Dr. Rachel Dolan Discusses The Antipsychotic Drug Epidemic
Welcome to the healthcare policy podcast on the host David Intra. Kosovo. With me today Dr Rachel Dolan the US House of Representatives ways and Means Committee majority staffer to discuss the majority staffs recently released report titled Under enforced and over prescribed. ANTIPSYCHOTIC drug epidemic ravaging America's nursing homes. Dr Dole and welcome to the program. I David thanks so much for having me. Please call me Rachel. While this'll be the last time Dr Dolan's bio is posted on, of course, the podcast website. In testimony before the House Energy and Commerce Committee two, thousand seven, the FDA's Dr David Graham stated quote. Unquote. Fifteen thousand adults elderly people in nursing homes are dying each year from the off label use of antipsychotic medications. For an indication that the FDA knows the drug doesn't work the problem has been only FDA for years and years close quote. Legal the FDA does provide a black box warning label. Regarding off label use of these drugs, eleven years later, Human Rights Watch published a report titled They Want Docile. How. Nursing homes in the US overmedicated people with dementia. The report found in two thousand, sixteen, seventeen quote unquote massive use or abuse of Anti Psychotics, for example, Sarah. Quel. Doll and Rispler doll that have serious side effects including sudden cardiac death. The human rights report estimated in an average week over one hundred, seventy, nine, thousand, long-stay Nursing Home Facility patients who administered antipsychotic drugs. Without a diagnosis which the drugs are indicated or approved rover, polar disorder and schizophrenia in testimony the ways and means. Committee. Heard this past November Richard Mollet Executive Director of the Long Term Care Community coalition concluded quote the use of San Anti psychotics in skilled nursing facilities is so extensive that puts the US in violation of internal conventions and covenants on torture and cruel inhumane and degrading treatment or punishment. Close quote. This is my third related interview. In December twenty twelve I discussed the topic with Diana Zuckerman. And in February, eighteen high interviewed Hannah Lamb who authored the above mentioned human rights report. With me again to discuss the ways and means report just released titled Under enforced and over prescribed is Rachel Dolan the reports lead author. So that Rachel as background let's get right into this or immediate neatly into the specifics of the report. What did the report find regarding the extent to which? They're persists overuse or misuse of anti psychotics in skilled nursing. David. So the report showed what what you what we would expect from your introduction, which is the use of antipsychotic does persist in nursing homes across the country and it remains quite high and not of course, has implications for patient safety and and health We found in the fourth quarter of Twenty nineteen approximately twenty percent of all skilled nursing facility residents in the US. So that's about two, hundred, Ninety, eight, thousand, six, hundred, fifty people every week received some form of antipsychotic medication and most of that was without any psychosis diagnosis for which these drugs are indicated So specifically, we actually looked at trends and surveyor citations for unnecessary medication use in nursing home. So that's kind of the. Part of this study and what we found was a clear change in citation rates for these facilities between the change in administrations from the Obama Administration to trump administration So we found citations for antipsychotic misuse in sniffs increased by two hundred percent between twenty, fifteen, twenty seventeen but then declined by twenty two percent from two thousand, seventeen to twenty eighteen, and importantly a ten percent of citations associated with actual harm or immediate jeopardy to a residence health or safety. So those are some of the most severe citation surveyors ever capture resulted in no fine from twenty seventeen to twenty eighteen under the trump administration. So you know. I. Would say even though this study in particular couldn't determine causation we we did see a clear association between the Trump Administration's regulatory rollback campaign twenty, seventeen, twenty eighteen and a reduction in citations for these particular drugs. Okay thank you and we'll get into the trump administration's regulatory decisions in this regard in a minute let me just ask as a follow up or an aside question and I don't think I saw this new report. So you may not have these numbers top of mind but worth asking, can you give an approximation of the cost? To the Medicare program at least relative to the overuse I, mean, this is a massive amount of money in reimbursement for these medications. I don't remember offhand. Let's see I think in the in the actually in the report we got About one third of older adult Medicare part d enrolling with dementia who spent more than one hundred days in a nursing humber prescribed antipsychotic in two, thousand, twelve constituting roughly three, hundred, sixty, three, million part D plan payments that year and of course, there's also cost associated with hospitalizations for inappropriate use of these drugs So I would expect you know that that that is obviously very under an understatement understated estimate that does not capture the full realm of payments. So it's it's fairly substantial.