Prescription Drugs- When Safety is Jeopardized
The inappropriate prescription of medications is an issue that has been brought into the nation's collective consciousness as more is learned about the corruption and politics that are involved. Discussed in a recent article in the New York Times, the company Johnson & Johnson is paying 2.2 billion dollars in settlements in response to accusations of inappropriate marketing of multiple medications. One of the medications under question is Risperdal (risperidone), an antipsychotic commonly used to treat schizophrenia. Johnson & Johnson marketed Risperdal for safe use in older adults with dementia, children, and those with developmental disabilities, in clear violation of the Food and Drug Administration's regulations.
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| Symbol of inappropriate and dangerous medication prescription |
In order to reach this goal, CMS is working with a variety of providers and participants in nursing home care as well as the pharmaceutical companies themselves to promote education, non-pharmacological dementia treatment options, and patient-centered care. Importantly, CMS is also working with these groups to create a culture of accountability and transparency, publicizing rates of antipsychotic use in nursing homes for consumers to compare and make educated decisions.
According to CMS, these efforts have been effective. Data that came out in July of 2013 show that antipsychotic use in nursing homes is down over 9%. It is necessary to note that Risperidone and other antipsychotic medications have been shown to be effective in treating behavioral and psychotic symptoms in dementia (BPSD), but not without risk. Being more judicious about antipsychotic use serves to increase the safety of nursing home residents and other elderly patients by decreasing the risk of cerebrovascular accidents and other adverse events associated with use. Pharmaceutical companies and health care providers are responsible for carefully discerning when antipsychotic use is clinically indicated, with the benefits likely outweighing the risks.
Mental health is on the top tier of priorities in the University of Michigan Community Health Needs Assessment and is gaining recognition nationwide as a critical component to overall health and well-being. Abuses such as those posed by Johnson & Johnson threaten the advances being made in terms of public perception and the stigma associated with mental illness and its treatment. As long as financial gain outweighs patient safety and pharmaceutical companies are not properly regulated in their marketing, mental health will remain poorly understood and improperly treated. Initiatives such as the CMS partnership will hopefully continue to inform the public and change the culture in mental health treatment.
Excellent post, Aubree. I'm staggered by the statistic you list: a "sample size of over 16,000 nursing home residents recently admitted to their facilities found that at least 29% were prescribed one or more antipsychotic medication; nearly one third of these individuals had no clinical indication for antipsychotic use." That is simply unacceptable. With some antipsychotic/antidepressant medications being prescribed for other reasons, such as Xanax for assistance with sleeping, one wonders if the number will continue to grow. Overmedicating individuals leaves an uncertain future, as it is impossible to see the long-term effects (from elders to children). Moreover, one wonders what the future will hold if medication prescriptions continue to be handed out so freely.
ReplyDeleteWow, Aubree! I never heard about this. A part of me is not surprised because we have seen similar studies in hospitals where patients are over-sedated and become delirious. Also, we learned about the use of medical restraints to avoid physical restraints. It is very disconcerting that our most vulnerable populations, children, the elderly, and the mentally ill, are at such great risk for abuse.
ReplyDeleteAubree this is definitely a very eye-opening post and although there is part of me that doesn't want to believe it, there is another sad part that is not particularly surprised. It is definitely evident from this post that medication abuse is prevalent in many vulnerable populations. I think it is important for us as nurses to be aware of this trend and to advocate for our patients when we suspect this is occurring.
ReplyDeleteGreat post Aubree! This validates why as nurses we need to do medication reconciliation with patients. Knowing this information, we must carefully assess the need of each medication and make effort to eliminate any unnecessary medication. It is important for us to focus on the non-pharmaceutical interventions to address mental health, rather than relying on medication on it's own.
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