Texas Youth Commission's $60,000 a month Seroquel bill | Focal Point

One of the many fascinating pieces of information contained in this recent report from Youth Today, a newspaper for workers in the youth corrections field, is this: In 2008, the Texas Youth Commission was spending an average of $60,000 a month on the powerful anti-psychotic drug Seroquel.

For those keeping score, that’s a rate of $720,000 a year.

Also this: Before the agency changed its policy this year, following an in-house review, psychiatrists working on behalf of the agency prescribed Seroquel 2,553 times in 2008.

Seroquel is one of a handful of second-generation anti-psychotic drugs that has received critical attention recently. Approved by the Food and Drug Administration to treat the serious psychiatric disorders of schizophrenia and bipolar disorder, Seroquel and other so-called “atypical” drugs like it — Abilify, Risperdal, Zyprexa — increasingly have been prescribed for off-label treatments of lesser mental disorders.

This appears to be especially true with children, despite little research on how the powerful atypicals affect adolescents. What research exists has linked use of the drugs to side effects ranging from sedation, involuntary body movements and dramatic weight gain to diabetes, with little understanding of their long-term effect.

According to this recent article in the New York Times, the use of anti-psychotic drugs among even children as young at two years old has soared in recent years.

Critics have claimed that atypicals are used In juvenile detention centers as forms of “chemical sedation” to reduce aggressive behavior. The Youth Today investigation attempted to report a national story measuring the use of anti-psychotics in juvenile inmate facilities across the country. But only a handful of states responded to the paper’s query. To its credit, TYC was one of them.

According to the youth commission, in 2008 more than a quarter of the 1,600 to 1,900 incarcerated juveniles in the agency’s care were on the anti-psychotic medications. Many already had prescriptions when they entered the Texas system.

The Youth Today report, which quotes TYC Executive Director Cherie Townsend at length, said a total of 4,000 prescriptions for atypicals were written in 2008, suggesting that many of the incarcerated Texas youth were on more than one of the drugs. The agency reported that only 29 percent of the TYC adolescents taking the drugs had a diagnosis of schizophrenia or bipolar disorder.

Meaning that more than 70 percent of TYC youth were using the drugs off-label. Townsend said the agency’s subsequent review of its use of anti-psychotics suggested that Seroquel, in particular, often was being prescribed as a sleep aid.

TYC says a medical review completed last year resulted in some major changes in how youth receive psychiatric evaluations today. A few weeks ago, Townsend referenced the changes in a written update to TYC staff. “The medical staff revised the formulary that guides physicians when prescribing anti-psychotic medications, achieving a 70 percent reduction in the use of Seroquel,” she wrote in the September 17 memo.

I asked TYC spokesman Jim Hurley for some numbers to back up that claim. According to the agency, 123 incarcerated youth were on Seroquel at the beginning of the year. Last month it was only 23.

The reduction in cost reflects that. In October 2009, TYC spent about $61,000 on Seroquel. By January 2010, it was down to about $38,500. For June, the last month for which Hurley said the agency had numbers, TYC spent $16,021 on the anti-psychotic drug.

The cost of atypicals generally has also dropped. Last October, TYC reported spending $127,737 on a half-dozen different brands of anti-psychotic. By this past June the figure was $54,000.

via statesman.com

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