418,000 Children Under 5 on Psychotropics: CCHR Advocates Responsible Practices

In recognition of Universal Children’s Day in November and Human Rights Day on December 10th, the Citizens Commission on Human Rights International (CCHR) has initiated a campaign to promote greater scrutiny and oversight of psychotropic drug prescriptions for children. Data from IQVIA (formerly IMS Health) reveals that, in 2020, approximately 6.1 million children in the United States were prescribed psychotropic medications, including 418,425 children aged 0-5. This statistic underscores the need for a dialogue on responsible prescribing practices, particularly for vulnerable age groups.

Government programs like Medicaid and the Children’s Health Insurance Program (CHIP) play a significant role in ensuring access to healthcare for millions of children. In 2023, these programs covered 6.5 million beneficiaries aged 0-2 and 20.6 million aged 3-11.[1] These programs are the largest payers for mental health services and substance abuse treatment. However, CCHR emphasizes the need for policies that prioritize the use of alternative, non-drug interventions where appropriate and ensure that medications are prescribed only when truly necessary and with full awareness of potential risks.

CCHR advocates for the implementation of policies inspired by approaches in the United Kingdom to encourage a reduction in the prescribing of psychotropic medications to children. In the UK, a group of medical experts and policymakers highlighted that increased antidepressant prescribing has not correlated with improved mental health outcomes and, in some cases, outcomes have worsened. The group recommended measures such as reducing antidepressant prescriptions for mild conditions in new patients, ensuring informed consent and regular harm reviews, and providing support through resources like a 24-hour prescribed drug withdrawal helpline.[2] CCHR calls for similar initiatives in the U.S. to promote responsible prescribing practices and prioritize the well-being of children.

CCHR emphasizes that policies addressing psychotropic drug use in children should apply to all classes of these medications. Medicaid administration programs have taken steps to address concerns about the prescribing of antipsychotics and other psychotropics, particularly for children and adolescents in foster care, following government reports highlighting excessive use. Some state Medicaid oversight programs have reported reductions in antipsychotic prescriptions among children, as noted by Julie Zito, a professor of Pharmacy and Psychiatry at the University of Maryland, and her colleagues in Frontiers in Psychiatry.[3] CCHR encourages continued oversight to ensure that such reductions are both accurate and meaningful, advocating for sustained efforts to safeguard children’s health and well-being.

In 2023, a study published in Health Affairs reported a significant 43% decline in antipsychotic use among children aged 2-17 covered by Medicaid between 2008 and 2016. The largest absolute decline was observed in White children (-1.37%), followed by Black (-0.62%), Hispanic (-0.31%), and Asian (-0.17%) children.[4] However, antipsychotic use remained disproportionately high among children in foster care. In 2016, 7.7% of foster care children were prescribed antipsychotics compared to 1.19% of children not in foster care. Researchers cautioned that these medications carry serious potential side effects, including type 2 diabetes, cardiometabolic effects (such as high blood pressure and weight gain), and, in rare cases, unexpected death.

Antipsychotics have consistently ranked among the top drug classes for Medicaid spending across all age groups. In 2019, psychotherapeutic agents, including antipsychotics and antidepressants, were the third most expensive outpatient drug class within the program. That year, antipsychotics accounted for 9% of Medicaid’s total spending ($6.2 billion) and 10% of all prescriptions (73.1 million claims). Between 2016 and 2021, the number of antipsychotic prescription claims increased by 23.3%, from 18.5 million to 22.8 million, while total gross spending on these drugs rose by 16.7%, from $5.17 billion to $6.03 billion.[5]

Children in the welfare system are also disproportionately prescribed psychotropic medications. A 2023 study published in JAMA Pediatrics examined the prevalence of psychotropic drug use and polypharmacy—the practice of prescribing multiple medications—among Medicaid beneficiaries and children in the child welfare system, including those receiving adoption assistance, foster care, or guardianship care. The study analyzed drug use patterns and associated mental health conditions across different age groups (3-17, 3-5, 6-11, and 12-17 years).

The findings revealed that 26.25% of children in the child welfare group had been prescribed at least one psychotropic drug, with 13.27% experiencing polypharmacy. In contrast, only 9.06% of other Medicaid-enrolled youths were prescribed psychotropic medications, and 3.11% experienced polypharmacy. Among the child welfare group, the most commonly prescribed psychotropic drugs were stimulants (15.95%), followed by antidepressants (9.88%) and antipsychotics (7.87%).[6]

The practice of psychotropic polypharmacy is also more prevalent among children and adolescents today. Julie Zito, Ph.D., reported that as many as 300,000 youth now receive three or more classes of psychotropic drugs concurrently, with the duration of such use ranging from 69% to 89% of the year. These multi-drug regimens are associated with a higher number of adverse event reports compared to those involving two drugs.[7]

Supporting a zero-tolerance de-escalation policy should involve informing parents and caregivers of children in welfare and Medicaid-CHIP populations about the potential adverse effects of psychotropic drugs. This critical information is typically provided in FDA-approved Medication Guides, which are handouts included with many prescriptions to help consumers recognize and avoid serious side effects.

CCHR calls on both state and federal governments to implement a strong “de-prescribing” policy for powerful psychotropic drugs used in children and adolescents.

By prioritizing these measures, the U.S. can take meaningful steps to safeguard the well-being of its youngest and most vulnerable populations, protecting them from the potential harms of psychotropic medications.

Sources:

[1] www.medicaid.gov/medicaid/quality-of-care/downloads/beneficiary-ataglance-2023.pdf

[2] www.bmj.com/content/383/bmj.p2730

[3] pmc.ncbi.nlm.nih.gov/articles/PMC8236612/

[4] pmc.ncbi.nlm.nih.gov/articles/PMC10845053/

[5] link.springer.com/article/10.1007/s11414-024-09889-0

[6] pmc.ncbi.nlm.nih.gov/articles/PMC10442784/

[7] pmc.ncbi.nlm.nih.gov/articles/PMC8236612/

Citizens Commission on Human Rights International
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