Study: Prescriptions for antipsychotic drugs to state's poor kids increase 270% in 10 years; data also show painkiller patterns

By Amy Wilson and Al Cross
Kentucky Health News

A new report from the University of Kentucky has documented the rate at which the state's poor and disabled children are more and more frequently being prescribed very powerful drugs to treat what is assumed to be attention-deficit, schizophrenia, bi-polar disease and depression. The results indicate that males are more likely than females to be assigned those drugs by physicians, and minority males even more than their white counterparts. The study, conducted by the UK College of Communication and Information and Center for Business and Economic Research, shows that the amount of anti-psychotic drugs distributed to children on Medicaid in Kentucky jumped 270 percent in the decade from 2000 to 2010. Minority children were prescribed those medications at three times the rate of white children.

Beth Musgrave of the Lexington Herald-Leader reports that the study also "found unexplained geographical differences in how minority children are treated for mental illnesses. For example, minority children in Bath County in Eastern Kentucky are taking anti-psychotic medications at a rate nearly 26 times higher than minority children in Christian County in Western Kentucky. Yet the report found little difference in white children in those two counties.

The study also revealed wide geographical variances in prescriptions for drugs meant to treat attention deficit hyperactivity disorder, or ADHD. Poor children in Western Kentucky received much larger quantities of ADHD drugs than their counterparts in Eastern Kentucky. For example, Henderson County children take medications to treat ADHD at a rate 11 times higher than children in Leslie County."

Researcher Michael Childress looked at patterns for all drugs, and found a strong correlation between high use of painkillers and a high percentage of people who say they are in fair or poor health. He used that correlation to figure what level of painkiller use should be expected, and created a county-by-county map showing where the use is higher than expectation:

Childress told Musgrave that the study didn't try to answer why there are variances in prescription patterns. "This report provides data that should cause people to ask questions and to seek out answers," he said. "Health providers and people in these communities need to look at this data and start asking questions about what some of this data shows."

Cabinet for Health and Family Services Secretary Audrey Tayse Haynes called some of the report's findings "disturbing." "We're taking a hard look at behavioral health in children and youth in this state," Haynes said. "Clearly, we need to have some education and training with our providers about prescribing habits. These are powerful drugs."

Dr. Paul Glaser, a pediatrician and child and adult psychiatrist and associate professor at the UK College of Medicine, had a different perspective. He said the increase in antipsychotic drugs may show that the state is finally treating child and adolescent mental illness.  (Read more)

To read the report, including county-by-county maps and drug-by-drug county tables, go here. To read an issue brief on ADHD, go here. To read an issue brief of anti-psychotics, go here. To read an issue brief of analgesic narcotics, go here.

State task force will look at substance abuse, mental health care for military members, veterans and families

To help the increasing number of veterans and military service personnel who are needing treatment for substance abuse and mental health issues in Kentucky, a task force has been assembled to come up with strategies that show the most promise in providing care.

The team, made up of military personnel as well as health care experts, will go to a conference in Washington, D.C., to gain learn what is working elsewhere. The goal is to strengthen statewide behavioral health care systems and services, a press release from Gov. Steve Beshear's office says.

Over the past three years, the number of veterans seeking mental-health care has risen dramatically, according to the U.S. Department of Veterans Affairs. About 335,000 veterans live in Kentucky. There are also 45,000 active-duty personnel in Kentucky and about 8,400 members of the Kentucky Army National Guard and Kentucky Air National Guard.

"This is an extremely important and timely topic that requires collaboration across federal, state and local lines," said Col. David Thompson, executive director of the Kentucky Commission on Military Affairs. Task force members include Thompson; Maj. Gen. Edward W. Tonini, Kentucky adjutant general; state Rep. John Tilley, D-Hopkinsville; representatives from the Cabinet for Health and Family Services, the Kentucky Department of Veterans Affairs, military and civilian health facilities and the Kentucky court system. (Read more)

Searching for a fundamental 'particle' of mental health

The discovery of the Higgs particle, which gives matter its mass, was a huge breakthrough for scientists since "confirming its existence was imperative to a full scientific understanding of the world," and its has an equivalent that has yet to be found when it comes to mental health, forensic psychiatrist Erik Roskes writes for The Crime Report.

The equivalent of the "Standard Model" of mental health — Higgs plays an essential part in the "Standard Model" of physics — is a world in which "people are not penalized for their illnesses but rather than an array of tools from which to choose and which they can use to become mentally healthy," Roskes writes.

Though those tools have not yet been identified, there are paths down which researchers are going to find them, including molecular and pharmaceutical research; psychotherapies and rehabilitation. Research has led to pharmaceutical approaches, "not perfect, but far preferable to a world without them," he writes. It has led to cognitive therapy to treat depression, anxiety and, in some cases, psychosis. It has also led to advances in rehabilitation of mental illnesses and developmental disabilities like autism.

Like the search for the Higgs particle, finding its equivalent in the world of mental health is worth the search, Roskes concludes. (Read more)

Most Ky. nursing homes give more antipsychotic drugs to non-psychotic patients than U.S. median, but get little attention so far

Most Kentucky nursing homes exceeded the national average of the share of residents without psychosis or a related condition who nevertheless received antipsychotic drugs, according to federal data gathered by The Boston Globe and distributed by Kentuckians for Nursing Home Reform.

The data from the Centers for Medicare and Medicaid Services showed that 16.7 percent of patients fell into that category, and that 161 of the 280 Kentucky nursing facilities for which data were available exceeded the national average. Twenty had percentages more than double the national average, and three were more than triple: the Glasgow State Nursing Facility, at 62 percent; Arbor Place of Clinton, 61 percent; and the nursing home at Western State Hospital in Hopkinsville, 60 percent.

The data are for 2010. Nursing homes were not included if there were no data on antipsychotic drug use. Some data were taken from 2009 because no 2010 data were available. The Globe put the data into an easily reviewable database, available here, the Kentucky reform group issued a press release about it on June 14, and Kentucky Health News reported it on June 22.

However, only two Kentucky newspapers have reported on the survey and a local facility that exceeded the national average, according to our limited subscriptions and the news-clipping service subscribed to by the Foundation for a Healthy Kentucky and shared with Kentucky Health News. Those were the Kentucky New Era in Hopkinsville, which mentioned several facilities in its area (Western State's director said state policy prevented him from commenting), and The Anderson News of Lawrenceburg. Its June 20 edition had a story focusing on Heritage Hall in Lawrenceburg, where 20 percent of non-psychotic patients received antipsychotic drugs.

A spokesman for Heritage Hall's operator, Elmcroft Senior Living and Memory Care of Louisville, told Anderson News Editor Ben Carlson that physicians "may choose to prescribe a medication such as antipsychotics without a diagnosis of psychosis or related condition such as controlling a patient's anxiety over a specific disease process."

Bernie Vonderheide, spokesman for the reform group, told Carlson that it suspects that many nursing homes use the drugs to keep patients under control and to avoid hiring more staff. "That is the single biggest problem in nursing homes, the lack of caregivers." (Read more; the New Era's story is behind a pay wall.)

Besides the Glasgow, Clinton and Hopkinsville facilities, the following had a percentage of non-psychotic patients receiving antipsychotic drugs that was more than double the national average:

Dawson Pointe, Dawson Springs 49%
Dover Manor, Georgetown, 49%
Edgemont Health Care, Cythiana, 46%
Pineville Community Hospital, Pineville, 44%
Edgewood Estates, Frenchburg, 42%
Wesley Manor Nursing Center, Louisville, 42%
Wellington Parc of Owensboro, 42%
Stanton Nursing Center, Stanton, 41%
Shady Lawn Nursing Home, Cadiz, 41%
Charleston Health Care Center, Danville, 37.5%
Breckinridge Memorial Nursing Facility, Hardinsburg, 37%
Cedar Ridge Health Campus, Cynthiana, 37%
Brighton Cornerstone Health Care, Madisonville, 36%
Carmel Home, Owensboro, 36%
Ridgeway Nursing and Rehabilitation Facility, Owingsville, 36%
J.J. Jordan Geriatric Center, Louisa, 35%
Medco Center of Henderson, 35%
Wolfe County Health and Rehabilitation Center, Campton, 34%
(Figures are rounded to the nearest percentage unless .5)

Large percentage of patients with dementia given drugs they don't need; see how your nursing home is doing

Kentucky reporters can now see how the nursing homes in their area are treating patients with dementia. The Boston Globe has published a list of all the nursing homes in the country that shows the percentage of residents without psychosis or a related condition but who are being given antipsychotic drugs. The data came from the federal Centers for Medicare & Medicaid Services.

Almost 40 percent of nursing home residents with dementia are on powerful antipsychotic drugs though they don't have psychosis or a related condition, federal regulators announced at the end of May. Their aim is to cut the use of these drugs on these patients by 15 percent by the end of this year.

The median use nationwide for patients being given antipsychotic drugs but who don't have psychosis is 16.7 percent. In Kentucky, 161 of 280 nursing homes surveyed were over the median number, according to the nonprofit advocacy group Kentuckians for Nursing Home Reform.

To see how your nursing home is doing, click here. (Read more)

Three Ky. physicians and one nurse practitioner investigated for high numbers of prescriptions for antipsychotic drugs

State and federal officials are investigating three Kentucky doctors and one nurse practitioner because of the unusually high amounts of antipsychotic drug prescriptions they write for Medicaid patients.

In 2008 and 2009, the four wrote the most prescriptions in the state for Abilify, Geodon, Seroquel, Zyprexa and risperidone, antipsychotic drugs that can cost up to $10 a pill, The Courier-Journal's Laura Ungar reports.

Somerset psychiatrist Dr. Zev Zusman wrote 6,556 prescriptions in 2008 and 2009, resulting in $2.2 million in Medicaid charges.

Mount Sterling's Dr. Samuel Welch, left, wrote 5,881 prescriptions, costing taxpayers $1.9 million.

Deborah Bradford, an Owensboro-based nurse practitioner and psychologist, wrote 4,279 prescriptions, at a cost of $1.2 million.

Paducah-based Dr. Duncan Darnell, a child and adolescent psychiatrist, wrote 3,536 prescriptions, costing $1.1 million.

Welch and Darnell defended their practices. Welch, the medical director of Pathways Inc., said he sees about 20 patients a day in a 10-county area. "The biggest chunk of what I do is see patients for medications," he said, adding that other psychologists provide talk therapy.

Darnell, the medical director at Four Rivers Behavioral Health, said he prescribes for more than 1,000 of his own patients, as well as sometimes prescribing for patients cared for by another psychiatrist and a nurse practitioner. "The folks I end up seeing are often very mentally ill," he told Ungar. "For me, medicines are used as a last resort."

Tracking the prescription levels is part of "a federal review into concerns about over-prescribing, waste and health care fraud in an era of tight government budgets," Ungar reports. Sen. Chuck Grassley, R-Iowa, is leading the review, and has asked every state to list the top 10 prescribers for certain medications. (Read more)