The study found a 43% drop in antipsychotic prescriptions for Medicaid-enrolled children in 45 states, a stark contrast from the sharp rise in the 2000s.
“The decline we observed likely reflects the convergence of multiple state safer-use policies along with educational initiatives and the implementation of quality metrics for safe antipsychotic prescribing,” said senior author Stephen Crystal, director of the Center for Health Services Research at Rutgers Institute for Health, Health Care Policy and Aging Research (IFH), in New Jersey.
“They reflect the results of many cross-state and within-state efforts to address national concerns about safe prescribing,” he said in an institute news release.
The researchers used data from Medicaid claims data between 2008 and 2016, looking at the off-label usage of these medications. They found that use declined across age, sex, racial and ethnic groups, and foster care status.
While certain antipsychotic medications are approved by the U.S. Food and Drug Administration to treat children diagnosed with mental health conditions, they had also been prescribed for unapproved conditions.
The drugs are approved for treating schizophrenia, irritability associated with autism, bipolar disorder and Tourette syndrome. They are not approved for attention-deficit/hyperactivity disorder. Potentially serious side effects include type 2 diabetes and sudden cardiac death.
Even with the drop, most antipsychotic use is still in children without FDA-approved mental health conditions. Still, prescribing antipsychotics has started to become more focused on children with approved diagnoses, the study showed.
“Despite declines in pediatric antipsychotic use, safety concerns remain,” said study co-author Greta Bushnell, a faculty member at the Center for Pharmacoepidemiology and Treatment Science at IFH. “Our findings highlight the need for continued focus on the judicious prescribing of antipsychotics in this young population.”
More research is needed to shed light on disparities in antipsychotic use, from inappropriate prescribing to underprescribing, the study authors said.
The study was supported by the Agency for Healthcare Research and Quality, the U.S. National Institutes of Health and the National Center for Advancing Translational Sciences.
The findings were published in the July issue of Health Affairs.
The U.S. Centers for Disease Control and Prevention has more on children’s mental disorders.
SOURCE: Institute for Health, Health Care Policy and Aging Research at Rutgers University, news release, July 5, 2023
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