Tuesday, March 27, 2007

Accountabilty for overmedicating children

Photograph of Rebecca's parents, Michael and Rebecca Riley from the Boston Globe.

In Hull, Massachusetts, Rebecca Riley perished from an overdose of prescription drugs.

Was it an accident? Did she sneak into the medicine cabinet?
No, her doctor prescribed the drugs, and her parents gave them to her, just as they also doled out similar drugs to her 6-year-old sister and 11-year-old brother.

Here are the drugs that four-year-old Rebecca was prescribed:

1.) Seroquel, an antipsychotic drug
2.) Depakote, a mood stabilizing drug
3.) Clonidin, a blood pressure medication often prescribed for ADHD

These drugs are approved by the FDA for adult use only - yet doctors frequently prescribe them for children.

When parents overmedicate their four-year-old child with psychotropic drugs and kill her, we are shocked. We want them to be held accountable. Because of this, Rebecca's parents are being prosecuted for murder.

Let's not overlook the other entitities that should be held accountable for unnecessarily drugging children...

1.) If the government is "parenting" foster children, then it should be held to the same standard as Rebecca Riley's parents.

In the foster care system, 3-year-olds are given anti-schizophrenic medication. Six-year-olds are taking Prozac. Nine-year-olds are being prescribed four psychotropic medications at the same time.

Poor record-keeping masks the scope of this problem. But recent CBS research into Los Angeles group homes for foster children uncovered evidence of teenagers being medicated without court intervention, and with minimal doctor oversight. As one social worker reported to CBS, "It's just a chemical restraint. We don't know what else to do with you."

Former foster children report overmedication during their time in the system. Trayvon Walker reports, "In one day, I would say (I was given) probably 20 different medications. I was on Depakote, Wellbutrin, Triptal, Clonidin, Dispar." (Do these drugs seem familiar? Two of them were also prescribed to Rebecca, above).

What was the outcome of these drugs on Trayvon's health? It caused him to have kidney renal failure.

2.) Insurance companies contribute to this problem, because they are often more willing to pay for drugs than therapy. Phamaceutical and managed care companies benefit financially from prescribing lots of drugs to foster children. So do group homes.

3.) Shouldn't medical practioners be held accountable for overmedicating children and teenagers?

Regarding Rebecca's untimely death, Dr. Kayoko Kifuji has taken a leave of absence until the case has been resolved. The medical establishment where Rebecca was treated, Tufts-New England Medical Center has issued a statement saying that they support Dr. Kifuji and her decisions.

Doctors of conscience, however, are speaking out about this issue.

*Dr. Bessel van der Kolk, a professor of psychiatry at Boston University who runs a trauma clinic said, "Most of the patients I see who have been misdiagnosed have been told that they have bipolar disorder."

He continued, "This diagnosis is made with no understanding of the context of their life. Then they're put on these devastating medications and condemned to life as a psychiatry patient."

*Child psychiatrist Joseph Penn of Brown University Medical School expressed his dismay at the practice of "polypharmacy" with children:

When one drug causes side effects in children, they are often given another drug to deal with the side effects. If stimulants cause insomnia, the child is given sleeping pills - despite the fact that safety tests have not been done to measure the effects these drugs have on children, both alone and (especially) in conjunction with other drugs.

Child's death raises concerns about psychiatric drugs. CNN, March 23, 2007.
Cramer, Maria and Raja Mishra. Girl fed fatal overdose, court told. Parents arraigned; lawyer questions doctor's role. Boston Globe, Feb. 7, 2007.
Elias, Marilyn. More kids get multiple psychiatric drugs. USA Today, Aug. 1, 2005.
Goldstein, David. Foster kids medicated for money? CBS, Nov. 13, 2006.
Higgins, Gary. Debate over children and psychiatric drugs. New York Times, Feb. 15, 2007.
States wrestle with medicating foster kids; Critics worry that psychiatric drugs flow too frequently to forgotten children. MSNBC, March 13, 2007.

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What an important post, Lisa.

As you know I'm currently in the adoption process. Without yet knowing the child it's impossible for me to determine if they're overmedicated. But I have suspected it many, many times. It's always disturbing when I ask social workers and foster parents to explain why a child is on a certain med. Often, the answer is they don't know. I think Dr. Penn's comment about "polypharmacy" is so accurate and so frightening.
Thanks so much for posting this. I'm lucky, in that we foster through a private agency and the psychiatrists/psychologists they work with are very conservative with diagnoses and drugs. We've gotten kids who've been with other agencies who've been diagnosed and medically treated for things like bipolar, which our doc says he never diagnosis in anyone under 18.
It is so sad that pills are cheaper than therapy and behavioral treatment, and are so preferred.
Great information - much appreciated. We are in the process of adopting a child who is coming from residential care and lots of meds. We've reduced one and hope to get rid of all some day. Depakote, Zyproxa, Adderall with every diagnosed disorder under the sun.
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