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Study Shows That Poor Children are Likelier to Get Antipsychotic Medications


A New drug research that was federally funded discloses a bleak picture about under privileged children who are covered by Medicaid. The F.D.A. has approved antipsychotic drugs for children specifically to treat schizophrenia, autism and bipolar disorder. But they are more frequently prescribed to children for other, less extreme conditions, including attention deficit hyperactivity disorder, aggression, persistent defiance or other so-called conduct disorders especially when the children are covered by Medicaid, the new study shows.

The research team from Rutgers and Columbia will clearly add fuel to a long-running debate. The debate is, do too many children from poor families receive powerful psychiatric drugs not because they actually need them and will help them, but because it is a cost efficient way to control problems that may be handled differently for middle-class children?

It is critical that people realize the questions about the drugging or poor children on Medicaid go beyond the psychological impact. These antipsychotic drugs can have severe physical side effects, causing drastic weight gain and metabolic changes resulting in lifelong physical problems.

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This past week, the pediatric advisory committee to the Food and Drug Administration met to talk about the health risks for all children who take antipsychotics. One of the topics discussed was considering recommending new label warnings for the drugs, that are now used by over 300,000 children under age 18 in this country.

Some experts say they are stunned by the disparity in prescribing these drugs. However, others say it reinforces previous indications that children with diagnoses of mental or emotional problems in low-income families are more likely to be given drugs than receive family counseling or psychotherapy. One of the main reasons why this is happening is because of insurance reimbursements. Medicaid often pays much less for counseling and therapy than private insurers do.

“It’s easier for patients, and it’s easier for docs,” said Dr. Derek H. Suite, a psychiatrist in the Bronx whose pediatric cases include children and adolescents covered by Medicaid and who sometimes prescribes antipsychotics. “But the question is, ‘What are you prescribing it for?’ That’s where it gets a little fuzzy.”

Congress will work on health care legislation that could expand the nation’s Medicaid rolls by 15 million people which is a 43 percent increase and the scope of the antipsychotics problem, and the expense, could grow in coming years.

Even though the drugs are typically cheaper than long-term therapy, they are the single biggest drug expenditure for Medicaid, costing the program $7.9 billion in 2006, the most recent year for which the data is available. The Rutgers-Columbia research, based on millions of Medicaid and private insurance claims, is the most extensive analysis of its type yet on children’s antipsychotic drug use.