CCHR calls for urgent reforms to protect vulnerable foster children from psychotropic drug risks.

By CCHR International
The Mental Health Industry Watchdog
August 9, 2023

A recent study published in the Journal of Child and Adolescent Psychopharmacology has unveiled the high prevalence of psychotropic drug usage among foster children. The study published in May 2023 shows that more than one-third (35%) of children in the foster care system who are covered by Medicaid are prescribed psychotropic drugs. This is four times higher than the 8% of non-foster children under the same Medicaid coverage, who receive such prescriptions.[1] 

According to the study, the psychotropic drugs these children were prescribed included antidepressants, antipsychotics, mood stabilizers, anti-anxiety drugs, and stimulants. Three of these drug classes carry the FDA’s most severe warning, the black box: antidepressants for suicidal ideation[2]; and stimulants (ADHD) drugs for addiction.[3] Anti-anxiety drugs can include benzodiazepines as a subclass. Benzodiazepines carry a black box warning due to “serious risks and harms,” with prolonged use leading to “clinically significant physical dependence.”[4]

Sonya Muhammad, a retired counselor from the Los Angeles County Office of Education and Foster Youth Services, worked in the system for 12 years. 

As she began pulling children’s medical records, she found the majority of them were being drugged, “It was rare to see a child on one drug. It was always at least two, or three, or sometimes four. I would say that more than 75% of my caseload were on some type of drug. It was about restraining them, a chemical restraint. The main goal was to shut the child up and shut the child down.”

There has been public outcry over the psychotropic drugging of foster children for years. As far back as 2011, the U.S. Government Accountability Office (GAO) conducted evaluations in five states (Florida, Massachusetts, Michigan, Oregon, and Texas) and found that foster children were prescribed psychotropic drugs 2.7 to 4.5 times more often than non-foster children in Medicaid. Many were subjected to cocktails of psychotropics. The GAO explained that “no evidence supports the concomitant use of five or more psychotropic drugs in adults or children, yet hundreds of both foster and non-foster children in the five states had such a drug regimen.”[5]

A 2015 report by the U.S. Department of Health and Human Services Office of Inspector General also identified significant problems in the administration of psychotropic drugs to children in the foster care system. The report flagged 67% of those being prescribed the drugs as problematic cases, including prescriptions for kids who were too young and prescriptions for the wrong dose or as a wrong treatment.[6]

A 2018 JAMA Pediatrics study further compounds the issue. Researchers investigated the patterns of mental health diagnosis and drug treatment within a group of children from birth to 8 years old insured by Medicaid. They found that “20% of medication users received two or more medication classes concurrently for 60 days or more.” Further, “At age 7 years, half or more of the medicated children had more than 200 days of drug exposure.”[7] Particular attention was given to the use of antipsychotics for behavioral management in children as “most pediatric psychotropic medication use (67%) is not approved by the Food and Drug Administration.”[8]

CCHR says there is an urgent need for increased oversight and accountability in the prescription of psychotropic drugs to children under Medicaid. The 2011 GAO report stated, “In our draft report, GAO recommended that HHS consider endorsing guidance for states on best practices for overseeing psychotropic prescriptions for foster children.”

Clearly, this recommendation has not been implemented. It is up to legislators, both state and federal, to hold these agencies within the child welfare system accountable for the damage they are inflicting upon some of our most vulnerable—foster children.

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[1] Rachael J Keefe, “Psychotropic Medication Prescribing: Youth in Foster Care Compared with Other Medicaid Enrollees,” Journal of Child and Adolescent Psychopharmacology, 2023 May;33(4):149-155. doi: 10.1089/cap.2022.0092, https://pubmed.ncbi.nlm.nih.gov/37204275/; “Children in Foster Care Much More Likely to be Prescribed Psychotropic Medications Compared with Non-Foster Children in Medicaid Program,” American Academy of Pediatrics, 7 Oct. 2021, https://www.aap.org/en/news-room/news-releases/aap/2021/children-in-foster-care-much-more-likely-to-be-prescribed-psychotropic-medications-compared-with-non-foster-children-in-medicaid-program/

[2] “Suicidality in Children and Adolescents Being Treated with Antidepressant Medications,” Food and Drug Administration, https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/suicidality-children-and-adolescents-being-treated-antidepressant-medications

[3] “FDA updating warnings to improve safe use of prescription stimulants used to treat ADHD and other conditions,” Food and Drug Administration, 11 May 2023, https://www.fda.gov/drugs/drug-safety-and-availability/fda-updating-warnings-improve-safe-use-prescription-stimulants-used-treat-adhd-and-other-conditions

[4] “FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class. Includes potential for abuse, addiction, and other serious risks,” Food and Drug Administration, 23 Sept. 2020, https://www.fda.gov/media/142368/download

[5] “Foster Children: HHS Guidance Could Help States Improve Oversight of Psychotropic Prescriptions,” Statement of Gregory D. Kutz, Director Forensic Audits and Investigative Service, Government Accounting Office, 1 Dec. 2011, https://www.gao.gov/assets/files.gao.gov/assets/gao-12-270t.pdf

[6] Daniel R. Levinson, “Second-Generation Antipsychotic Drug Use Among Medicaid-Enrolled Children: Quality-Of-Care Concerns,” Department of Health and Human Services, Office of Inspector General, Mar. 2015, https://oig.hhs.gov/oei/reports/oei-07-12-00320.pdf

[7] Dinci Pennap, MPH, Julie M. Zito, Ph.D., et al., “Patterns of Early Mental Health Diagnosis and Medication Treatment in a Medicaid-Insured Birth Cohort,” JAMA Pediatrics, June 2018, 172(6): 576–584,

doi: 10.1001/jamapediatrics.2018.0240, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6137539/

[8] Hannah Emerson, “Poor and Foster Care Children More Likely to be Diagnosed and Treated with Psychiatric Drugs,” Mad In America, 11 July 2018, https://www.madinamerica.com/2018/07/poor-foster-care-children-likely-diagnosed-treated-psychiatric-drugs/