Psychiatric Drug Overuse Is Cited by Federal Study
by R. Pearmarch; New York Times; 3/1/15


Federal investigators say they've found proof of widespread overuse of psychiatric drugs by older Americans with Alzheimer’s disease, and they are recommending that Medicare officials act immediately to reduce unnecessary prescriptions.

The findings will probably be released Monday with the Government Accountability Office, an arm of Congress, and are available as the Obama administration has already been working with nursing homes to lessen the inappropriate using antipsychotic medications like Abilify, Risperdal, Zyprexa and clozapine. But in the research, investigators said officials also needed to focus on overuse for these drugs by those with dementia who live fitness center in assisted living facilities.

The Department of Health and Human Services “has taken little action” to relieve the use of antipsychotic drugs by older adults living outside assisted living facilities, the report said. Doctors sometimes prescribe antipsychotic drugs to calm patients with dementia who display disruptive behavior like hitting, yelling or screaming, the report said. Researchers said this became often the case in nursing homes that had inadequate numbers of employees.

Dementia is most often associated with a decline in memory, but doctors say it might also cause modifications in mood or personality and, from time to time, agitation or aggression. Experts have raised concern about the using antipsychotic drugs to address behavioral symptoms of Alzheimer’s and other forms of dementia. The Food and Drug Administration says antipsychotic drugs are often associated with an increased likelihood of death when used to treat older adults with dementia who have psychosis.

Senator Thomas R. Carper of Delaware, the senior Democrat for the Homeland Security and Governmental Affairs Committee, said the report showed that “many seniors with dementia are receiving risky mind-altering medications,” financed oftentimes by taxpayers plus the Medicare program.

Senator Susan Collins, Republican of Maine and chairwoman in the Senate Special Committee on Aging, who with Mr. Carper requested case study, said, “The report raises many warning signs concerning the potential misuse and excessive using antipsychotic drugs for patients with Alzheimer’s along with other dementias.”

Toby S. Edelman, who represents patients as a lawyer at the Center for Medicare Advocacy, said, “We could lower your expenses and provide better care if nursing facilities reduced the inappropriate usage of antipsychotic drugs.”

A Chicago psychiatrist pleaded guilty a few weeks ago to taking illegal kickbacks of nearly $600,000 to prescribe an antipsychotic drug for his patients. The doctor, Michael J. Reinstein, also decided to pay $3.79 million on the federal government and also the State of Illinois to stay a lawsuit asserting which he had been mixed up in submission of at least 140,000 false claims to Medicare and Medicaid. Law enforcement officials said he had prescribed clozapine for a huge number of older and indigent mentally ill patients at 30 nursing facilities and other sites. Continue reading the principle story Continue reading the key story

The lawsuit said drug companies had paid kickbacks, consulting fees and entertainment expenses for Dr. Reinstein in an effort to induce him to publish prescriptions for clozapine.

Last March, Teva Pharmaceuticals Industries as well as a subsidiary, IVAX Pharmaceuticals, opted for pay $27.6 million to be in allegations that they had violated federal and state False Claims Acts by making payments to Dr. Reinstein.

Investigators through the Government Accountability Office said in 2011 that Medicare officials were doing little to evaluate the usage of prescription drugs by Medicare patients. But Medicare also designates antipsychotic medications as one of six “protected classes,” and therefore drug plans must cover all or substantially all drugs in this therapeutic class.

The American Health Care Association, a trade group for convalescent homes, says antipsychotic drugs can help some patients with dementia that have hallucinations or delusions, nonetheless it has supported efforts to cut back their inappropriate use.

“Antipsychotic medicine is expensive, costing poisonous of Medicare dollars,” the association says. “They also increase the probability of death, falls with fractures, hospitalizations and also other complications.”

 

 

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