California youth are less drugged, in some ways, than they were just six months ago, but are possibly a tad more psychotic. 

New restrictions on prescriptions of powerful antipsychotic medications for children under 18 took effect in October, and Karen de Sá at the San Jose Mercury News called the change “dramatic.”

De Sá wrote that state regulators rejected 1 in 5 prescription requests on behalf of poor children, including foster home youth, in an effort to rein in the profligate use of the drugs, according to findings from a public records request from the National Center for Youth Law.  

The number of antipsychotic prescription requests (pdf) dropped from 16,915 in October to 6,950 in January, according to the California Department of Public Health (CDPH). The approval rate on first submissions dropped from 80% to 67%, although some decisions were deferred. The flat-out denial rate rose from 6% to 18%.  

In the old days, all the prescriptions for 6-to-17-year-olds would have been filled.

The Mercury News ran a series of stories last year, and they weren’t alone, on the overdrugging of the state’s most vulnerable children, pegged at a rate three times the national average. Twenty-five percent of California kids in foster care were found to be receiving antipsychotics, antidepressants, mood stabilizers or stimulants.

The new rule requires doctors to provide a medical rationale for an antipsychotic prescription to a team of state pharmacists before they sign off on a Treatment Authorization Review (TAR) for youngsters covered by Medi-Cal. It expands existing rules that already cover kids 5 and younger. 

Not everyone is happy with the turn of events. Saul Wasserman, a leader of the California Academy of Child and Adolescent Psychiatry, told the Mercury News the new process was a “cumbersome and time-consuming . . . bottleneck” whose “shotgun” approach was inappropriate for crisis-care management.

Right now, the verdict is out on whether the new rule is working. There is not enough data to claim a pronounced pattern. Quantifying whether the truly needy are receiving their medication while the unneedy are denied will be fraught with peril and subject to interpretation.

The inevitable anecdotal horror stories of troubled kids not getting their meds, however, will not be so equivocal.

–Ken Broder

California Rejects Thousands of Requests for Antipsychotic Drugs for Poor Kids, Foster Youth (by Karen de Sá, San Jose Mercury News)

California State Regulators Blocking Excessive Prescribing for Foster and Low-Income Kids (by McCarton Ackerman, The Fix)

Rampant Medication Use Found Among L.A. County Foster, Delinquent Kids (by Garrett Therolf, Los Angeles Times)

Dramatic Rise in Prescribing Psychiatric Drugs to Children Younger than Five (by David Wallechinsky, AllGov California)