Friday, December 2, 2011

Foster Care Children Inappropriately Overdrugged

Children in foster care are a very vulnerable population having been removed from abusive or neglectful homes. These children are experiencing childhood trauma, grief at loss of their biological family, loss of their home community and often having experienced severe abuse – physical, psychological, emotional and sexual. These are children who often have experienced years of trauma leaving them with complex post traumatic stress. Thus they are prone to show the symptoms of PTSD - which is often misunderstood and therefore is often treated as other mental health conditions instead.

Post Traumatic Stress Disorder or PTSD is best handled by cognitive behavioral therapy – this is proven to be effective for victims/survivors of sexual assault and also survivors of combat trauma. Cognitive behavioral therapy is usually provided by a therapist or psychologist. These children have come from a home environment which is like a combat zone – domestic violence, drug dealers, drive by shootings, child sexual abuse by relatives, abusive punishments, parents with mental illness who act irrationally and arbitrarily, and other traumatic events. Psycho-social treatment has better outcomes.

Child placement agencies, foster care parents and residential treatment centers get paid a daily sum for the care of a foster child. These allocated amounts are based on the federal entitlement system IV-e and are based on the level of care the child needs. The more difficult the child is to care for the higher the daily payment for care. Thus it is in the interest of the state agencies, social service workers, foster parents, and therapeutic clinicians to make the child appear on paper to need the highest level of care possible. Many foster children are labeled with more than one psychological diagnosis in order to upgrade their status to a higher level. Foster care daily rates run from $17 per day to $1,000 per day. To those in the business of providing welfare medical services, a child diagnosed with a mental disorder and placed on psychiatric drugs provides more income than a child without problems. In addition pharmaceutical companies often provide a "finders fee" to doctors who find additional children to place in clinical trials of drugs for "off label use". Psychiatrists who prescribe these medications according to pharmaceutical company directives are rewarded with paid educational conferences and continuing education credits, research funding and priority for selection to serve on prestigious posts at universities and on governmental agencies or public commissions. Talk therapy is not the usual work of psychiatrists in this modern age of mind altering psychiatric medications. Instead the standard psychiatrist is a clinician who uses drugs to alter behavior and spends very direct face to face time with patients. Prescribing psychiatrists are only required to spend 15 minutes every 90 days with their patient in order to collect their professional fee as a patient's doctor.

Thousands of foster children are routinely prescribed doses of psychotropic drugs that are higher than the maximum levels cited in guidelines based on FDA approved labels. This increases the potential for adverse side effects and does not typically increase the efficacy of the drugs to any appreciable extent. Even children as young as one year old were prescribed psychiatric drugs even though there were no mental health conditions in infants which would warrant their use. This certainly could result in serious adverse effects including metabolic and cardiovascular problems.

A 3 year old girl in Kansas died as a result of being overdosed on Seroquel. Both parents were former drug addicts and both diagnosed with bipolar disorder. This 3 year old girl starts acting out, banging her head against the wall, and even tried to suffocate a dog. The little girl who was only 37 pounds was prescribed 6o mgs/day.

Many of these drugs cause symptoms that can themselves be construed as mental illness. The side effects of these drugs include suicidal thoughts, loss of coordination, hallucinations, kidney, thyroid, liver and pancreas damage, polycystic ovaries, weight gain, diabetes, tremors, potentially fatal neuroleptic malignant syndrome, rigidity, tardive dyskinesia, depression, agitation, sleeplessness, nightmares, blurred vision, decreased appetite, tics, and psychosis. As a class of drugs SSRIs can create a unique combination of side effects that may severely impair judgment and impulse control in individual patients. Excessive doses of antidepressants can cause brain dysfunctions including disorientation, confusion, and cognitive disturbances. The FDA warning specifically links antidepressant use to suicidal behavior in four percent of kids on these drugs compared to two percent for kids on placebos.

When the children show these symptoms they are often given higher doses of the drugs or even additional drugs, rather than being given lower dosages or taken off these medications. So a spiral occurs of increasing dosages of more powerful drugs leading to great symptoms and decreasing function of the child. When the child becomes unmanageable, they are placed in a residential treatment facility at $700 or more a day for weeks sometimes much longer. If the psychiatrist wants to change their medication and get them “habituated” on a new medication the child might be hospitalized for half a year or more. This all happens at the US taxpayers’ expense.

In an effort to expand the market for psychiatric drugs, pharmaceutical companies capitalized on the use of foster children to test their products on this vulnerable population. These children were not given the right to informed consent, they were wards of the court in a judicial system that is overworked and understaffed and where even CASA volunteers have little time to carefully review FDA information or scientific literature about the safety or effectiveness of prescribed medications. The legal surrogate decision makers for the child are not medically trained and often accept blindly the advice of the treating psychiatrist. No information about the long term consequences of the use of these medications in children is given to these decision makers so crisis decision making is the norm with the pills looking like the perfect quick fix. In addition the pharmaceutical industry has for decades controlled the release of negative information about their products by controlling all the publicity of research findings (funded by the industry), using an aggressive legal campaign to shut down any malpractice law suit¸ out of court settlements with gag orders for silence and suppressing court documents from discovery by having them sealed by the judge.

Through aggressive marketing to medical professionals, teachers, CASA volunteers, welfare case managers, and guardians, the pharmaceutical companies have now pushed the treatment of children for such mental diseases as attention deficit hyperactivity disorder (ADHD), bipolar disorder, depression and schizophrenia, often diagnosing them for these problems so as to use psychiatric medications “off label”. The Teen Screen program which pushed psychiatric drugs on school children is an example of this direct marketing by pharmaceutical companies. The pharmaceutical industry has placed industry representatives on major governmental panels and commissions order to influence policy to facilitate passing legislation that would approve the Medicaid payment of psychiatric medications for “off label” uses. But these drugs are not without risk, there are serious side-effects, including irreversible movement disorders, seizures, and increased risk of diabetes. Many patients who take these drugs also develop over time Parkinsonian side effects.

The prescription of these drugs is oftentimes very questionable and inappropriate prescribing to youth in state custody has lead to increased costs to the US taxpayer over the lifetime of the child. These children, who are often medicated with up to 5 drugs at the same time, have cognitive impairment, as well as physical dependency on the drugs. When they try to stop the medications they face severe withdrawal symptoms for up to 6 months and these symptoms can be misunderstood and the child instead re-drugged at high dosages. No study has been done to see if these foster children who were highly medicated were able to go on to productive independent lives after leaving foster care. During their years in foster care, many have been in and out of residential treatment, leading to disruption in their schooling. In addition these drugs change the child’s ability to think, reason, and also dull emotional awareness and response. This makes it difficult to learn and to relate to peers and their foster/adoptive family.

When they age out of the foster care system, they find themselves thrown out into a world that labels them as mental misfits, treats them with disrespect and forces them into being repeat users of the psychiatric industry/medical complex. Many end up in prison and then are force drugged by court order in prison and when they are released court ordered medicated for life. The costs of the repeat hospitalizations – at $700 -$1,000 a day along with the cost of medications at tens of thousands of dollars a year, is a cost borne by the US taxpayer often until the former foster child’s death.

Although these drugs produce no tolerance and no euphoria, they produce enduring post-discontinuation changes that are as extensive and long lasting as the changes underpinning current disease models of addiction. Patients also get withdrawal or discontinuation syndromes when they stop taking their medication or when their medication is lowered in dose. So when a patient runs out of medication or is suddenly put on a lower dosage they can demonstrate exacerbation of their clinical signs. Therapeutic dependence can be lifelong and thus the cost to the US taxpayer is also for the life of the foster child who often transitions into a life long welfare recipient or a prison inmate.

The danger of withdrawal from antidepressants and antipsychotics is well documented. The brain compensates for the blockage of the serotonin and dopamine receptors by growing additional receptors for these neurotransmitters. When the medications are discontinued or suddenly decreased, these additional receptors contribute to 'overload' of serotonin and dopamine flooding the receptor. This is known as discontinuation syndrome. What usually happens to the patient in withdrawal is that they end up back in the hospital again. These crisis admissions lead to being labeled with a new disease diagnosis – schizophrenia, or delusional or manic depressive and then placed on even greater dosages of even more dangerous drugs. The doctors in these instances are quick to blame the patient, for a relapse rather than considering when the patient last took his medication. Discontinuation syndrome can sometimes last for weeks or months - some people have said they can last as long as six months.

It has been estimated that 70% of the US prison population was once in foster care. Three in 10 of the nation's homeless adults report foster care history and this points to an obvious problem within our social service network. There are inadequacies in supervision of the placement of these children, clear indications of corruption within the system as well as neglect of the children’s needs. These traumatized children need us to protect them from abuse as human subjects for unauthorized research and we must as a nation be more careful in authorizing Medicaid payments for “off label use” of psychiatric drugs in our foster care system .

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