And once again, our country’s disadvantaged kids are being unnecessarily medicated nearly three times more often.
There are few studies on the impact of psychostimulant ADHD drugs like methylphenidate (Ritalin) or amphetamines (like Adderall) in children this young. However, we do know that the side effects of ADHD drugs include stunted growth, insomnia, hallucinations, high blood pressure, involuntary movements, aggressive behavior, heart attack, brain hemorrhage, stroke, migraines, and seizures. Emerging evidence also suggests that Ritalin can cause long-term damage to developing prefrontal cortexes, resulting in “rigid behavior, difficulties with multitasking, or problems with short-term memory” later in life.
Technically, there is not even a diagnosis for ADHD in children under 3 years old. In part, this is because “hyperactivity and impulsivity are developmentally appropriate for toddlers”—meaning that we’re medicating kids just for being kids.
Another fact illuminated by the CDC study: toddlers on Medicaid—free or low-cost healthcare provided by the government for low income families—are disproportionately more likely to be prescribed ADHD drugs. The CDC analysis, which studied Medicaid recipients in Georgia and projected the data nationally, found that one in 225 toddlers on Medicaid are being medicated for ADHD. This means at least 10,000 poor kids are being drugged for a medically nonexistent disorder. By way of comparison, only 4,000 toddlers covered by private insurance are being given ADHD meds.
Researchers also found that “effective non-pharmacological treatments,” including providing “a more structured environment” for children, were being ignored.
It’s not just ADHD drugs—here’s what else kids and adults on Medicaid are more likely to be prescribed:
Powerful anti-psychotic medications. Kids on Medicaid are prescribed powerful antipsychotic medications at a rate four times higher than children on private insurance: from 2001 to 2004, 4% of Medicaid kids aged 6 to 17 received anti-psychotic drugs (less than 1% of kids on private insurance did).
Poorer kids are also more likely to be drugged for less severe conditions than middle class kids. For example, while anti-psychotics are intended to treat disorders like schizophrenia, autism, and bipolar disorder, poorer kids are more likely to be prescribed these dangerous meds for ADHD and simple misbehavior. This is called “off label” prescribing: it’s perfectly legal, though there are no long-term studies on the effect of these very dangerous drugs on children when prescribed for less severe conditions.
Antibiotics—for colds. More than half of adult Medicaid patients with colds or respiratory track infections were prescribed antibiotics in 2007—although antibiotics are not recommended in these cases and such inappropriate prescribing directly contributes to the global antibiotics resistance crisis.
Addictive opioids. As we recently reported, one in five pregnant women now take opioid painkillers. What’s worse, women on Medicaid are being prescribed painkillers during pregnancy at much higher rates: 23% of women on Medicaid, compared to 14% of women with private insurance, are being prescribed opioids (Medicaid covers the medical expenses for 45% of American births).
Additionally, a CDC report that analyzed opioid overdose deaths in Washington State from 2004 to 2007 found that 45.4% percent of overdose deaths were among persons enrolled in Medicaid. The overdose death rate was 30.8 per 100,000 people in the Medicaid-enrolled population, and just 4 per 100,000 in the non-Medicaid population.
What’s going on here? Why are our country’s poor so much more likely to be prescribed dangerous drugs?
Over all, research has shown that Medicaid patients don’t fare much better than those without insurance. Here’s why:
- Medicaid often reimburses doctors much less for non-drug interventions like counseling and therapy than it does for drug prescriptions.
- Some characteristics of disadvantaged neighborhoods—which form much of the Medicaid population— may contribute to misbehavior in kids. According to Dr. Nancy Rapport, a child psychiatrist who specializes in underprivileged youth, home environments can lead to “symptoms” of ADHD: “In acting out and being hard to control, they’re signaling the chaos in their environment. Of course only some homes are like this—but if you have a family with domestic violence, drug or alcohol abuse, or a parent neglecting a two-year-old, the kid might look impulsive or aggressive. And the parent might just want a quick fix, and the easiest thing to do is medicate. It’s a travesty.”
- Fewer and fewer doctors will see Medicaid patients, particularly since the Affordable Care Act vastly expanded the Medicaid program. It’s reasonable to assume that the doctors who do accept Medicaid patients have less and less time to spend with their patients, and are thus much more likely to use a “take these drugs and call me in the morning” approach. This is especially true of psychiatrists: a full 56% are not open to seeing new Medicaid patients. Since there can be extremely long wait times for psychiatrists accepting Medicaid, it’s often pediatricians that prescribe the medications. Not only are Medicaid kids not spending enough time with doctors, they’re likely not even seeing the right ones: only one in five children are receiving treatment for emotional and behavior “disorders” from an “appropriately trained professional.”
- Particularly when Uncle Sam is footing the bill, “selling” cash cow psychiatric drugs to poor kids is a favorite pastime of drug companies. In 2008 alone, psychiatric drugs netted $40.3 billion to Big Pharma; meanwhile, prescriptions for psychiatric drugs for kids rose nearly 45% between 2002 and 2007. In 2009, Pfizer was forced to pay a $2.3 billion settlement for illegally paying 250 child psychiatrists to promote the off-label prescription of Geodon—a powerful antipsychotic—to teens. One doctor was given $4,000 a day to promote its off-label use at conferences to doctors who had no idea he was being paid to do so.
Whatever the reasoning, over-prescription of dangerous drugs to kids—regardless of their socioeconomic status—is killing our children.
Take, for example, the case of four-year-old Rebecca Riley. On December 13, 2006, paramedics arrived at her Massachusetts home to find her slumped over her parents’ bed, dead. Medical examiners identified the cause of death brought on by the medications she was prescribed for ADHD and bipolar disorder when she was just two years old: Depakote, Seoquel, and Clonidine. None of the drugs Rebecca was prescribed are approved by the FDA for use in children her age.
What kind of society treats its children this way? Is nothing more important than drug company profits?