FRANKFORT The amount of powerful antipsychotic drugs distributed to poor and disabled children on Medicaid in Kentucky jumped 270 percent from 2000 to 2010, according to a new report by researchers at the University of Kentucky.
The largest growth was for minority children, who took medications to treat schizophrenia, bipolar disorder and depression at three times the rate of white children in 2010.
In addition, the report 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 antipsychotic 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.
The study, conducted by the University of Kentucky Center for Business and Economic Research, examined the top 50 drugs prescribed in the Medicaid program from 2000 to 2010 by grams, number of prescriptions and total costs.
The state-federal health insurance program for the poor and disabled has spent $6.6 billion on medications over that time period. Medicaid serves approximately 700,000 people in Kentucky. Michael Childress, who authored the study, said it does not make any conclusions about why there are such variances in prescriptions for ADHD or why so many minority children are prescribed antipsychotic medications.
"This report provides data that should cause people to ask questions and to seek out answers," Childress 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. There is a place for them in the treatment of children. But we also want to make sure that it's not just medical therapy that they are receiving but also behavioral therapy."
Haynes said the cabinet is pulling more data from the Medicaid program in an effort to answer some of the questions prompted by the report. The cabinet has been concerned about the rise of antipsychotic medications in children for some time, Haynes said. Cabinet staff attended a conference on the topic in Washington D.C. earlier this year. And after receiving a briefing on the UK report last week, Haynes appointed a work group within the cabinet to examine disparities in prescription habits and the rise in antipsychotic medications.
"What we have seen nationally is that kids in foster care are more often prescribed these medications," Haynes said. A combination of many factors is driving the uptick in use of antispychotic medications such as Risperidone, Seroquel and Zyprexan in children, clinicians say. Dr. Paul Glaser, a pediatrician and child and adult psychiatrist and associate professor at the University of Kentucky Medical School, said the increase may show that Kentucky is finally treating child and adolescent mental illness.
"Kentucky has been way behind in the treatment of childhood mental health disorders and I think we are finally catching up to the rest of the country," Glaser said. "We are catching these diseases earlier, which means there is less damage to the brain and better long-term outcomes for the patient."
However, the vast majority of powerful antipscyhotic medications are prescribed to children by pediatricians or family care doctors, not psychiatrists, said Dr. Owen Nichols, the president and CEO of NorthKey Community Care, a northern Kentucky community mental health center.
There are too few mental health professionals in Kentucky and too few child psychiatrists, Nichols and Glaser said. "They are easily prescribed by individuals that don't necessarily have a behavioral health background," Nichols said. "For years, our primary care doctors did not prescribe them because they were higher-risk medications.
But now the drugs are much safer, so we're seeing a lot more doctors prescribe them." Nichols said he would like to see Medicaid refer a child to a mental health professional if the program detects that the child is being prescribed more than one medication or multiple medications for a mental illness. Many diagnosis, such as anxiety disorder, are sometimes better treated through behavioral intervention rather than medication. In fact, medication can make some mental health disorders more difficult to treat, Nichols said.
"This trend is not unique to psychiatric medications," Nichols said of the increase in antipsychotic medications. "The United States is just one of two countries that allows for medications to be advertised on television. After that change, we have seen a steady increase in all medications." Haynes said the cabinet will drill deeper into the data to determine whether children are receiving mental health treatment along with medications.
She also cautioned that portions of the study rely on the number of grams of medications prescribed per Medicaid patient. But some antipsychotic medications have more grams per dosage than others, which could skew county-by-county statistics. That's also true with ADHD drugs, but the cabinet will further examine why those drugs are more prevalent in Western Kentucky. Glaser said it's difficult to say why ADHD drugs would be more common in one part of the state over another part of the state. The rate of ADHD is fairly consistent across the population, he said.