Report criticizes antipsychotic use in US nursing homes

 
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PostPosted: Fri Jul 08, 2011 4:26 pm    Post subject: Report criticizes antipsychotic use in US nursing homes Reply with quote

Antipsychotic drugs are prescribed much too often in my opinion. This story provides the appalling information that 1 in 7 elderly persons in US nursing homes has been put on an antipsychotic drug.

Quote:
The Lancet, Volume 378, Issue 9786, Page 116, 9 July 2011

Report criticises antipsychotic use in US nursing homes

Sharmila Devi

A US Government audit has found that the controversial off-label use of antipsychotic drugs for patients with dementia is widespread in the nation's nursing homes. Sharmila Devi reports.
The debate over the use of antipsychotic drugs to treat dementia in elderly patients has been re-ignited in the USA with the publication of a government audit showing nearly one in seven elderly nursing home residents were prescribed the atypical drugs even though they are not approved for such treatments.

The audit has pitted those who advocate least drugging as the norm against some doctors who say antipsychotic drugs are valuable in the absence of other substances approved by the Food and Drug Administration (FDA) to treat dementia and its symptoms, including agitation.

The Office of the Inspector General of the US Department of Health and Human Services's audit was released on May 4 and it said that more than half of antipsychotic drugs paid for by Medicare, the federal health program for people older than 65 years, in the first half of 2007 were “erroneous”, costing US$116 million for those 6 months. “Government, taxpayers, nursing home residents as well as their families and caregivers should be outraged and seek solutions”, wrote Daniel Levinson, the inspector general, when releasing the audit.

But Daniel Carlat, editor of The Carlat Psychiatry Report, a newsletter for psychiatrists, said the report “was a bit sensationalistic”.

“To say doctors are prescribing drugs erroneously is a misunderstanding of physicians who very commonly prescribe off-label drugs because they work”, he told The Lancet.

After the FDA approves a drug for a specific use, physicians are allowed to prescribe that drug for other uses. More than 60% of drugs prescribed by both pediatricians and oncologists were off-label and almost all drugs prescribed by obstetricians fell into this category, Carlat wrote in an opinion article for the CNN website.

Levinson said antipsychotic drugs were “potentially lethal” to many of the patients getting them and that some drug companies were “putting profits before safety” in their marketing of these drugs.
The audit found that of the 2·1 million elderly patients in nursing homes during the first 6 months of 2007, 304,983 had at least one Medicare claim for an antipsychotic drug. Some 83% of these prescriptions were for uses not approved by federal drug regulators and 88% were to treat dementia and its behavioral symptoms.

The 48-page audit listed the eight most commonly prescribed atypical or second-generation antipsychotic drugs: aripiprazole, clozapine, olanzapine, olanzapine/fluoxetine, paliperidone, quetiapine, risperidone, and ziprasidone.

These drugs were approved by the FDA for schizophrenia and bipolar disorder. They carry the agency's strongest black box warning emphasising an increased risk of death when given to elderly people with dementia and leaving them vulnerable to risks that include diabetes, heart problems, pneumonia, and strokes.
S
enator Chuck Grassley of Iowa, who requested the audit in 2007, and Senator Herb Kohl of Wisconsin, have written to the Centers for Medicare and Medicaid Services (CMS) asking how the agency intended to protect nursing-home residents from unnecessary, off-label, antipsychotic prescriptions. “Alzheimer's patients who do not have a diagnosis of psychosis can be seriously harmed by this class of drugs”, Kohl said in a statement. “CMS must find ways to encourage the medical community to use appropriate non-pharmacological treatments for these patients, who deserve to lead dignified lives.”

In his own opinion article for the CNN website, Levinson, the inspector general, wrote: “The report didn't investigate why patients with dementia are prescribed antipsychotic drugs so often. But a series of lawsuits and settlements that my office helped bring about suggests that many pharmaceutical companies have improperly promoted these drugs to doctors and nursing homes for many years.”

Levinson wrote that most physicians and nursing homes did dispense antipsychotic drugs “with the best interests of patients in mind” but they should ensure they determined that the benefits outweighed the risks.

Carlat agreed in his CNN article that “we psychiatrists are far too quick to reach for our prescription pads and that the pharmaceutical industry has, in many cases, illegally manipulated our prescribing habits”. But, he said, when anti-psychotic drugs were successful, “they soothe the inner turmoil that makes life intolerable for these patients”.

“About 15 per cent of people over 65 have dementia, and half of them will develop agitation at some point”, he wrote. “Anybody who has visited a loved one in the Alzheimer's unit of a nursing home understands agitation only too well; it includes combativeness, shouting, verbal abuse, extreme hyperactivity and sometimes outright violence to caregivers and family.”


The article can be seen here.
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