CCHR launches new campaign to obtain “zero tolerance” for the psychotropic drugging of children, some too young to even walk

By CCHR International
The Mental Health Industry Watchdog
December 6, 2024

In commemoration of Universal Children’s Day in November and Human Rights Day on December 10th, the Citizens Commission on Human Rights International launched a new campaign in the U.S. aimed at securing legislative and policymaker support for a zero-tolerance approach to psychotropic drugging of children. CCHR is deeply concerned by the 6.1 million children in America prescribed psychotropic drugs in 2020, including 418,425 in the 0–5 age group. The group obtained this data from IQVIA (formerly IMS Health), the largest vendor of U.S. physician prescribing data. While these figures reflect the broader scope of psychotropic drugging, government programs such as Medicaid and Children’s Health Insurance Program (CHIP) are essentially funding “child abuse” as infants, toddlers and preschoolers are subjected to powerful drugs that can pose serious, long-term risks to their health and development.

In 2023, 6.5 million Medicaid/Children’s Health Insurance Program (CHIP) beneficiaries were ages 0-2 and a further 20.6 million were aged 3-11. CCHR says there needs to be a massive overhaul of Medicaid and CHIP, which has become a lucrative system for those prescribing mind-altering drugs to millions of children—some so powerful they can drive them to suicide and acts of violence. Medicaid and CHIP are the largest payers for mental health services and substance abuse treatment.[1]

There needs to be the adoption of policies similar to those in the United Kingdom to start reducing the drugging of children. In the UK, a group of about 30 medical experts and politicians discovered that “Rising antidepressant prescribing is not associated with an improvement in mental health outcomes at the population level, which, according to some measures, have worsened as antidepressant prescribing has risen.” They called for a reversal in the rate of antidepressant prescribing (de-prescribing) which includes, stopping the prescribing of antidepressants for mild conditions for new patients, proper informed consent and regular review of harms, as well as funding and delivering a national 24-hour prescribed drug withdrawal helpline and website.[2]

CCHR asserts that policies must encompass all psychotropic drugs. Medicaid administration programs have attempted to address the overprescribing of antipsychotics and other psychotropics in children and adolescents, particularly foster care youth, following government reports highlighting excessive use. Consequently, some state Medicaid oversight programs have published research indicating a reduction in antipsychotic use among children, according to Julie Zito, a professor of Pharmacy and Psychiatry at the University of Maryland, and her colleagues in Frontiers in Psychiatry.[3] However, CCHR questions the accuracy of these reduction claims.

In 2023, a study published in Health Affairs did show there was a sizeable 43% decline in antipsychotic use among children aged 2–17 under Medicaid between 2008 and 2016. The largest absolute decline was observed in White children (−1.37%) vs. Black (−0.62%), Hispanic (−0.31%), and Asian (−0.17%) children.[4]

However, for children in foster care, antipsychotic use was still overrepresented. Although slightly decreased, in 2016, 7.7% were prescribed the drugs compared to 1.19% not in foster care. The researchers warned that antipsychotics are associated with potentially serious side effects, including type 2 diabetes, cardiometabolic effects (such as high blood pressure, weight gain, cholesterol problems, etc.), and unexpected death.[5]

Antipsychotics have consistently ranked among the top drug classes for Medicaid spending across all age groups. In 2019, psychotherapeutic agents—including antipsychotics and antidepressants—were the third most expensive outpatient drug class for the program. That year, antipsychotics represented 9% of Medicaid’s total spending ($6.2 billion) and 10% of all prescriptions (73.1 million claims). Between 2016 and 2021, the total number of antipsychotic prescription claims rose by 23.3% from 18.5 million. Similarly, total gross spending on these drugs increased by 16.7%, climbing from $5.17 billion in 2016 to $6.03 billion in 2021.[6]

Children in the welfare system are also a target for these drugs. A 2023 study published in JAMA Pediatrics analyzed the prevalence of psychotropic drug use and polypharmacy—the practice of prescribing two or more drugs—among Medicaid beneficiaries and children in the child welfare system. This latter group included youth accessing adoption assistance, foster care, or guardianship care.

The study reviewed data from all CHIP beneficiaries aged 3 to 17 years across all 50 states, Washington, DC, Puerto Rico, and the US Virgin Islands, who were enrolled for at least six consecutive months within the year. It included 719,908 beneficiaries from the child welfare population and 31,473 608 other Medicaid-enrolled youths. Researchers estimated the rates of psychotropic drug use, polypharmacy, and associated mental health conditions by age group (3-17, 3-5, 6-11, and 12-17 years).”

Findings revealed that 26.25% of children in the child welfare group had been prescribed at least one psychotropic drug, and 13.27% experienced polypharmacy. By comparison, 9.06% of other Medicaid-enrolled youths were prescribed psychotropic drugs, with only 3.11% experiencing polypharmacy. The disparity was especially pronounced in the 12-to-17 age group, where 34.3% of child welfare youths were prescribed psychotropic medications, compared to 12.81% of their Medicaid peers. Similarly, polypharmacy rates were significantly higher in this group (19.1% vs. 5.05%).

The most common class of psychotropic drugs in the child welfare group was stimulants (15.95%), followed by antidepressants (9.88%) and antipsychotics (7.87%).[7]

Psychotropic polypharmacy affects substantially more children and adolescents today than has been the case, Julie Zito, Ph.D. reported. As many as 300,000 youth now receive three or more classes concomitantly. The duration of concomitant use is relatively long, e.g., 69–89% of annual medicated days. More adverse event reports are associated with 3-class compared with 2-class drug regimens.[8]

CCHR says that psychotropic drugs are often prescribed off-label for many conditions, leaving consumers and their families unaware that they are being given powerful psychiatric chemicals. This lack of awareness is further compounded by the fact that a significant portion of psychotropic drugs are not prescribed by mental health specialists. Data from 58,547 psychotropic prescriptions reported by 7,693 unique individuals found more than 60% of psychotropic drugs were prescribed by providers other than psychiatrists (33.5%) or psychologists (2.2%), such as general practitioners, nurse practitioners, and physician assistants.[9]

Supporting a zero-tolerance de-escalation policy should include warning parents and caregivers of children in the welfare and Medicaid-CHIP populations about the critical adverse drug effects. This information is concisely presented in FDA-approved Medication Guides—handouts provided with many prescriptions—designed to help consumers recognize and avoid serious adverse events.

The mental health industry watchdog urges both state and federal governments to adopt a strong policy of “de-prescribing” powerful psychotropic drugs to children and adolescents. Established in 1969 by the Church of Scientology and Dr. Thomas Szasz, a New York professor of psychiatry, the organization has achieved many child protection reforms. Notably, it played a key role in the 2004 passage of the Prohibition of Mandatory Medication in Schools legislation, which prohibits schoolchildren from being forced to take psychotropic drugs as a requisite for their education. The group has also helped obtain state legislation that banned the practice of Child Protective Agencies threatening criminal prosecution if parents refused to drug their children.

By prioritizing these measures, the U.S. can take significant steps toward safeguarding the well-being of its youngest and most vulnerable populations, protecting them from harmful psychotropic drugs.

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References:

[1] “2023 Medicaid & CHIP Beneficiaries at a Glance: Child & Adolescent Behavioral Health,” Centers for Medicare & Medicaid Services, Oct. 2023, https://www.medicaid.gov/medicaid/quality-of-care/downloads/beneficiary-ataglance-2023.pdf

[2] James Davies “Politicians, experts, and patient representatives call for the UK government to reverse the rate of antidepressant prescribing,” BMJ, 5 Dec. 2023,
https://www.bmj.com/content/383/bmj.p2730

[3] Julie M. Zito, et al., “Psychotropic Polypharmacy in the US Pediatric Population: A Methodologic Critique and Commentary,” Frontiers in Psychiatry, 14 June 2021, https://pmc.ncbi.nlm.nih.gov/articles/PMC8236612/

[4] Greta Bushnell, et al., “Antipsychotic Medication Use In Medicaid-Insured Children Decreased Substantially Between 2008 And 2016,” Health Affairs, July 2023, https://pmc.ncbi.nlm.nih.gov/articles/PMC10845053/

[5] Greta Bushnell, et al., “Antipsychotic Medication Use In Medicaid-Insured Children Decreased Substantially Between 2008 And 2016,” Health Affairs, July 2023, https://pmc.ncbi.nlm.nih.gov/articles/PMC10845053/

[6] “Descriptive Trends in Medicaid Antipsychotic Prescription Claims and Expenditures, 2016 – 2021,” The Jour. of Behavioral Health Services and Research, 10 July 2024,
https://link.springer.com/article/10.1007/s11414-024-09889-0

[7] Laura F Radel, et al., “Psychotropic Medication and Psychotropic Polypharmacy Among Children and Adolescents in the US Child Welfare System,” JAMA Pediatrics, 21 Aug. 2023, https://pmc.ncbi.nlm.nih.gov/articles/PMC10442784/

[8] Julie M. Zito, et al., “Psychotropic Polypharmacy in the US Pediatric Population: A Methodologic Critique and Commentary,” Frontier Psychiatry, 14 June 2021, https://pmc.ncbi.nlm.nih.gov/articles/PMC8236612/

[9] Phillip M. Hughs, Ph.D., “Psychotropic Medication Prescribing Across Medical Providers, 2016–2019,” Psychiatric Services, 29 Nov. 2023, https://www.psychiatryonline.org/doi/10.1176/appi.ps.20230156