Almost one in four teenagers living in foster care in California is prescribed some type of psychotropic medication, found an investigation by the San Jose Mercury News. And of those teens, 60 percent are being prescribed anti-psychotics.
Now several lawmakers are gearing up to introduce legislation aimed at curbing the use of psychiatric drugs in the foster care system.
Many of these drugs are untested and not officially approved for children by the Food and Drug Administration. They can range from the medications used to treat attention deficit disorder (ADD) to more powerful drugs designed for severe mental illnesses, like schizophrenia and bipolar disorder -- both of which are very rare in children.
"The concern is a lot of the prescribing is for the caregivers' convenience rather than what's best for the child," says Karen de Sá, an investigative reporter with the San Jose Mercury News. "The problem with the drugs is, while they're very sedating, they have significant side effects as serious as obesity and diabetes, and uncontrollable tremors."
The reliance on these drugs is also quite costly for the state. Psych meds accounted for 72 percent of the Medi-Cal spending on foster children over the past 10 years, according to the paper's analysis.
Lawmakers have until late February to introduce bills related to this issue. Advocates looking to cut down on the use of these drugs are finding the bills' early language promising:
- Ensure that kids, caregivers, attorneys and judges are informed about medications and their side effects
- Grant kids the right to alternative treatments that do not involve powerful drugs, as well as the right to a second medical opinion when potentially dangerous combinations of drugs or high dosages are prescribed
- Train caregivers to understand medications' risks and benefits -- and better handle children who display difficult behaviors
- Ensure children on medications receive baseline monitoring so that side effects can be caught early
- Identify group homes where children are being overmedicated
- Empower public health nurses to ensure psych meds are used appropriately
"One of the central things is to get more information to juvenile court judges who authorize these medications," said de Sá.
The bills will likely face a fight. Some medical professionals and associations representing foster group homes are worried that new regulations could make it harder for kids who need the drugs to get them.
When the state issued a call for restrictions on the prescribing of anti-psychotic medications for youth on Medi-Cal last fall, some clinicians pushed back. From the San Jose Mercury News:
In a November letter to health care director Toby Douglas, the California Alliance of Child and Family Services representing group homes, the California Pharmacists Association and the California Academy of Child and Adolescent Psychiatry, among others, called the new policy "alarming" and stated it has resulted in "medically necessary medications" being delayed or denied.
"Even if, as recent media accounts report, there is an issue of overprescribing of antipsychotics to youth, the DHCS solution uses a shotgun approach to address a problem that needs surgical precision," the letter states.
The issue was discussed Feb. 3 on KQED Forum.