Incarcerated kids drugged with antipsychotics

Evelyn Pringle

On October 1, 2010, John Kelly reported on an investigation by Youth Today that found atypical antipsychotics were prescribed to many incarcerated youths in juvenile facilities in the US without a diagnosis of schizophrenia or bipolar disorder, the only FDA-approved indications for use with juveniles.

A wide variety of diagnoses were listed for the prescribing of the drugs including general mood disorders, intermittent explosive disorder, oppositional defiant disorder, PSTD and ADHD.

However, Kelly reports that critics believe most of these diagnoses are simply a cover for the fact that prisons now use drugs as a substitute for the banned physical restraints that were once used on juveniles who aggressively acted out.

“Fifty years ago, we were tying kids up with leather straps, but now that offends people, so instead we drug them,” Robert Jacobs, a former Florida psychologist and lawyer who now practices psychology in Australia, told Kelly.

“We cover it up with some justification that there is some medical reason, which there is not,” he said.

The atypical drugs include Bristol-Myer Squibb’s Abilify, Pfizer’s Geodon, Seroquel from AstraZeneca, Eli Lilly’s Zyprexa, and Risperdal and Invega from Johnson & Johnson.

Youth Today has been working for over a year to find out how much money individual states have been spending on the drugs for incarcerated youth, and for what reason. Medicaid records would not contain the relevant information because federal Medicaid money cannot be used to fund medical care for anyone incarcerated for a crime, whether adult or juvenile, Kelly reports.

Because funds for medications prescribed to juvenile inmates must come from state sources, each state’s juvenile justice agency was asked how much was spent, in the most recent year available, on five drugs – Abilify, Geodon, Risperdal, Seroquel, and Zyprexa – and to provide the diagnosis listed for the prescriptions.

Only 14 states provided some information on the amount spent in either 2008 or 2009, with wide variations. For instance, New Jersey and Minnesota reported spending less than $100,000 a year, while Texas, Florida and Virginia each spent over $1 million.

Only five states were able to provide a comprehensive list of diagnoses along with the amounts. The total number of prescriptions for those five states combined was 5,299, with an off-label condition listed as the diagnosis for 3,709, or 70 percent.

In Texas, nearly 4,000 atypical prescriptions were written in 2008, for a total juvenile population in state facilities of between 1,600 and 1,900, with only 29 percent diagnosed with schizophrenia or bipolar disorder and no diagnosis listed for nearly 25 percent of the prescriptions.

Because Seroquel accounted for so many prescriptions with no diagnosis, Texas officials feared that it had become the “sleeping pill of choice” for agency clinicians, Kelly reports. Seroquel was prescribed 2,553 times in 2008, almost twice as often as the other four atypicals combined.

The Rise and Fall of Provigil – Part II

Evelyn Pringle

A little over a year after the Volkow study reported that Provigil (modafinil), affects the same brain chemicals as stimulants and may be addictive, on July 20, 2010, in the Atlanta Science News Examiner, Kevin Murnane reported that research showed modafinil “produces some effects that are similar to abused stimulants, such as cocaine.”

In what may turn out to be the final nail in the modafinil coffin, rhesus monkeys were given modafinil prior to undergoing behavioral, neurochemical, and brain imaging studies for a study led by Monica Andersen, conducted at the Yerkes National Primate Research Center at Emory University, in the June 2010, “Psychopharmacology” journal.

“Similar to other stimulants, these researchers found that modafinil increased movement or locomotion in their subjects,” Murnane wrote. “Furthermore, an acute bolus of modafinil elicited a return or reinstatement of cocaine self-administration that had been previously diminished through extinction training.”

“These behavioral effects are very consistent with those of other stimulant-type drugs,” he reported.

Mechanistically, the researchers found “using Positron Emission Tomography (PET) imaging that modafinil bound to and occupied a protein in the brain called the dopamine transporter,” he explained. “This protein is the same one that cocaine binds to.”

“Furthermore, they found that modafinil increased dopamine neurotransmission,” Murnane said. “This is the same mechanism thought to mediate the euphoric and addictive properties of cocaine.”

He pointed out that the findings “closely paralleled those of a study by Volkow and colleagues in human subjects that was published in the March 2009 issue of the Journal of the American Medical Association.”

“Collectively, these studies show that modafinil has similar behavioral and pharmacological effects to stimulant-type drugs of abuse, such as cocaine,” he wrote.

“These data indicate that modafinil has the potential to be abused or produce dependence,” Murnane said. “Accordingly, closer monitoring of the modafinil supply and abuse patterns may be warranted.”

Continue reading “The Rise and Fall of Provigil – Part II”