More concerns about excessive psychotropic drug use by foster children were raised Thursday by the U.S. Government Accountability Office. In a review of 2008 Medicaid fee-for-service records in Texas, Florida, Michigan, Massachusetts and Oregon, the GAO found psychotropic prescription rates for foster children that were 2.7 to 4.5 times higher than the rates for nonfoster children.

It's possible these publicly funded prescriptions are appropriate -- and that mental disorders are more common in traumatized foster children -- but the GAO report found three smoking guns that suggest overmedication:

  1. No evidence supports the concomitant use of five or more psychotropic drugs in adults or children, yet hundreds of both foster and nonfoster children were prescribed such a medication regimen.
  2. Thousands of foster and nonfoster children were prescribed doses exceeding maximum levels cited in guidelines based on FDA-approved drug labels, which our experts said increases the potential for adverse side effects, and does not typically increase the efficacy of the drugs to any significant extent.
  3. Foster and nonfoster children under 1 year old were prescribed psychotropic drugs, which our experts said have no established use for mental health conditions in infants and could result in serious adverse effects.

Antipsychotic drugs can be lifesavers for children and adults with biological mental disorders, but they appear to do little for children whose problems stem from their own behaviors or traumatic histories. And the drugs come with the potential for whopping side effects -- including metabolic problems, muscle tics and even hallucinations.

The GAO recommends more federal guidance to states on how to manage their Medicaid prescriptions and to flag potential inappropriate prescriptions. Minnesota leaders have already been working on a consult service by which primary care doctors would seek second opinions from contracted psychiatrists before presrcibing certain mental health drugs. However, this consult service wouldn't necessarily address the fact that some of the questionable prescriptions are coming from psychiatrists, and not primary care doctors.


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