A series of articles in the Palm Beach Post has revealed that children in the custody of the Florida juvenile justice system are being prescribed massive doses of powerful antipsychotic drugs, often by doctors with questionable records and/or financial conflicts of interest.

In a two-year period ending in mid-2008, the state purchased 326,081 tablets of Seroquel, Abilify, Risperidal, and other powerful antipsychotic drugs for use in state-operated juvenile jails and group homes for what are euphemistically known as “at-risk” youth. That’s enough to provide 446 pills a day, seven days a week, for facilities that have room for no more than 2,300 children on any given day.

These figures include 217,563 tablets of Seroquel, a drug which is associated with a high risk of weight gain, hyperglycemia, and diabetes. That’s not my opinion, by the way – it’s the opinion of the office of the Florida Attorney General, which last March reached a record $68.5 million settlement with Seroquel’s maker, AstraZeneca, for alleged improper marketing. Seroquel had not been approved for use in children during the period in question.

The Florida Department of Juvenile Justice purchased more of the heaviest dose of Seroquel, 400 milligrams, than it did of any of the five lighter doses. The series quotes Doctor Glen Currier, Associate Professor of Psychiatry at the University of Rochester: “That is an over-the-limit dose for refractory schizophrenics. I have heard of doses that high in large adult males. But not in girls.”

Even these figures fail to convey the true magnitude of the situation. While they include the 25 juvenile jails and 3 state-operated group homes, they do not include some 113 privately-operated group homes. Some of the companies that operate these homes have no drug-reporting requirements written into their contracts. No one is keeping track of  what kind of drugs these kids are being dosed with, or how much, or why.

The series quotes neuropsychologist Antoinette Appel: “They’re not allowed to put kids in restraints, so they put kids in restraints this way.”

Broward County Public Defender Howard Finkelstein puts it more bluntly: “If kids are being given these drugs without proper diagnosis, and it is being used as a chemical restraint, then I would characterize it as a crime. A battery – a battery of the brain each and every time it is given.”

Well-known side effects of this class of drugs, in addition to the ones already mentioned, include tardive dyskinesia (look it up), suicidal thoughts, and heart problems.

Some of the docs doing the prescribing have less than stellar records. Just ask the family of Mary Tuxbury. Her treating physician, Doctor Charles J Dack, prescribed to her a powerful cocktail of antidepressants and painkillers, including methadone and morphine. At the age of 42 she was found dead, and the toxicology report noted that she died of “multiple drug intoxication, namely opiates and tricyclic antidepressants.”

State officials accused Dr. Dack of keeping her at “a toxic level of morphine for approximately two and a half years” and charged him with inappropriate prescribing. A settlement was reached in which Dack admitted no wrongdoing but agreed to pay a $7000 fine and to complete a course on misprescribing drugs. A year later he was hired to work at three privately-run programs for troubled youth, and he continued working there until last April.

Or ask the family of David Morganthal. David had been labeled as having “Attention-Deficit-Hyperactivity Disorder,” and his treating physician, Doctor Samuel McClure, prescribed mirtazapine and citalopram, neither of which had been approved for use in children. His mother found him dead on the floor of their trailer in November 2001. The autopsy revealed that eleven-year-old David had stood four feet two inches tall and weighed 49 pounds. The toxicology report noted that the concentration of mirtazapine in his blood was 60% greater than expected, and ruled that the boy probably had died of seizure and heart problems related to a reaction to prescription medication.

In 2004, David’s mother filed a wrongful death suit against Dr. McClure. In January of 2006, while the case was still pending, the Florida Department of Juvenile Justice hired McClure to work in two state-run group homes for children. The next year the case was settled for $500,000, and McClure continued to work for the DJJ until June of 2009.

What is behind this relentless drugging of these children? Follow the money. One out of three DJJ psychiatrists has accepted money from the drug companies, including board-certified psychiatrist Doctor Umesh Mhatre. Between the time he went to work for the DJJ in the middle of 2009, and the end of 2010, he accepted $65,475 in speaking fees and gifts from AstraZeneca as well as Pfizer, the maker of Geodon. His colleague, Doctor Rex Birkmire, has accepted nearly $129,000 from the makers of psychiatric drugs since mid-2009.

Links to the full series, by reporter Michael LaForgia, can be found here:

Huge doses of potent antipsychotics flow into state jails for troubled kids 21 May 2011

Drug firms pay state-hired doctors 22 May 2011

Troubled doctors hired to treat kids in state custody 19 June 2011

Investigators focus on antipsychotic doses for kids and possible fraud 14 August 2011

Senator rips agency over juvie meds 19 October 2011

The children in the custody of our juvenile justice system are some of the most vulnerable and voiceless members of our society. Why are the doctors entrusted with their care – doctors who are salaried employees of the state – allowed to moonlight as shills for the companies who manufacture the drugs these same doctors prescribe in massive quantities to these children? Would any sane society permit this? We live in a society in which children are exploited as consumers – of nutritionally barren junk food, of manufactured entertainment, of poisonous psychiatric “medicines” – just as ruthlessly as they once were for their labor.

Photo via Wikimedia Commons

UPDATE 24 DECEMBER 2011: An article in the December 22 edition of the New York Times on the use of psychotropic medication at group homes for the developmentally disabled in the State of New York described practices eerily reminiscent of those detailed in the Palm Beach Post series. Clients reportedly are being prescribed large quantities of antipsychotic drugs, without rigorous or regular review, and low-level workers in group homes are given discretion to increase medication doses “as needed.” New York State Health Department reviews have found repeated violations of basic drug treatment protocols at all nine of New York’s large residential institutions for the developmentally disabled. Courtney Burke, Commissioner of the state Office for People With Developmental Disabilities, has promised new regulations to “help move the system to one that does not rely on medication or physical intervention.”