California Toughens Stance on Use of Mind-Altering Antipsychotic Drugs for Poor Children, Foster Youth

By Sa, Karen de | Pasadena Star-News, March 13, 2015 | Go to article overview

California Toughens Stance on Use of Mind-Altering Antipsychotic Drugs for Poor Children, Foster Youth


Sa, Karen de, Pasadena Star-News


State regulators are rejecting thousands of requests from California physicians to prescribe antipsychotic drugs to poor children and foster youth, a dramatic first step in the state's new effort to curb the excessive prescribing of powerful mind-altering medications.

Nearly 1 in every 5 requests for the medications were denied in January because they were medically unnecessary or unsubstantiated. That is triple the rate of denials that occurred in October, when the state first began requiring an extra level of oversight, suggesting the scrutiny is growing tougher over time.

Fifteen physicians, pharmacy experts and academic researchers who reviewed the results at this newspaper's request agreed that the numbers represent a still early but potentially hopeful sign that the new policy is already working to protect California's most vulnerable children from dangerous prescribing - the focus of this newspaper's yearlong investigation "Drugging Our Kids."

"The fact that any are denied is encouraging and interesting," said longtime Walnut Creek behavioral pediatrician Lawrence Diller. "Any second opinion or watchdog oversight is fortunate for these powerless, unrepresented kids."

Since October, prescribers have had to take extra steps to demonstrate the need for antipsychotics, a potent psychiatric drug that this newspaper found is often used in foster care to control children's behavior, not for the severe mental illnesses those drugs are approved to treat.

Now, doctors must provide a diagnosis and a medical rationale to a team of state pharmacists before an antipsychotic prescription is filled for patients 17 and younger. Previously, doctors only needed approval to prescribe the drugs to children 5 and younger.

So far, initial requests for antipsychotics have plunged from 16,915 in October to 6,950 in January. While the vast majority of the requests over that period have been approved, 4,771 were denied on their first submission, with the rejection rate rising from 6 percent in October to 18 percent in January. The state also has deferred thousands more requests that were incomplete and needed additional information to be approved.

The denials are telling because before October, prescriptions for youngsters ages 6-17 would have been filled with no questions asked.

"It really shows the power of prior authorization," said Adriane Fugh-Berman, an associate professor in the department of pharmacology and physiology at Georgetown University Medical Center who studies how antipsychotics are prescribed in foster care. "Just indicating that 'we're watching you' makes a difference."

The numbers of Treatment Authorization Reviews, known as "TARs," were revealed following a request from the California Alliance of Child and Family Services, which represents residential group homes and has been concerned about the new policy delaying access to medication.

Youth advocates, including the National Center for Youth Law, say the new restrictions are a good start. But they are pushing for much broader reforms that would require treatments for traumatized children that do not rely on medication, better monitoring of children prescribed psych meds and training for caregivers in handling children without using chemical restraints. The center is now working with the state Legislature on four bills to further tackle the widespread problem.

State health care and social service officials have spent years studying possible curbs as well, but until October, they had done little to rein in high rates of antipsychotic use in foster care. This newspaper found that 62 percent of teens in California foster care prescribed psychiatric drugs over the past decade have been given the heavily sedating antipsychotics, which can cause obesity, diabetes and uncontrollable tremors. …

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