Parents at their wits' end, wearing long sleeves to hide bruises and bite marks inflicted by their own offspring. Psychiatrists struggling to cope with children as young as 2 who show intractable behavior problems. Drug companies ready to suggest powerful drugs that can produce marked changes in a child's behavior -- getting heavily involved in state-level determinations of which drugs should be prescribed for which conditions. And a state struggling to keep up with rapid changes that have pushed Medicaid costs for powerful anti-psychotic drugs from $9 million seven years ago to almost $30 million in 2006.
Something doesn't add up. Do all these children need the drugs they're being prescribed? Without a careful review of individual medical records, it's difficult to say -- but the trend is disturbing. Other states are already pushing hard for answers, and Florida should join in.
The drugs in question are known as atypical anti-psychotics and include Risperdal, Abilify, Geodon and Seroquel. Originally intended to treat major mental illnesses like schizophrenia and bipolar mania, they have become increasingly widely prescribed for children with autism and attention-deficit disorder with tics.
Yet, the U.S. Food and Drug Administration has approved few of these drugs for use with children -- especially in conjunction with many of the conditions for which the powerful drugs are prescribed. There's little research on the effects of the drugs, and a growing number of reports suggest that the medication could be responsible for deaths or serious side effects, including tardive dyskenisa (involuntary jerking of the limbs and grimacing).
State Medicaid programs across the country have found themselves paying for increasing quantities of these drugs. In Florida, the number of child Medicaid recipients taking atypical anti-psychotics has doubled since 1999, despite a lack of evidence suggesting that they're any more effective than other cheaper drugs.
Twenty-six states are exploring legal action against drug companies for unfair trade practices or consumer-protection violations (Florida is one of them; the Attorney General's Medicaid Fraud Control Unit served drug manufacturer Eli Lilly with a request in 2005 for information regarding its marketing of the drug Zyprexa.) Other states are being more aggressive; several have actually filed suit seeking to reclaim some of the millions spent on these drugs.
But Florida owes a more important duty to the thousands of children across the state who are taking powerful medications. Immediately discontinuing Medicaid reimbursement for the medications would be a mistake -- too many children are currently stabilized on drugs and might actually be benefiting. But the state should move to develop better standards for when the drugs should be prescribed. And this time around, the state should look first to public-health officials and the FDA.