Youth in Juvenile detention: antipsychotics instead of physical restraints: Texas rears its ugly head using Seroquel for control: what about Foster kids?
This "Psych Meds in Jails", article has brought up the topic of using antipsychotics as chemical restraints in U.S. juvenile detention facilities.
A complex subject, where informed consent, age of children being given neuroleptics such as Seroquel, Abilify, Zyprexa and other antipsychotics can become riddled with questions.
Questions of rights of children, whether incarcerated or in foster care--these kids and youth have no choices whether or not to be given potent drugs in more cases than not--for restraint purposes and off-label use.
The state of Texas known for the TMAP--adult mandatory protocol for mental health care and CMAP, for kids reared its head in this ground-breaking investigative report by Youth Today.
I recommend reading the entire article regarding the drugging of detained youth, then take a look at a few highlights from the state of Texas and the care of foster kids.
Foster kids and kids in juvenile detention represent the most silent of all vulnerable youth: the ones who have no advocates, family or other way to speak about their care.
I find the list from the Texas DSHS medication protocol for foster kids alarming, as the panel of people used to create the guidelines are heavily conflicted--meaning the researchers and doctors have taken pharma drug company income for various reasons, therefore the recommendations are tainted--yet the Texas work group is touted as "renowned researchers and experts".
FROM the "Psych Meds In Jails" article:
"A ground-breaking, year-long investigation by Youth Today has uncovered ample evidence that many youths incarcerated in American juvenile facilities are getting potent anti-psychotic drugs intended for bipolar or schizophrenic patients, even when they have not been diagnosed with either disorder."
AND
"Texas Youth Commission Executive Director Cherie Townsend learned soon after taking the job in 2008 that more than a quarter of the youths in her facilities were on anti-psychotic medication. Just as surprising was that many of them entered her facilities already having been prescribed the drugs."
AND
"When she assumed the Texas post, one trend rose to the surface very quickly. TYC was relying heavily on atypicals to treat mental health disorders.
Nearly 4,000 prescriptions for atypicals were written in 2008, and Townsend said more than a quarter of the population – which hovered between 1,600 and 1,900 – were being prescribed the atypicals. That means some juveniles had to have been prescribed more than one anti-psychotic medication.
“I was pretty overwhelmed,” Townsend says. “I think everyone who has worked in a detention center, when we see a lot of kids on psychotropic medications and atypicals, it’s a great concern to us.”
Data provided by Texas show that the state was using the atypicals most often for youths with no indication of bipolar or schizophrenia. Only 29 percent of the juveniles taking atypicals were diagnosed with either of those two disorders.
The records for more than a quarter of the 3,924 prescriptions for the atypicals did not indicate any condition. The diagnoses records for those prescriptions were labeled “missing” in TYC’s response to Youth Today.
Of the 1,100 prescriptions for which no diagnosis was recorded, 695 were for Seroquel. In 2008, Seroquel was prescribed by TYC psychiatrists 2,553 times, nearly twice as often as the other four atypicals combined."
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Read about the Foster kids psych drug protocol in Texas
Psychotropic Medication Utilization Parameters for Foster Children-TEXAS
Psychotropic Medication Utilization Parameters for Foster Children
Developed by: Texas Department of State Health Services
Criteria Indicating Need for Further Review of a Child’s Clinical Status
7) Psychotropic medications are prescribed for children of very young age, including children receiving the following medications with an age of:
• Antidepressants: Less than four (4) years of age
• Antipsychotics: Less than four (4) years of age
• Psychostimulants: Less than three (3) years of age
Usual recommended maximum doses of common psychotropic medications These tables are intended to reflect usual maximum doses of commonly used psychotropic medications.
The preferred drug list of medications potentially prescribed for foster children is the same as for all other Medicaid recipients.
These doses represent usual daily maximum doses, and are intended to serve as a guide for clinicians. The tables are not intended to serve as a substitute for sound clinical judgment in the care of individual patients, and individual patient circumstances may dictate the need for the use of higher doses in specific patients. In these cases, careful documentation of the rationale for the higher dose should occur, and careful monitoring and documentation of response to treatment should be observed. Not all medications prescribed by clinicians for psychiatric diagnoses in children and adolescents are included below. However, in general, medications not listed do not have adequate efficacy and safety information available to support a usual maximum dose recommendation.
Antipsychotics Usual Maximum Dose per Day
Children Adolescents
Aripiprazole 15 mg 30 mg (Abilify)
Clozapine 300 mg 600 mg (Clozaril)
Haloperidol 5 mg 10 mg (Haldol)
Olanzapine 12.5 mg 20 mg (Zyprexa)
Perphenazine No data 32 mg
Quetiapine 300 mg 600 mg (Seroquel 300mg for 3-4 yr olds and up to 600mg for teens)
Risperidone 4 mg 6 mg (Risperdal)
Ziprasidone No data 180 mg
Texas DSHS touts one guideline member as being "renowned" which is a red flag for having conflict of interest drug company income, so I looked him up:
Members of the Ad Hoc Working Group on Psychotropic Medication Guidelines for Foster Children
"Peter Jensen, M.D.: Dr. Jensen is Professor and Director of the Center for Advancement of Children’s Mental Health, Columbia University, NYC, NY. He is a renowned researcher and clinician in the care of children with mental disorders."
ADHD study
Large ADHD Study Finds Improvement Sustained at 3 Years in Most Children
During the course of the MTA, since 1992, Dr. Jensen has received research funding from McNeil and unrestricted grants from Pfizer; has consulted for Best Practice Inc, Shire, Janssen, Novartis, and UCB; and has participated in the speakers' bureaus of Janssen-Ortho, Alza, McNeil, CME Outfitters, and the Neuroscience Education Institute.
Journal of Managed Care
Journal of Managed Care:
Participating Faculty (CME -Continuing Medical Education)
Peter S. Jensen, MD
President & CEO
The REACH Institute
REsource for Advancing Children's Health
New York, New York
Faculty Disclosures
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) assesses conflict of interest with its instructors, planners, managers, and other individuals who are in a position to control the content of CME activities. All relevant conflicts of interest that are identified are thoroughly vetted by PIM for fair balance, scientific objectivity of studies utilized in this activity, and patient care recommendations. PIM is committed to providing its learners with high-quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest or a commercial interest. The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:
Peter S. Jensen, MD
Consultant:
Ortho-McNeil Janssen Scientific Affairs, LLC
Otsuka America Pharmaceutical, Inc.
Shire
Another from the advisory guideline group
"Steven Shon, M.D., M.S.: Dr. Shon is recently retired as Medical Director for Mental Health Services, DSHS, Austin, TX. Dr. Shon is a psychiatrist and has years of experience in public sector psychiatry and mental health administration. He has faculty appointments with the UTHSC at San Antonio and The University of Texas at Austin. He served as a project co-director for the Texas Medication Algorithm project."
Dr. Steven Shon
Conflict of interest fears halt children's mental health project August 2008-Dallas Morning News
"A state mental health plan naming the preferred psychiatric drugs for children has been quietly put on hold over fears drug companies may have given researchers consulting contracts, speakers fees or other perks to help get their products on the list.
The Children's Medication Algorithm Project, or CMAP, was supposed to determine which psychiatric drugs were most effective for children and in what order they should be tried at state-funded mental health centers. In April, high-ranking state health officials gave researchers the go-ahead to roll out the guidelines.
A month later, the officials delayed the protocol, after Texas Attorney General Greg Abbott's office objected to it.
At most, the suspension indicates that state investigators fear fraud has occurred. At the least, it reflects nationwide unease with potential conflicts of interest between leading medical researchers and the pharmaceutical firms that fund much of their work.
Publicly, officials say it's because the state is suing a pharmaceutical company alleged to have used false advertising and improper influence to get its drugs on Texas' now-mandatory adult protocol, the Texas Medication Algorithm Project."
AND
"Dr. Shon, then the medical director for the Department of State Health Services, was ousted over allegations the pharmaceutical company Janssen improperly influenced him to include its schizophrenia drug in the protocol, according to previous news reports and the TMAP lawsuit.
Dr. Shon was accused of accepting consulting money from the company – income he says was unrelated to his work for the state – and of taking dozens of trips underwritten by drug companies to promote the protocol."
*Members of the work group for Foster kids in Texas and Psychotropic med use also developed CMAP
Conflicts of Interest PHARMA COMPANY INCOME (from the news article)
"Several of the researchers who developed the Children's Medication Algorithm Project have received income or grants from drug companies, according to their published papers and university financial disclosure forms:
DR. M. LYNN CRISMON*: The CMAP project director who heads UT-Austin's College of Pharmacy has received research funding or consulting dollars from at least 10 different drug companies, according to his published studies, including Eli Lilly, Janssen, and Pfizer. He said he could not comment on CMAP or the lawsuit.
DR. GRAHAM EMSLIE: The UT-Southwestern Department of Psychiatry researcher has consulted for several different drug companies, including GlaxoSmithKline and Pfizer. He has received research grants from at least three drug companies, including Eli Lilly and Forest Laboratories. University financial disclosure forms, where these drug companies are listed, report income in broad ranges. They indicate he may have made up to $125,000 from drug companies since 2004. He said the CMAP protocol was about evidence-based medicine, "not the [drug] the most recent representative told me about."
DR. STEVEN PLISZKA*: The UT Health Science Center in San Antonio scientist has received research funding from Cephalon and AstraZeneca and has served as a consultant and speaker for McNeil and Shire. University financial disclosure forms, where these drug companies are listed, indicate he has made at least $130,000 in drug company speakers fees and consulting contracts since 2002. Dr. Pliszka said he didn't know CMAP had been delayed until a reporter asked about it. "For any physician, the bottom line is, does their patient get better," he said.
DR. CARROLL HUGHES: The UT-Southwestern's Department of Psychiatry doctor has received research funding from GlaxoSmithKline. University financial disclosure forms also indicate he was once an ad-hoc consultant for BioBehavioral Diagnostics, which designs equipment to test for behavioral disorders, and was awarded shares of company stock. He declined to comment. "
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America's youth are at risk. They are at risk of being medicated to death as a result of antipsychotics being prescribed at younger and younger ages. These drugs have side effects such as diabetes, cardiac arrest, metabolic issues, weight gain and more.
America's youth are marketing targets for billion dollar pharmaceutical companies that have been fined by the DOJ for illegal marketing promotion of drugs for use in children.
When will Americans say, NO TO THE PHARMACEUTICAL INDUSTRY making profits at the expense of our future?
The children of America are in crisis. The crisis is not the untreated mental illness propaganda the drug companies are influencing doctors to tout...if there is so much mental illness in children, ask yourself why is this crisis only in America?
These drugs have not been approved by the FDA for use in kids under age 10 and the average "guideline" expert has been paid by drug companies to promote their drugs in various ways.
It is time for a wake up call. Is it yours?
Who do you trust?
Hat tip for finding the Youth Detention article to Stan.
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