Child Advocates Fear Drug PerilsJun 20, 2004 | www.sun-sentinel.com More information on Serzone side effects
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For years, attorneys who represent children, along with parents and some legislators, have said that too many juvenile offenders in the state's custody are prescribed potentially dangerous antidepressants and other mental health drugs.
Children's advocates say they fear some youths are medicated to make them more docile and easily controlled while in Department of Juvenile Justice programs.
Their concerns were heightened in March when the federal Food and Drug Administration asked manufacturers of Prozac, Zoloft, Paxil, Effexor, Serzone, Wellbutrin and other antidepressants to include a warning label stating that children taking the drugs should be watched closely for suicidal tendencies.
The Department of Juvenile Justice did not issue advisories to make their program operators, guards and medical professionals aware of the increased risk of suicide linked to the antidepressants, even though 80 children have attempted suicide within the department this year.
Department spokeswoman Catherine Arnold said the child's physician or the program's licensed medical provider is responsible for weighing FDA pronouncements.
But some critics contend that the department needs to take a greater role in evaluating whether children in its custody are properly diagnosed, treated and monitored for adverse side effects.
A strict policy proposed within the department in early 2003 to better regulate the administration of psychotropic drugs was never fully implemented. Records show that department leaders received complaints from program providers that the policy was too burdensome and costly.
On any given day, the Department of Juvenile Justice does not know how many of the roughly 8,500 children in the state's more than 150 detention and residential programs are on prescription drugs for mental illness, department spokesman Bob Finch said. That information, he said, is kept in each child's medical file but not reported to Tallahassee.
The only study that has been done indicates the number could be large. Nearly half of the 1,031 girls and 21 percent of the 5,278 boys in residential programs were taking some sort of mind-altering prescription between November 2002 and April 2003, the department reported in a federally funded review. It did not look at the state's detention centers.
Broward Juvenile Court Judge Larry Seidlin said some young offenders write to him, saying they don't want to be on psychotropic drugs. Seidlin said he sets up hearings to review their concerns. Some of the youths, he said, appear "sort of in a semi-coma."
Dr. Robert Wray, psychiatrist at the Arthur G. Dozier School for Boys and Jackson Juvenile Offender Correctional Center in Marianna west of Tallahassee, two Department of Juvenile Justice programs for 1,000 teenage boys, agrees that too many children within the department are put on psychotropics.
"Unlike many of the DJJ facilities I hear about, our facility here is very conservative," Wray said. "For literally 15 years, we've been, at first, routinely taking all boys off all psychotropics when they come in. Now we just have a philosophy of me seeing them first before we discontinue the medication. But we almost always discontinue."
Wray said most of the boys they observe were prescribed medications without a proper diagnosis. "As far as we're concerned, the use of psychotropics in the community is grossly abused," he said.
Among those calling for greater accountability is state Rep. Walter "Skip" Campbell, a Tamarac Democrat who has pushed the Department of Children & Families, which provides foster care, to address the same issue.
"It seems the same questions we have asked of DCF should be asked of DJJ," Campbell said. "Because you don't want to overmedicate these kids to the point they become zombies and to the point that they have suicidal events."
In November, DCF Secretary Jerry Regier told a Senate committee that one of every 10 children in DCF custody about 5,100 kids are on drugs to treat depression, schizophrenia and other mental illnesses. About 550 children age 5 and younger were prescribed potent medications such as Valium and Ritalin.
In response to the FDA warning, DCF sent an alert to its mental health and child welfare staff. The department also set up a "MedConsult" hotline through the University of Florida's College of Medicine to provide free advice on psychotropic medications to physicians, judges, caseworkers and foster parents.
Legislators this spring, however, turned down bills that would have authorized the University of Florida to create a Center for Juvenile Psychotropic Studies that would collect and track information on how many juvenile delinquents and foster children are prescribed psychotropics.
"All we were trying to do was gather what we considered was accurate information to be able to come up with good public policy," said Ocala Republican Rep. Larry Cretul, the legislation's sponsor in the House. A companion piece in the Senate also stalled.
Cretul said some legislators objected to amendments that prohibited school personnel from recommending psychotropics for children and DCF and DJJ officials worried that the bill would pose added costs to the agencies to collect the desired information.
Cretul said the Department of Juvenile Justice's lack of accountability from its contractors is "somewhat scary."
A strict policy for psychotropic drug use that the department considered implementing in the winter of 2003 would have required operators of detention centers and residential programs to monitor the dosage and side effects of drugs regularly, justify the use of one or more drugs in writing, obtain written permission from parent, and inform parents over the phone by a physician of the benefits and risks of the medication.
The potential side effects of psychotropic drugs, according to the aborted medication policy, include in part: depression, tremors, irritability, increased appetite, anxiety, slurred speech, drooling, vision problems, chest pain, crying and hallucinations.
Records available through the department's Web site show that the proposed regulations generated widespread complaints from some operators of the state's juvenile lockups. Among their objections: it would be too costly and cumbersome to force doctors to call parents.
"Our contracted medical professionals have already informed us that this responsibility is not a requirement and that they do not have the time to make all these calls (and in several instances have told us they won't do it)," Peter Plant, a vice president of Securicor New Century, a private juvenile corrections company that contracts with the state, wrote in response to the department's solicitation for public comments. "Even if they agreed, the additional costs would be considerable."