“Psychotropic drugs are being used to sedate, restrain, and silence, and, as such, are a tool of oppression. CCHR asserts that this practice meets the legal definition of elder abuse and must be treated as a criminal offense.” – Jan Eastgate, President CCHR International

CCHR demands a ban on chemical restraints in U.S. nursing homes and accountability for prescribers, facilities and pharmaceutical companies alike.

By Jan Eastgate
President CCHR International
June 20, 2025

Key Facts

• Over 179,000 elderly U.S. nursing home residents were given antipsychotics in a single week—without an approved diagnosis—placing them at double the risk of death.

• Psychiatric drugs are now the third leading cause of death in older Americans—killing an estimated 209,000 seniors annually.

• Nursing home doctors increasingly mislabel elderly patients with schizophrenia—a near-nonexistent diagnosis in seniors—to justify the use of dangerous antipsychotics.

• Up to 80% of long-term nursing home residents are prescribed psychotropic drugs, and only 1 in 24 cases of elder abuse—including chemical restraint—is ever reported.

Federal health officials are once again sounding the alarm over the chronic, unchecked drugging of America’s elderly in long-term care and nursing homes. The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) is prioritizing enforcement to curb the use of antipsychotic and psychotropic drugs in nursing homes—especially for residents with dementia. Over 15,000 facilities nationwide house more than 1.2 million seniors, many of whom are vulnerable to sedation under the guise of treatment.[1] This constitutes nothing short of institutional elder abuse.

CCHR is urging U.S. lawmakers to adopt the call by a United Nations expert to prohibit the use of chemical restraints for behavior control in aged-care facilities. This follows a searing report by Claudia Mahler, UN Independent Expert on the enjoyment of all human rights by older persons. Mahler warned that in some countries, including the U.S., older people are “more likely to be deprived of liberty in care facilities than in prisons.” She described the use of chemical restraints—drugs administered to control behavior without therapeutic justification—as “widespread and abusive.”[2]

In 2018, she said, more than 179,000 nursing home residents in the U.S. were given antipsychotics despite lacking an approved psychiatric diagnosis. Mahler emphasized that for elderly individuals with dementia, the risk of death can double when subjected to these drugs.

Mounting Death Tolls, Warnings Ignored

These findings are consistent with longstanding warnings from federal experts. In 2007, Dr. David Graham, then a senior drug safety official with the Food and Drug Administration (FDA), warned that at least 15,000 nursing home residents die annually from antipsychotic use.[3] Since then, the problem has only worsened.

Dr. Peter Gøtzsche, a physician and internationally recognized expert on pharmaceutical safety, estimates that among Americans aged 65 and older, psychiatric drugs—including neuroleptics, benzodiazepines, and antidepressants—are responsible for approximately 209,000 deaths annually. Alarmingly, sleeping pills alone could contribute to another 320,000 to 507,000 deaths each year.[4]

In 2013, prescription drugs were the third leading cause of death in the Western world, “after heart disease and cancer,” Gøtzsche warned. By 2015, psychiatric drugs alone were the third leading cause of death. He explained that “polypharmacy”—the practice of prescribing multiple drugs concurrently, particularly common in psychiatry—greatly increases the risk of fatal drug interactions.

As he pointed out, combining a benzodiazepine with a neuroleptic can increase mortality by 50–65%. In dementia care specifically, published studies show that for every 100 patients prescribed a newer antipsychotic for just ten weeks, one patient dies.

Patterns of Abuse, Decades of Failure

Despite federal attempts at reform, the pharmaceutical exploitation of the elderly has continued for decades:

• 1987: Federal regulations prohibited the use of psychotropics for staff convenience or facility management purposes. Prescriptions were to be independently reviewed monthly.[5]

• 2005: The FDA mandated a black-box warning for antipsychotic use in dementia patients due to elevated death risks. In response, doctors began labeling seniors with schizophrenia—a diagnosis virtually nonexistent in the elderly—to justify prescriptions.[6]

• 2011: Then Health and Human Services (HHS) Inspector General Daniel Levinson issued a scathing report: “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.”[7]

• 2012–2015: The Center for Medicaid and Medicare Services (CMS) implemented the National Partnership to Improve Dementia Care, which led to some reductions in antipsychotic prescribing in nursing homes—from 23.9% in 2011 to 14.1% in 2020. Yet real progress was undermined by diagnosis manipulation and lack of enforcement.[8] The number of unsupported schizophrenia diagnoses increased194% from 2015 through 2019.[9]

• 2021: An investigation by The New York Times exposed that many nursing home physicians continued to falsely diagnose residents with schizophrenia to sidestep restrictions, with 21% of residents still receiving antipsychotics.[10]   

• 2023: CMS initiated another crackdown after discovering that certain facilities were systematically mislabeling patients to justify dangerous prescribing—despite well-known risks, including death.[11]

Drugmakers’ Profits vs. Public Health

Some of this crisis is fueled by pharmaceutical greed. Johnson & Johnson (J&J), the maker of the antipsychotics Risperdal (risperidone) and Invega (paliperidone palmitate), has long been at the center of investigations into antipsychotic promotion. According to the U.S. Department of Justice (DOJ), J&J paid tens of millions in kickbacks to Omnicare, a pharmacy consultant company that regularly influenced prescribing in nursing homes. J&J knew doctors accepted Omnicare’s drug recommendations more than 80% of the time.[12]

In 2013, J&J and subsidiaries paid $2.2 billion to settle civil and criminal charges related to illegal promotion and kickbacks. At the time, it was one of the largest healthcare fraud settlements in U.S. history.[13]

Journalist Gardiner Harris’s 2025 exposé, No More Tears: The Dark Histories of Johnson & Johnson, shed further light. He noted that J&J’s initial clinical trials for Risperdal included only 85 patients over age 65. Even in this small cohort, those on the drug had elevated blood pressure and higher death rates than placebo. An FDA letter to J&J in January 1998 raised concerns over “an excess number of deaths.” Still, the company plowed forward—motivated by profit margins exceeding 90%.[14]

By 1999, Risperdal was generating $892 million a year.[15] In the first nine months of 2022, the injectable version, Risperdal Consta, brought in $373 million globally.[16] The global risperidone market alone was worth $4.5 billion in 2023—and is projected to grow to $6.8 billion by 2032.[17] 

Ghostwritten Science, Manufactured Legitimacy

Drug marketing is further enabled by corrupted academic practices. As The Guardian reported, pharmaceutical companies often ghostwrite scientific papers and recruit “guest authors”—doctors willing to sign their names without reviewing the underlying data.[18]

Legal scholars Simon Stern and Trudo Lemmens have called for these practices to be prosecuted under the U.S. Racketeer Influenced and Corrupt Organizations (RICO) Act, arguing that such ghostwriting constitutes a form of “legal fraud.”[19]

This manipulation has deadly consequences. A meta-analysis in the Journal of Clinical Psychopharmacology found consistent increases in mortality among dementia patients treated with atypical antipsychotics like risperidone.[20] A separate study of 4,717 seniors found the risperidone cohort had the highest death rate.[21]

The American Bar Association has weighed in, too, calling the improper use of antipsychotics in nursing homes “dangerous,” citing side effects including movement disorders, strokes, and elevated mortality. It warned that unless prescribing practices change, “the aging population will continue to be hospitalized or die when the resources are there to prevent this from happening.”[22]

Direct-to-Consumer Marketing: Aiding and Abetting

In 1997, regulations on Direct-to-Consumer (DTC) marketing were relaxed, allowing a massive surge in television and magazine advertising for prescription drugs.[23] By 2005, psychiatric drugs accounted for 13% of all advertised prescription medications featured in 11 popular magazines. These ads often promoted unrealistic expectations—suggesting easy cures, low failure rates, and minimal side effects, despite the well-documented risks associated with many psychiatric drugs. A report from the University of Pittsburgh highlighted this deceptive marketing trend.[24] In 2007, the editor of Annals of Family Medicine called DTC advertising “a huge, uncontrolled public health experiment on American people.”[25]

Data from 2014 to 2015 show that psychiatric drugs made up 20% of the 10 most advertised drugs and 10% of the 100 top-selling drugs.[26]

By 2019, antipsychotics accounted for 9% of all Medicaid spending ($6.2 billion) and 10% of all Medicaid prescriptions (73.1 million claims). Risperidone alone represented 17.3% of this market. Between 2016 and 2021, overall spending on brand-name antipsychotics rose 36.4%, from $4.0 billion to $5.5 billion. By 2021, brand-name antipsychotics comprised 90.8% of total antipsychotic spending.[27]

A 2021 study published in the Journal of Alzheimer’s Disease found that DTC advertising significantly influenced prescription use among adults aged 65 and older. The study focused on television advertising, given its popularity with seniors—who watch, on average, two more hours of television daily than younger Americans. Researchers found older adults to be especially vulnerable to the “illusion of truth” effect, in which repeated misinformation is more likely to be accepted as fact. After the introduction of Medicare Part D, which expanded prescription drug coverage for seniors, elderly-dense regions were subjected to higher volumes of televised pharmaceutical ads compared to younger areas. Between 2006 and 2017, over $1.6 billion was spent on televised DTC advertising for just three psychiatric drugs—$528 million of that spent on the antipsychotic Abilify.[28]

In June 2025, the federal End Prescription Drug Ads Now Act was introduced to ban DTC advertising, prohibiting drug companies from promoting prescription drugs through television, radio, print, digital platforms, and social media. In 2024, the ten largest pharmaceutical companies made over $100 billion in profits, while the industry spent more than $5 billion on television ads alone. Prescription drug commercials now consume over 30% of ad time during major network evening news programs. Yet, studies show that more than half of these ads are misleading or outright false.[29]

A Hidden Epidemic of Elder Abuse

Beyond drug harms, elder abuse in U.S. facilities is rampant. According to available data, about 16% of nursing home residents experience some form of abuse, yet only 1 in 24 cases is reported. Even more disturbing, up to 40% of staff admit to the psychological abuse of residents.[30]

Psychotropic drugs are being used to sedate, restrain, and silence,[31] and, as such, are a tool of oppression. CCHR asserts that this practice meets the legal definition of elder abuse and must be treated as a criminal offense.

Calls for Reform

The exploitation and harm of elderly residents in nursing homes is not an isolated scandal—it is a systemic failure, sustained by government inaction, corporate profiteering, and institutional corruption. Reform must be sweeping and unflinching.

Veteran health journalist Gardiner Harris, whose investigative work uncovered the dark history of psychiatric drug promotion, outlined critical measures in his book No More Tears to stop what he described as a “criminal enterprise and killing machine.” His recommendations include:

1. Prohibit doctors from accepting gifts or money from pharmaceutical or device manufacturers while treating patients. “They can’t do both because too many patients have died as a result.”

2. Ban doctors from participating in CMS or Medicare-funded care if they have received industry payments within the past three years.

3. End the use of clinical trials where payments to physicians function as thinly veiled bribes rather than scientific research.

4. Eliminate industry-funded Continuing Medical Education (CME) courses, which serve as disguised marketing campaigns.

5. Stop pharmaceutical industry funding of the FDA. A separate, independent agency should be tasked with post-market surveillance of medical products and regulation of their commercial promotion.

6. Hold companies and executives criminally accountable for lying to the FDA or in court proceedings.[32]

Building upon Harris’s foundation, CCHR recommends additional reforms aimed at eliminating the systemic abuse of seniors through psychotropic drugging:

7. Ban the use of antipsychotics and other psychotropic drugs as chemical restraints—especially on dementia patients—for behavioral control in nursing homes.

8. Enforce civil, financial, and criminal penalties against top prescribers and facility operators who violate these prohibitions.

9. Prohibit ghostwritten scientific papers funded by pharmaceutical companies and prosecute doctors who falsely claim authorship under fraud or RICO statutes.

10. Abolish the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) as the guiding authority in mental health diagnoses and research due to the pervasive financial conflicts among its contributors.

11. Empower residents and families with legal recourse by designating chemical restraint as a form of elder abuse under federal and state law.

12. End Direct-to-Consumer marking of psychiatric drugs, which is a likely significant influence on prescription trends.

Conclusion: Stop Sedating Seniors—Start Protecting Them

What’s happening in nursing homes today is not treatment. It is tranquilization disguised as care. Behind closed doors, our most vulnerable citizens are being chemically silenced—not for their benefit, but for profit and convenience. The use of antipsychotics on elderly patients, particularly those with dementia, continues to result in premature death, physical injury, and psychological harm.

This is not just a policy failure—it is a national disgrace.

It is time to outlaw chemical restraints in nursing homes. It is time to hold prescribers, companies, and regulatory agencies fully accountable. And it is time to prioritize the lives of our elders over the bottom lines of the psychiatric-pharmaceutical industry.

Our seniors deserve compassion, not coercion. Safety, not sedation. Dignity, not death by prescription.

[1] Poliakoff & Associates, P.A., “Nursing Home Oversight and Antipsychotic Drug Use,” 12 June 2025, https://gpoliakoff.com/nursing-home-oversight-and-antipsychotic-drug-use/

[2] Bridget Sleap, “‘Chemical Restraints’ Deprive Older People of Liberty,” Human Rights Watch, 19 Sept. 2022, https://www.hrw.org/news/2022/09/19/chemical-restraints-deprive-older-people-liberty

[3] https://www.cchrint.org/2023/01/27/dangerous-mental-health-practices-must-stop-on-our-elderly-in-nursing-homes/; Testimony by Dr. David Graham, House Hearing, 110th Congress – The Adequacy of FDA to Assure the Safety of the Nation’s Drug Supply General, 13 Feb. 2007, https://www.govinfo.gov/content/pkg/CHRG-110hhrg35502/pdf/CHRG-110hhrg35502.pdf, p. 66

[4] Peter C. Gøtzsche, “Prescription Drugs Are the Leading Cause of Death,” Brownstone Institute, 16 Apr. 2024, https://brownstone.org/articles/prescription-drugs-are-the-leading-cause-of-death/

[5] Gardiner Harris, No More Tears: The Dark Histories of Johnson & Johnson, (Random House, New York) 2025, p. 180

[6] https://www.cchrint.org/2021/09/20/cchr-urges-greater-govt-oversight-of-elderly-chemically-restrained-and-shocked/; Katie Thomas, Robert Gebeloff and Jessica Silver-Greenberg “Phony Diagnoses Hide High Rates of Drugging at Nursing Homes,” The New York Times, 16 Sept. 2021, https://www.nytimes.com/2021/09/11/health/nursing-homes-schizophrenia-antipsychotics.html

[7] https://www.cchrint.org/2023/01/27/dangerous-mental-health-practices-must-stop-on-our-elderly-in-nursing-homes/; https://oig.hhs.gov/newsroom/news-releases-articles/overmedication-nursing-home-patients-troubling/

[8] Carl Dimitri, “Brown Study Challenges Common Perceptions of Antipsychotic Use in Nursing Homes,” Brown University School of Public Health, 5 Sept. 2024, https://sph.brown.edu/news/2024-09-05/nursing-homes-antipsychotics

[9] “Long-Term Trends of Psychotropic Drug Use in Nursing Homes,” Health and Human Services Office of the Inspector General, 11 Nov. 2022, https://oig.hhs.gov/reports/all/2022/long-term-trends-of-psychotropic-drug-use-in-nursing-homes/

[10] https://www.cchrint.org/2021/09/20/cchr-urges-greater-govt-oversight-of-elderly-chemically-restrained-and-shocked/; Katie Thomas, Robert Gebeloff and Jessica Silver-Greenberg “Phony Diagnoses Hide High Rates of Drugging at Nursing Homes,” The New York Times, 16 Sept. 2021, https://www.nytimes.com/2021/09/11/health/nursing-homes-schizophrenia-antipsychotics.html  

[11] https://www.cchrint.org/2023/01/27/dangerous-mental-health-practices-must-stop-on-our-elderly-in-nursing-homes/; “Nursing Homes Under Investigation for Abuse of Antipsychotics,” Newsmax, 18 Jan. 2023, https://www.newsmax.com/health/health-news/nursing-homes-government-federal/2023/01/18/id/1104862/; Amanda Seitz, “Feds to investigate nursing home abuse of antipsychotics,” AP News, 18 Jan. 2023, https://apnews.com/article/health-nursing-homes-medication-schizophrenia-ad76a524c9e97c5eaf857d89c4119b34

[12] “Johnson & Johnson paid millions in kickbacks to Omnicare, False Claims suit alleges,” Fierce Healthcare, 20 Jan. 2010, https://www.fiercehealthcare.com/healthcare/johnson-johnson-paid-millions-kickbacks-to-omnicare-false-claims-suit-alleges

[13] “Johnson & Johnson to Pay More Than $2.2 Billion to Resolve Criminal and Civil Investigations,” Health and Human Services Office of the Inspector General, 4 Nov. 2013, https://oig.hhs.gov/fraud/enforcement/johnson-johnson-to-pay-more-than-22-billion-to-resolve-criminal-and-civil-investigations-allegations-include-off-label-marketing-and-kickbacks-to-doctors-and-pharmacists/

[14] Gardiner Harris, No More Tears: The Dark Histories of Johnson & Johnson, (Random House, New York) 2025, pp. 177, 180

[15] Gardiner Harris, No More Tears: The Dark Histories of Johnson & Johnson, (Random House, New York) 2025,, p. 182

[16] “Entering J&J’s fiefdom, Luye wins FDA approval of long-acting schizophrenia drug,” Fierce Healthcare, 17 Jan. 2023, https://www.fiercepharma.com/pharma/entering-jjs-fiefdom-luye-wins-fda-approval-long-acting-schizophrenia-drug

[17] “Risperidone Market Report _ Global Forecast From 2025 To 2033,” https://dataintelo.com/report/global-risperidone-market

[18] https://www.cchrint.org/2017/07/26/bring-criminal-psychiatrists-under-law/; Ian Sample, “Scientists credited on ghostwritten articles ‘should be charged with fraud,’” The Guardian, 2 Aug 2011, https://www.theguardian.com/science/2011/aug/02/scientists-ghostwritten-articles-fraud.

[19] https://www.cchrint.org/2017/07/26/bring-criminal-psychiatrists-under-law/; “Legal Remedies for Medical Ghostwriting: Imposing Fraud Liability on Guest Authors of Ghostwritten Articles,” PLoS Medicine, 2 Aug. 2011, https://doi.org/10.1371/journal.pmed.1001070

[20] Martin Haupt, et al., “Mortality in elderly dementia patients treated with risperidone,” Journ. Clin. Psychopharmacology, Dec. 2006, https://pubmed.ncbi.nlm.nih.gov/17110812/

[21] Bhalerao, S., et al., “Mortality Risk with Use of Atypical Antipsychotics in Later-Life Bipolar Disorder,” J Geriatr Psychiatry Neurol, Mar. 2012, https://pmc.ncbi.nlm.nih.gov/articles/PMC4216676/

[22] Jordan Sibley-Diggs, “Improper Use of Antipsychotic Medication,” American Bar Association, 12 Jan. 2023, https://www.americanbar.org/groups/law_aging/publications/bifocal/vol44/bifocal-vol-44-issue3/improper-use-of-antipsychotic-medication/

[23] “Impact of advertising psychiatric drugs,” Brown University, Science Daily, 13 Sept. 2016, https://www.sciencedaily.com/releases/2016/09/160913134000.htm

[24] Rebecca Abromitis, “Direct-to-Consumer (DTC) Advertising of Psychiatric Drugs in Popular Magazines: How are Mental Disorders Portrayed?” MLA ’06 Abstracts, Medical Library Association, Health Sciences Library System, University of Pittsburgh, p. 66, https://www.mlanet.org/wp-content/uploads/2024/09/mla2006_abstracts.pdf

[25] “Impact of advertising psychiatric drugs,” Brown University, Science Daily, 13 Sept. 2016, https://www.sciencedaily.com/releases/2016/09/160913134000.htm

[26] https://www.medscape.com/viewarticle/868880

[27] Nicole C Giron et al., “Descriptive Trends in Medicaid Antipsychotic Prescription Claims and Expenditures, 2016 – 2021,” J Behav Health Serv Res, 10 July 2024, https://pmc.ncbi.nlm.nih.gov/articles/PMC11445305/

[28] Robin Feldman, “Physicians Treating Alzheimer’s Disease Patients Should Be Aware that Televised Direct-to-Consumer Advertising Links More Strongly to Drug Utilization in Older Patients,” Jour. Alzheimers Dis. June 2021, https://pmc.ncbi.nlm.nih.gov/articles/PMC8293633/

[29] Richard Payerchin, “Sanders, senators float ban on direct-to-consumer ads for prescription drugs,” Medical Economics, 12 June 2025, https://www.medicaleconomics.com/view/sanders-senators-float-ban-on-direct-to-consumer-ads-for-prescription-drugs

[30] Usama Khan, “Elder Abuse Statistics,” Retirement Living Journal of Retirement Research, 19 May 2025, https://www.retirementliving.com/nursing-care-facilities/elder-abuse-statistics

[31] Eric Carlson, “Why Too Many Psychotropic Medications,” Justice in Aging, Jan. 2023, https://justiceinaging.org/issue-brief-why-too-many-psychotropic-medications-in-nursing-facilities/; “They Want Docile,” Human Rights Watch, 5 Feb. 2018, https://www.hrw.org/report/2018/02/05/they-want-docile/how-nursing-homes-united-states-overmedicate-people-dementia

[32] Gardiner Harris, No More Tears: The Dark Histories of Johnson & Johnson, (Random House, New York) 2025, pp. 349-350