit suicide daily, largely due to psychiatric drugs? Not likely. As reported by Neev M. Arnell in NaturalNews, “the increasingly high number of deaths among both veterans and active duty soldiers-including suicides, accidental overdose, and lethal drug interactions-have now been linked to the exponential increase in the prescribing of drugs for post traumatic stress disorder, depression and other psychological illnesses.” (http://www.naturalnews.com/032598_v…)

5) Anticipating the “silver tsunami” as the Baby Boomer generation moves into the over-65 bracket, psychiatrists stressed the need for more psychiatric services for the elderly.

Not stressed, if mentioned at all, is the rampant over-use of psychiatric drugs in nursing homes. Elderly patients’ reactions to physical ailments are often squelched with mind-altering drugs. And a recently released government audit shows nearly one in seven elderly nursing home residents are given antipsychotics – nearly all of them dementia patients for whom the drugs can be lethal. Many lawsuits and settlements have revealed that drug companies have falsely promoted these drugs to doctors and nursing homes for years.

6) While not on the “hot” list, another issue that bit was bedbugs. A New York psychiatrist and his colleagues presented a detailed study showing bedbugs can trigger anxiety.

What a remarkable – and potentially profitable – discovery! Gee, with the rise in bedbug infestation in New York City, maybe Bedbug Anxiety should be included in the next edition of the DSM (psychiatry’s diagnostic and billing bible).

Father of psychiatry – the bloodletter

The American Psychiatric Association calls itself “the voice and conscience of modern psychiatry.”

Adorning the convention hall was the APA logo which enshrines Dr. Benjamin Rush (1746-1813) as the father of psychiatry. A very influential doctor, teacher and statesman of his time, Rush propagated his theory that Blacks suffered from an inherited disease called “Negritude.” The only evidence of a cure, he said, was the skin turning white. He warned, “whites should not intermarry with them, for this would tend to infect posterity with the ‘disorder.’” Whites, seeking not to be “infected,” used this fabled disease to justify segregation.

Rush was also a chief proponent of bloodletting as a cure-all for mental and physical illnesses. Widespread in America in those days, he made lots of money at it. One of Rush’s students applied his teachings to a patient who complained of a sore throat: nine pints of blood were removed from the man’s body in twenty-four hours and he died. That patient was George Washington, the first President of the United States.

Sources for this article include:
http://www.medscape.com/viewarticle…

http://www.medscape.com/viewarticle…

http://healthland.time.com/2011/05/…

http://healthland.time.com/2011/04/…

http://www.nytimes.com/2011/05/10/h…

http://www.jstor.org/pss/985399

http://www.websters-online-dictiona…

http://www.cchr.org/cchr-reports/cr…

About the author:
Monica G. Young is a human rights investigator and educational writer with a purpose to expose the truth about the pharmaceutical and psychiatric industries and safeguard human liberty. She encourages non-drug alternative approaches based on healthy lifestyles and human decency. She supports the Citizens Commission on Human Rights and like-minded groups.

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DesMoines Register
May 31, 2011

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CNN
By Daniel R. Levinson, Special to CNN
May 31, 2011

Daniel Levinson, inspector general for the OIG in the Department of Health and Human Services.

When a loved one moves into a nursing home, the support of family and friends is particularly important. This is especially true when the nursing home patient has dementia and can’t adequately advocate on his or her own behalf.

A newly released report from my office — the Office of the Inspector General for the Department of Health and Human Services — makes clear just how crucial it is for families to monitor and ask questions about medications that such patients receive. The report found that too often, elderly residents are prescribed antipsychotic drugs in ways that violate government standards for unnecessary drug use.

Frequently, they are prescribed in ways that don’t qualify as medically accepted for Medicare coverage. In addition, the drugs were predominately prescribed for uses that are not approved by the Food and Drug Administration.

But the most potentially troubling finding of the study is this: Researchers found that 88% of the time, these drugs were prescribed for elderly people with dementia.

This is precisely the population that faces an increased risk of death when using this class of drugs, according to the FDA. That’s why the agency puts its strongest safety warning, called a “black box warning” on these antipsychotic drugs, cautioning about the risk of death when taken by elderly people with dementia.

The report didn’t investigate why patients with dementia are prescribed antipsychotic drugs so often. But a series of lawsuits and settlements that my office helped bring about suggests that many pharmaceutical companies have improperly promoted these drugs to doctors and nursing homes for many years.

Another view: In defense of antipsychotics for dementia

The study began a few years ago, when a member of Congress questioned how many nursing home residents received a class of antipsychotic drugs introduced in the 1990s, among them risperidone and olanzapine. These drugs are known as “atypical” or “second generation” antipsychotics. They replaced the antipsychotic drugs introduced in the 1950s and 1960s to treat schizophrenia — and, incidentially, are far costlier.

The report found about 305,000 nursing home residents (about 14%) had Medicare claims for atypical antipsychotic drugs. Of these, about one in five residents was prescribed these antipsychotics in a way that violated government standards for their use. For example, residents were on a drug for too long, or at too high a dose.

Another finding: A little more than half the antipsychotic drug claims for which Medicare paid should not have been covered. Why? The claimed drugs were not used for medically accepted reasons or there were no records the drugs were actually provided.

To be clear: Most physicians and nursing homes dispense antipsychotic drugs with the best interests of patients in mind. Physicians can use their medical judgment to prescribe drugs for uses unapproved by the FDA, and also to patients for whom the boxed warning applies. Ideally, however, doctors who prescribe in such ways first determine that the benefits outweigh the risks.

Yet it remains a concern that so many elderly nursing home residents with dementia are prescribed antipsychotics. And, unfortunately, examples abound of companies’ improper promotion of these drugs.

Government investigations of Bristol-Myers Squibb, AstraZeneca and Pfizer found that they improperly promoted their antipsychotic drugs for unapproved uses.

Federal prosecution is pending against Johnson & Johnson for allegedly paying millions of dollars in kickbacks to induce Omnicare, the nation’s largest long-term care pharmacy, to recommend the use of Risperdal in treating nursing home patients, many of whom had dementia.

And Eli Lilly pleaded guilty to criminal charges associated with illegally marketing its drug Zyprexa, including to doctors who treat elderly nursing home patients.

Pharmaceutical companies have paid billions to resolve civil and criminal liabilities under federal health and safety laws. But money can’t adequately compensate for corporate campaigns that could put vulnerable, elderly patients at risk.

How do we solve this problem? There’s plenty to do.

Family members of nursing home residents must learn about their loved ones’ medications, the reasons for their use, proper dosages and possible side effects.

Nursing homes and pharmacies that serve the elderly must keep the best interests of the patient in mind when dispensing pharmaceuticals and not base the decision on the improper influence of drug companies.

Doctors, too, should rely on their best medical judgments and engage in an especially careful analysis when prescribing drugs for off-label use.

Government must combat illegal off-label promotion of these powerful and potentially lethal drugs and uphold nursing home safety standards.

And drug companies should follow the laws, and refrain from promoting drugs for unapproved uses — or paying kickbacks to influence doctors and institutions. About 46 million people are enrolled in Medicare. That will only grow as the huge baby boomer population retires. We cannot afford to leave unaddressed the urgent problem of antipsychotic drug use among elderly nursing home residents.

The opinions in this commentary are solely those of Daniel Levinson.

Read article here:  http://www.cnn.com/2011/OPINION/05/31/levinson.nursing.home.drugs/

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TIME
By Maia Szalavitz
May 26, 2011

Maryland Correctional Institution, Jessup, Maryland - Marvin Joseph/The Washington Post/Getty Images

Pharmaceutical companies have recently paid out the largest legal settlements in U.S. history — including the largest criminal fines ever imposed on corporations — for illegally marketing antipsychotic drugs. The payouts totaled more than $5 billion. But the worst costs of the drugs are being borne by the most vulnerable patients: children and teens in psychiatric hospitals, foster care and juvenile prisons, as well as elderly people in nursing homes. They are medicated for conditions for which the drugs haven’t been proven safe or effective — in some cases, with death known as a known possible outcome.

The benefit for drug companies is cold profit. Antipsychotics bring in some $14 billion a year. So-called “atypical” or “second-generation” antipsychotics like Geodon, Zyprexa, Seroquel, Abilify and Risperdal rake in more money than any other class of medication on the market and, dollar for dollar, they are the biggest selling drugs in America. Although these medications are primarily approved to treat schizophrenia and bipolar disorder, which combined affect 3% of the population, in 2010 there were 56 million prescriptions filled for atypical antipsychotics.

In a presentation this week at an American Psychiatric Association meeting, Dr. John Goethe, director of the Burlingame Center for Psychiatric Research in Connecticut, reported that over the last 10 years, more than half of all children aged 5 to 12 in psychiatric hospitals were prescribed antipsychotics — and 95% of these prescriptions were for second-generation antipsychotics. Many of these children didn’t have a condition for which the drugs have been shown to be helpful: 44% of youngsters with post-traumatic stress disorder (PTSD) and 45% of children with attention deficit hyperactivity disorder (ADHD) were treated with them.

Pharmacologically, the ADHD prescriptions make no sense: FDA-approved drugs for the condition raise levels of the neurotransmitter dopamine, while antipsychotics do they opposite, lowering them.

Geothe also noted another study that showed that the number of office visits by children and teens that included antipsychotic drug prescriptions rose 600% from 1993 to 2002. “The obvious second-generation bias is very apparent in these data, as is the irrational use of antipsychotics for indications such as PTSD and ADHD for which there is no controlled evidence whatsoever that these are safe or effective treatments,” says Dr. Bruce Perry, senior fellow at the ChildTrauma Academy in Houston. (Full disclosure: Dr. Perry is my co-author on two books.)

The situation may be similar in state-run juvenile detention systems. Late last week, an exposé by the Palm Beach Post revealed that antipsychotics were among the top drugs purchased by the Florida Department of Juvenile Justice (DJJ), and were largely used in kids for reasons that were not approved by the government — for instance, sleeplessness or anxiety. The Post reported:

In 2007, for example, DJJ bought more than twice as much Seroquel as ibuprofen. Overall, in 24 months, the department bought 326,081 tablets of Seroquel, Abilify, Risperdal and other antipsychotic drugs for use in state-operated jails and homes for children.

That’s enough to hand out 446 pills a day, seven days a week, for two years in a row, to kids in jails and programs that can hold no more than 2,300 boys and girls on a given day.

Among the psychiatrists hired by the state to evaluated incarcerated kids, about a third received drug company money, the Post reported. Those 17 psychiatrists wrote 54% of the prescriptions for antipsychotics; the 35 doctors who did not take such payments wrote the rest. In other words, one-third of doctors — all of whom were paid by drug companies — wrote more than half of all antipsychotic prescriptions for the state’s locked-down youth.

The statistics on children in foster care are equally alarming. Youth in foster care are not only three times as likely to be medicated as comparable low-income youth on Medicaid, but more than half are treated with antipsychotics. It is not likely that all or even most of these children have a condition for which antipsychotics have been approved by the government to treat.

Among the problems with unnecessary use of antipsychotic medications is that they can cause serious, sometimes irreversible, damage. Atypical antipsychotics are associated with weight gain and may double users’ risk of Type 2 diabetes. Recent research also suggests that they may shrink the brain and there is little data on how they affect brain development during the teen years, when the brain grows more than at any other time but infancy. Indeed, youth are more vulnerable than any other group to the drugs’ worst side effects (excluding death).

“The majority of antipsychotic medication use in children and adolescents has not been limited to the few age groups or conditions for which there is credible evidence of efficacy and safety,” says Perry. “There is no reason to expect irrational prescribers to change their bad habits.”

He adds that many experts would argue that if doctors began prescribing antipsychotics “responsibly and cautiously” — that is, being mindful of the lack of efficacy data and the evidence of harm — the rate of prescriptions in children would drop by 90%.

Meanwhile, rates of prescriptions for patients at the other end of the lifespan are also out of control. In nursing homes, 14% of residents have been given at least one prescription for a second-generation antipsychotic, according to a government investigation. A full 88% of these prescriptions are given to people with dementia, despite the fact that these drugs may double the risk of death in these patients (there is a black box warning on the drug to this effect). The investigation estimated that $116 million Medicare dollars have been spent filling antipsychotic prescriptions that never should have been written.

So why are these drugs so widely prescribed? Aggressive drug company marketing is only one part of the story. A key reason they are overused in institutional settings is that they are sedating, making patients easier to manage. Secondly, unlike other sedative drugs, they are not associated with misuse (with the possible exception of Seroquel, which has fans among some addicts). In fact, most people resist taking antipsychotics, which is why overmedication is much more common in settings where people are locked-in and compliance can be forced.

The second point — that these drugs are not considered addictive — by itself probably accounts for a big part of why drug companies have been able to get away with so much misleading marketing and the resultant overprescribing. Although prescribing of traditional sedatives like benzodiazepines (Valium, Xanax), which are vulnerable to misuse, is limited by their status as controlled substances, few people enjoy misusing antipsychotics (side effects like weight gain, pleasurelessness, movement disorders and low energy and motivation are not generally sought by recreational drug users), so they can be prescribed for unapproved uses like behavior control and sleep-inducement in children and the elderly.

In other words, addiction is basically seen as a worse side effect than death. The fact that the most vulnerable youth and elderly often cannot advocate for themselves has made it easier to sweep the problem under the rug.

Fortunately, there is at least one bright spot in this depressing picture. The main patent on Risperdal expired in 2007, and those for Zyprexa and Seroquel expire this year. Geodon’s patent expires next year, while Abilify’s comes up in 2015. When most drugs go off-patent, drug companies’ marketing pressure — and profits — will subside, perhaps keeping children and the elderly safer from inappropriate medication.

Read article here:  http://healthland.time.com/2011/05/26/why-children-and-the-elderly-are-so-drugged-up-on-antipsychotics/

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Santa Cruz Sentinel -  May 15, 2011

A recent study by the Office of the Inspector General of the United States indicates that residents of some nursing homes may be regularly given atypical antipsychotic drugs as a means of chemical restraint, sometimes to the detriment of their health, including death.

The report, published May 9, states: “For the period January 1 through June 30, 2007, we determined using medical record review that 51 percent of Medicare claims for atypical antipsychotic drugs were erroneous.”

A member of Congress requested the office evaluate the extent to which nursing home residents receive atypical antipsychotic drugs and the associated cost to Medicare. The member expressed concern with these drugs were being prescribed for off-label conditions — i.e. conditions other than schizophrenia and/or bipolar disorder — and/or in the presence of a condition specified in the Food and Drug Administration’s boxed warning.

“We determined that 83 percent of Medicare claims for atypical antipsychotic drugs for elderly nursing home residents were associated with off-label conditions and that 88 percent were associated with the condition specified in the FDA boxed warning,” the Office of the Inspector General found.

The California Advocates for Nursing Home Reform has been concerned about this issue for some time. For more information, visit www.canhr.org/help.html

http://www.santacruzsentinel.com/ci_18067580

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