The Overmedication of Foster Care Children
By: Andrew Leong, Staff Writer
There are over 510,000 children in foster care nationwide.1 They face tremendous emotional stress, affecting their behavior and mental health. To treat their symptoms, many are prescribed psychotropic medications. A study published in the journal of the American Academy of Pediatrics found that “21.3% are receiving mono-therapy, 41.3% are taking three or more classes of psychotropic medications, 15.4% are taking medication from four or more classes, and 2.1% are taking five or more classes of psychotropic drugs.”2 However, there is no evidence that using all of this medication in this pediatric population is of any benefit.
To try to define overmedicating is difficult. At the very least, there should be a discussion about the trade-offs between symptom management and side effects. However, there are no clear-cut guidelines to follow for medicating children on psychotropic medications owing to the fact that many of these medications are prescribed based on off-label indications. According to a study published in JAMA on pediatric drug labeling, approximately 50% to 75% of drugs used in pediatric treatment do not have adequate labeling.3 Fluvoxamine maleate (Luvox®), an SSRI used for OCD and depression, is one such drug found in the study.
Off-label prescribing in itself is not a problem. Many medications are effective in this way; for example, montelukast (Singulair®) is used for asthma but can be used off-label for COPD. The problem unfolds when there is a lack of drug therapy management. Without careful oversight, an effective psychotropic treatment can lend itself to dangerous side effects such as rapid weight gain, diabetes, and seizures.
While some people may try to blame doctors for overmedicating children, the problem is multifaceted. On average, children in the foster care system experience three different foster home placements.1 Not only is this a concern because of the child’s emotional well-being, it is also difficult for caretakers to properly monitor a child’s progress on therapy. Attorney Jennifer Rodriguez, a former foster youth, comments, “As a parent, when your child goes on something that’s dangerous, the most dangerous drugs that are out there, your doctor is relying on you– someone who knows that child, who watches over time.”4 Without a watchful eye, doctors are often left in the dark about a child’s past, both medical and familial, and so cannot make fully informed decisions.
Combined with the pressure from overwhelmed parents who want to reduce behaviors in the most troubled children, it is no wonder the system is conducive to overmedication. Edgardo Tolentino, a child psychiatrist, remarks on this pressure by stating, “The expectation is that they’ll be given some type of medication; if they are already on medications, the only thing I can do is continue them.”4 When the choice is between continually moving a child from home to home and medication, the system is bound to take the easier option.
Children are naturally vulnerable; those in foster care are even more so. It is harrowing to think that it is so easy to overmedicate a child in their formative years because of a flawed system. Thankfully, there are many states that have implemented Drug Utilization Review programs to “intensify the oversight of prescribing of these potent medications to children.”5 For instance, many states require pharmacists to manually review prescription requests while others have developed psychiatric telephone lines that can guide patients in their choice of therapy. Pharmacists are, as always, the last line of defense for this patient population. They are in a position to counsel and educate patients on these medications but sometimes are pressed for time. However, all providers need to make a concerted effort to make time for the future– our children.
- FosterClub. Foster Care Statistics. 2008. Available at: https://www.fosterclub.com/article/foster-care-statistics. Accessed January 4, 2015.
- Zito JM, Safer DJ, Sai D, et al. Psychotropic medication patterns among youth in foster care. Pediatrics. 2008;121(1):e157-63. Accessed February 21, 2015.ACYF. “Too Many, Too Much, Too Young”: Red Flags on Medications and Troubled Children. Reclaiming Children and Youth. 2012; 21: 59-61. Available at: https://reclaimingjournal.com/sites/default/files/journal-article-pdfs/21_2_ACYF.pdf. Accessed January 26, 2015.
- Roberts R, Rodriguez W, Murphy D, Crescenzi T. Pediatric Drug Labeling: Improving the Safety and Efficacy of Pediatric Therapies. JAMA. 2003;290(7):905-911.
- Drugging our kids | San Jose Mercury News. Drugging our kids | San Jose Mercury News. 2015. Available at: http://webspecial.mercurynews.com/druggedkids/?page=pt1. Accessed January 4, 2015.
- Medicaid. Summary of State Programs to Address Psychotropic Medication Use in Children in Foster Care. Available at: http://www.medicaid.gov/medicaid-chip-program-information/by-topics/benefits/prescription-drugs/downloads/cib-posting.pdf. Accessed January 4, 2015.