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).
Has America become a nation of psychotics? You would certainly think so, based on the explosion in the use of antipsychotic medications. In 2008, with over $14 billion in sales, antipsychotics became the single top-selling therapeutic class of prescription drugs in the United States, surpassing drugs used to treat high cholesterol and acid reflux.
Once upon a time, antipsychotics were reserved for a relatively small number of patients with hard-core psychiatric diagnoses – primarily schizophrenia and bipolar disorder – to treat such symptoms as delusions, hallucinations, or formal thought disorder. Today, it seems, everyone is taking antipsychotics. Parents are told that their unruly kids are in fact bipolar, and in need of anti-psychotics, while old people with dementia are dosed, in large numbers, with drugs once reserved largely for schizophrenics. Americans with symptoms ranging from chronic depression to anxiety to insomnia are now being prescribed anti-psychotics at rates that seem to indicate a national mass psychosis.
Phillip Sinaikin, MD, is a Florida psychiatrist who has been in practice for 25 years. Author of “Get Smart About Weight Control” and co-author of “Fat Madness: How to Stop the Diet Cycle and Achieve Permanent Well-Being,” his new book focuses on excesses and industry influence in the field of psychiatry.
Rosenberg: Your new book, Psychiatryland, traces how deception, conflicts of interest, medical enabling and direct-to-consumer advertising have resulted in millions being on psychiatric drugs they don’t need. One patient you describe has legitimate mourning and grief work to do after his wife leaves him for his own cousin. But his grief is pathologized into “bipolar disorder” by the system, including his own mother.
By the time Florida started paying Dr. Gold Smith Dorval to counsel and medicate jailed children, the Pembroke Pines psychiatrist already had experience with kids in state custody. He had used them, authorities said, to bilk the government out of money for the poor. When Dorval pleaded no contest to a felony grand theft charge, it should have barred him, by law, from working for Florida’s Department of Juvenile Justice. It didn’t.
And, like Dorval, other doctors have emerged from past troubles and gotten jobs at DJJ – with authority to prescribe drugs to kids in state jails, a Palm Beach Post investigation has found.
Some psychiatrists took DJJ jobs after they were cited for breaking the law, making grave medical missteps or violating state rules. Others were hired after they were accused of overmedicating patients, sometimes fatally.
All were empowered to prescribe drugs to jailed kids as powerful antipsychotic pills flowed freely into Florida’s homes for wayward children.
“It’s appalling. A psychiatrist is a psychiatrist. They’re licensed, they’ve been to medical school, and there is a certain trust placed in that person’s judgment when they tell you that this child needs to be medicated,” said John Walsh, an attorney with the Palm Beach County Legal Aid Society who has represented children in juvenile court. “This just illustrates that we always have to be on guard with children.”
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.