418,000 Kids Aged 0-5 on Psych Drugs: Campaign for "De-Prescribing"
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LOS ANGELES - Washingtoner -- In commemoration of Universal Children's Day in November and Human Rights Day on December 10th, the Citizens Commission on Human Rights International launched a new campaign in the U.S. aimed at securing legislative and policymaker support for a zero-tolerance approach to psychotropic drugging of children. CCHR is deeply concerned by the 6.1 million children in America prescribed psychotropic drugs in 2020, including 418,425 in the 0–5 age group. The group obtained this data from IQVIA (formerly IMS Health), the largest vendor of U.S. physician prescribing data. While these alarming figures reflect the broader scope of psychotropic drugging, government programs such as Medicaid and Children's Health Insurance Program (CHIP) are funding what CCHR deems "child abuse" as infants, toddlers and preschoolers are subjected to powerful drugs that can pose serious, long-term risks to their health and development.

In 2023, 6.5 million Medicaid/Children's Health Insurance Program (CHIP) beneficiaries were ages 0-2 and a further 20.6 million were aged 3-11. CCHR says there needs to be a massive overhaul of Medicaid and CHIP, which has become a lucrative system for those prescribing mind-altering drugs to millions of children—some so powerful they can drive them to suicide and acts of violence. Medicaid and CHIP are the largest payers for mental health services and substance abuse treatment.[1]

CCHR wants to see the adoption of policies similar to those in the United Kingdom to start reducing the drugging of children. In the UK, a group of about 30 medical experts and politicians discovered "Rising antidepressant prescribing is not associated with an improvement in mental health outcomes at the population level, which, according to some measures, have worsened as antidepressant prescribing has risen." They called for a reversal in the rate of antidepressant prescribing (de-prescribing) which includes, stopping the prescribing of antidepressants for mild conditions for new patients, proper informed consent and regular review of harms, as well as funding and delivering a national 24-hour prescribed drug withdrawal helpline and website.[2]

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The group says that policies must encompass all psychotropic drugs. Medicaid administration programs have attempted to address the massive prescribing of antipsychotics and other psychotropics in children and adolescents, particularly foster care youth, following government reports highlighting excessive use. Consequently, some state Medicaid oversight programs have published research indicating a reduction in antipsychotic use among children, according to Julie Zito, a professor of Pharmacy and Psychiatry at the University of Maryland, and her colleagues in Frontiers in Psychiatry.[3] However, CCHR questions the accuracy of these reduction claims.

In 2023, a study published in Health Affairs did show there was a sizeable 43% decline in antipsychotic use among children aged 2–17 under Medicaid between 2008 and 2016. The largest absolute decline was observed in White children (−1.37%) vs. Black (−0.62%), Hispanic (−0.31%), and Asian (−0.17%) children.[4]

However, for children in foster care, antipsychotic use was still overrepresented. Although slightly decreased, in 2016, 7.7% were prescribed the drugs compared to 1.19% not in foster care. The researchers warned that antipsychotics are associated with potentially serious side effects, including type 2 diabetes, cardiometabolic effects (such as high blood pressure, weight gain, cholesterol problems, etc.), and unexpected death.

Antipsychotics have consistently ranked among the top drug classes for Medicaid spending across all age groups. In 2019, psychotherapeutic agents—including antipsychotics and antidepressants—were the third most expensive outpatient drug class for the program. That year, antipsychotics represented 9% of Medicaid's total spending ($6.2 billion) and 10% of all prescriptions (73.1 million claims). Between 2016 and 2021, the total number of antipsychotic prescription claims rose by 23.3% from 18.5 million. Similarly, total gross spending on these drugs increased by 16.7%, climbing from $5.17 billion in 2016 to $6.03 billion in 2021.[5]

Children in the welfare system are also a target for these drugs. A 2023 study published in JAMA Pediatrics analyzed the prevalence of psychotropic drug use and polypharmacy—the practice of prescribing two or more drugs—among Medicaid beneficiaries and children in the child welfare system. This latter group included youth accessing adoption assistance, foster care, or guardianship care.

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Researchers estimated the rates of psychotropic drug use, polypharmacy, and associated mental health conditions by age group (3-17, 3-5, 6-11, and 12-17 years)."

Findings revealed that 26.25% of children in the child welfare group had been prescribed at least one psychotropic drug, and 13.27% experienced polypharmacy. By comparison, 9.06% of other Medicaid-enrolled youths were prescribed psychotropic drugs, with only 3.11% experiencing polypharmacy.

The most common class of psychotropic drugs in the child welfare group was stimulants (15.95%), followed by antidepressants (9.88%) and antipsychotics (7.87%).[6]

Psychotropic polypharmacy also affects substantially more children and adolescents today than has been the case, Julie Zito, Ph.D. reported. As many as 300,000 youth now receive three or more classes concomitantly. The duration of concomitant use is relatively long, e.g., 69–89% of annual medicated days. More adverse event reports are associated with 3-class compared with 2-class drug regimens.[7]

Supporting a zero-tolerance de-escalation policy should include warning parents and caregivers of children in the welfare and Medicaid-CHIP populations about the critical adverse drug effects. This information is concisely presented in FDA-approved Medication Guides—handouts provided with many prescriptions—designed to help consumers recognize and avoid serious adverse events.

Both state and federal governments are urged to adopt a strong policy of "de-prescribing" powerful psychotropic drugs to children and adolescents.

By prioritizing these measures, the U.S. can take significant steps toward safeguarding the well-being of its youngest and most vulnerable populations, protecting them from harmful psychotropic drugs.

Sources:

[1] www.medicaid.gov/medicaid/quality-of-care/downloads/beneficiary-ataglance-2023.pdf

[2] www.bmj.com/content/383/bmj.p2730

[3] pmc.ncbi.nlm.nih.gov/articles/PMC8236612/

[4] pmc.ncbi.nlm.nih.gov/articles/PMC10845053/

[5] link.springer.com/article/10.1007/s11414-024-09889-0

[6] pmc.ncbi.nlm.nih.gov/articles/PMC10442784/

[7] pmc.ncbi.nlm.nih.gov/articles/PMC8236612/