Psychiatric Drug Overuse Is Cited by Federal Study

WASHINGTON — Federal investigators say they have found evidence of widespread overuse of psychiatric drugs by older Americans with Alzheimer’s disease, and are recommending that Medicare officials take immediate action to reduce unnecessary prescriptions.

The findings will be released Monday by the Government Accountability Office, an arm of Congress, and come as the Obama administration has already been working with nursing homes to reduce the inappropriate use of antipsychotic medications like Abilify, Risperdal, Zyprexa and clozapine. But in the study, investigators said officials also needed to focus on overuse of such drugs by people with dementia who live at home or in assisted living facilities.

The Department of Health and Human Services “has taken little action” to reduce the use of antipsychotic drugs by older adults living outside nursing homes, the report said. Doctors sometimes prescribe antipsychotic drugs to calm patients with dementia who display disruptive behavior like hitting, yelling or screaming, the report said. Researchers said this was often the case in nursing homes that had inadequate numbers of employees.

Dementia is most commonly associated with a decline in memory, but doctors say it can also cause changes in mood or personality and, at times, agitation or aggression. Experts have raised concern about the use of antipsychotic drugs to address behavioral symptoms of Alzheimer’s and other forms of dementia. The Food and Drug Administration says antipsychotic drugs are often associated with an increased risk of death when used to treat older adults with dementia who also have psychosis.

Senator Thomas R. Carper of Delaware, the senior Democrat on the Homeland Security and Governmental Affairs Committee, said the report showed that “many seniors with dementia are receiving risky mind-altering medications,” financed in many cases by taxpayers and the Medicare program.

Senator Susan Collins, Republican of Maine and chairwoman of the Senate Special Committee on Aging, who with Mr. Carper requested the study, said, “The report raises many red flags concerning the potential misuse and excessive use of antipsychotic drugs for patients with Alzheimer’s and other dementias.”

Toby S. Edelman, who represents patients as a lawyer at the Center for Medicare Advocacy, said, “We could save money and provide better care if nursing homes reduced the inappropriate use of antipsychotic drugs.”

A Chicago psychiatrist pleaded guilty last month to taking illegal kickbacks of nearly $600,000 to prescribe an antipsychotic drug for his patients. The doctor, Michael J. Reinstein, also agreed to pay $3.79 million to the federal government and the State of Illinois to settle a lawsuit asserting that he had been involved in the submission of at least 140,000 false claims to Medicare and Medicaid. Law enforcement officials said he had prescribed clozapine for thousands of older and indigent mentally ill patients at 30 nursing homes and other sites.

The lawsuit said drug companies had paid kickbacks, consulting fees and entertainment expenses for Dr. Reinstein as part of an effort to induce him to write prescriptions for clozapine.

Last March, Teva Pharmaceuticals Industries and a subsidiary, IVAX Pharmaceuticals, agreed to pay $27.6 million to settle allegations that they had violated federal and state False Claims Acts by making payments to Dr. Reinstein.

Investigators from the Government Accountability Office said in 2011 that Medicare officials were doing little to monitor the use of prescription drugs by Medicare patients. But Medicare also designates antipsychotic medications as one of six “protected classes,” meaning that drug insurance plans must cover all or substantially all drugs in that therapeutic class.

The American Health Care Association, a trade group for nursing homes, says antipsychotic drugs can help some patients with dementia who have hallucinations or delusions, but it has supported efforts to reduce their inappropriate use.

“Antipsychotic drugs are expensive, costing hundreds of millions of Medicare dollars,” the association says. “They also increase the risk of death, falls with fractures, hospitalizations and other complications.”

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Psychiatric Drug Overuse Is Cited by Federal Study