Poor Children Prescribed ‘Off-Label’ Antipsychotics More Often

The New York Times this morning reports that children aged 6 to 17 on Medicaid are four times more likely to be prescribed powerful antipsychotic drugs than their middle-class counterparts covered under private health insurance.

The antipsychotic drugs approved to treat schizophrenia, autism and bipolar disorder are now given to Medicaid children with far less severe conditions such as ADHD, aggression, persistent defiance and other conduct disorders. There have been no long term studies of the drugs’ effects when used for such conditions. What is known is that the drugs’ side effects can be drastic weight gain and metabolic changes such as heart conditions that result in life-long physical problems.

While poverty itself may contribute to higher incidences of mental health problems (single-parent homes, poorer schools, no access to preventive care, higher incidences of familial mental health issues, etc.), too often, the children are mis-diagnosed and treated by general practitioners.

While much of the disparity in treatment trends between poor and middle class children may be the direct result of low and restricted Medicaid reimbursements, treating ‘off-label’ conditions with drugs is due to the perception of doctors that poor people won’t or can’t participate in counseling or therapy sessions even when available.

The antipsychotic drugs prescribed for children are the biggest drug expenditure for Medicaid.