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Half Of Vt. Doctors Don't Use Best Practices When Prescribing Kids Anti-Psychotic Meds, Expert Says

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Dr. David Rettew, an associate professor of psychiatry and pediatrics at the University of Vermont's College of Medicine, describes himself as a 'passionate moderate' when it comes to medicating children.

Vermont’s doctors are following “best practice” procedures about half the time when they prescribe anti-psychotic medication to children, according to an expert in pediatric medicine.
 

During a recent meeting of the Legislative Committee on Mental Health Oversight, Dr. David Rettew, associate professor of psychiatry and pediatrics at the University of Vermont’s College of Medicine, made the case that approximately half of doctors are not performing their due diligence before prescribing powerful anti-psychotic drugs to children as young as 3 years old.

“You should only be using these medications in the context of a careful, comprehensive plan, and should explore alternatives to medication first,” said Rettew, who described himself as a “passionate moderate” when it comes to medicating children.

Anti-psychotic drugs have been around for decades, and in their infancy they were prescribed to adults diagnosed with schizophrenia. However, in the mid-90s, the drugs were rebranded with names such as Abilify, Zyprexa and Seroquel and doctors began prescribing them to adolescents and young children to treat bipolar disorder.

It is unknown how many children in Vermont are taking anti-psychotic drugs. In 2013, Medicaid provided the drugs to 16 children ages 3 through 5; 415 children ages 6 through 12; and 574 children ages 13 through 17.

Rettew said those numbers represent approximately half the total number of children in Vermont taking anti-psychotic medications.

Across all age groups, boys are prescribed anti-psychotic drugs far more frequently than girls. Rettew said the most common reason for doctors to prescribe the medications is to treat aggression.

"The media tries to portray this as bad people trying to sedate kids, but that's never the case." - Dr. David Rettew, associate professor of psychiatry and pediatrics at the University of Vermont’s College of Medicine

“The media tries to portray this as bad people trying to sedate kids, but that’s never the case,” Rettew said.

Rettew told the committee that his concern is not the fact children are being prescribed these meds, but that in about half the cases, doctors did not follow what he called “best practices” before writing the prescriptions.

For example, potential side effects of anti-psychotic drugs includes diabetes, and Rettew said it is important to order blood work for a child before writing a prescription.

“We have to stop and pause and get lab work first,” Rettew said, noting that, in general, psychiatrists show better rates of following best practice procedures than general practitioners.

While the number of children on anti-psychotic medications might seem shocking, Vermont is actually bucking the national trend. Children across the United States are being prescribed anti-psychotic medications with increasing frequency, but in Vermont those numbers are dropping.

While the number of children on anti-psychotic medications might seem shocking, Vermont is actually bucking the national trend.

From 2011 to 2013, the number of children ages 3 through 5 on Medicaid who received anti-psychotic drugs dropped from 0.3 percent to 0.1 percent; the percentage of children ages 6 though 12 dropped from 3.1 percent to 1.7 percent; and the number of teens ages 13 through 17 dropped from 4.8 percent to 3.6 percent.

Rep. Mary Hooper, D-Montpelier, who sits on the Mental Health Oversight Committee, asked Rettew what he believed the percentage of children receiving the drugs should be. Rettew said he was more concerned with doctors following best practices before writing a prescription.

“I would have no problem with 1 or 2 percent of children going on anti-psychotic medications as long as we were following best practices 90 percent of the time,” Rettew said.

Josh O' Gorman is a reporter for the Vermont Press Bureau.