Potent Pills: Doctor critical of overuse of over-prescribing

Potent Pills: Doctor critical of overuse of over-prescribing

December 9, 2007

Gary Craig

In 2003, Livingston County social service officials decided to ensure that any foster child prescribed psychotropic drugs could safely use it. So they contracted Dr. Martin Irwin to review every prescription of a psychotropic drug to a foster child.

Irwin, who lives in Manlius, near Syracuse, is a leading critic of the prescription of psychotropic drugs to children. He does not completely oppose the use. Many times, he said, some medications are needed.

But too often, Irwin contended in an interview, pediatricians and psychiatrists too quickly turn to drugs when other options, such as more therapy and counseling, could resolve a child's troubles.

Within the foster care population, he maintained, the use of the drugs is out of control because there is little oversight. Plus, he said, many foster children understandably exhibit difficult behavior, and drugs provide a quick way to temper the episodes.

"(Foster children) have environments that model aggressive behavior and they have a lot to be angry about," said Irwin, 58.

Too few of the psychotropic drugs prescribed to children have been subjected to rigorous and reliable testing to see whether they are effective and safe for children, Irwin said.

Many children may face diabetes later in life because many psychotropic drugs promote extreme weight gain, he said.

"We have a huge number of kids that are going to be at risk of Type 2 diabetes," he said. " ... We go for the short-term gain, and the long-term problem is going to be on somebody else's watch."

Irwin is on contract with a handful of counties and residential foster care facilities around the state to review any psychotropic prescription for a foster child. Sometimes, he agrees with the prescriptions; other times, he differs.

Sandra Wright, Livingston County social services commissioner, said the county wanted an expert to review decisions because she and other officials had read about the "overprescribing of these drugs."

The county wanted a second opinion "since we are not medical experts," Wright said. The county has a "huge responsibility" as custodian of the 60-plus children in foster care, she said.

One of the residential centers Irwin has worked with is The Graham School in Westchester County. Over a three-year period, the school reduced its medication usage by more than 40 percent, he said.

Graham School vice president Gerald Leventhal said the school staff needed to know that, regardless of a child's behavior, medication is not the first alternative as a remedy.

"If a fragile kid is in crisis and storms out of the cottage, we will follow," he said. "We're not going to force a confrontation or altercation. There are alternatives (other than medication). Sometimes it takes 10 minutes to resolve. Sometimes it takes 50 minutes. But if you gauge the safety issues along the way, you can do it.

"There is a belief within the organization about medication use. And that is we won't use medication to manage behavior. Although I'm not a medical person, I have enough experience to know that kids are overmedicated in foster care."

GCRAIG@DemocratandChronicle.com