Pediatric Prescriptions

With an increase in available diagnostics, and the number of medications available to treat every possible disease increasing exponentially, it shouldn’t be any surprise that the number of prescriptions being written for both adults and children have risen dramatically over the past several years.

A professor of pediatrics at the University of Arkansas for Medical Sciences, Tom Wells, encourages healthier diet and exercise before drugs. Obesity is the largest cause of high blood pressure, diabetes and many other conditions in children, but only about 10% of families will adhere to his diet and exercise recommendations.

So Young and So Many Pills

In December of 2010, the Wall Street Journal reported the latest findings by Medco Health Solutions Inc. which determined that roughly 1 in 4 children and 30% of adolescents between the ages of 10 and 19 are taking a medication for a chronic condition in the United States. Nearly 7% of those are on two or more such drugs according to the company’s research for 2009. Dr. Robert Epstein, chief medical officer at Medco, said that these results were “shocking” to the company.

It was determined that the total number of prescriptions or refills dispensed to children and teens were the following (from most to least): asthma drugs 45,388,000 (children 0-9 years 28,252,000, 10-19 years 17,136,000); ADHD drugs 24,357,000 (children 0-9 years 7,018,000, 10-19 years 17,339,000); antidepressants 9,614,000 (children 0-9 years 1,026,000, 10-19 years 8,588,000); antipsychotics 6,546,000 (children 0-9 years 1,396,000, 10-19 years 5,150,000); antihypertensives (a treatment for high blood pressure) 5,224,00 (children 0-9 years 1,819,000, 10-19 years 3,405,000); sleep aids 307,000 (children 0-9 years 14,000, 10-19 years 293,000); non-insulin diabetes 424,000 (children 0-9 years 30,000, children 10-19 years 394,000); statins (a treatment for high cholesterol) 94,000 (children 0-9 years 11,000, 10-19 years 83,000).

From statins to sleeping pills, it’s clear that many of the drugs that were once considered necessary for adults only are being prescribed to children. IMS Health, a research firm, provided The Wall Street Journal with figures that confirmed this fact. Researchers believe that this rise may be caused by doctors and parents becoming “more aware of drugs as an option for kids” but the problem remains that many of these drugs have not been tested specifically for the pediatric population.

Danny Benjamin, a Duke University pediatrics professor, is specifically concerned about the well established drugs since the pharmaceutical companies have no incentive to test them. “We know we’re making errors in dosing and safety,” he said, and has suggested that parents themselves need to take the time to research any new medications suggested by their pediatricians. This can be done by reading labels, going to the FDA website, looking for current research at and collecting clinical guidelines from groups like the American Academy of Pediatrics.

Growing Problem

It appears that the growing childhood obesity problem could be partially to blame for these alarming statistics.

For instance, drugs used to lower cholesterol were taken by ten to nineteen year olds at a rate 50% higher than a decade ago. The concern with this is that these drugs are associated with weight gain and an increased risk of developing type 2 diabetes; meaning that the cure could actually exacerbate the problem.

Additionally, the researchers at Medco believe the obesity epidemic could be to blame for the greatest spike in prescriptions over the nine year span considered in the report. There was a 147% increase in the number of children being prescribed proton pump inhibitors, which are treatments for heartburn and gastroesophageal reflux disease (GERD).

The Medco report noted, “The increases in prescription drug use by children for chronic conditions could fuel significantly higher health care costs as those young patients enter adulthood.” However, perhaps the bigger concern should be that many of these drugs have not been tested and no research exists to tell parents what can happen when they are taken regularly from childhood into adulthood.

Growing Concern

The Medco report also indicated that ADHD treatment use is on the rise with 13.2% of the prescription drug benefit dollars spent in this area. However, the greatest concern could be the spike in use of atypical antipsychotics. Normally used to treat schizophrenia, these drugs have been recently prescribed to children for a variety of psychiatric disorders.

“Atypical antipsychotics are extremely powerful drugs that are being used far too commonly – especially in children – given their safety issues and side effects,” according to Dr. David Musina, a specialist in mood disorders and national practice leader of the Medco Therapeutic Resource Center for Neuroscience. He further noted that they are being prescribed for depression and anxiety, “for which there is not good evidence that they are an effective treatment and yet we’re exposing children to the possibility of extreme weight gain that could lead to a host of health problems, including diabetes.”

Medco also noted in their report that since the FDA issued a suicide warning in 2004 for certain antidepressants, there has been a 23% drop in children taking these pharmaceuticals. However, the FDA has expanded to pediatric patients the indications for many new antipsychotics, including: Abilify, Zyprexa and Seroquel, which specifically has the listed side-effects of “signs of diabetes” and “large or rapid weight gain”.

World Wide Problem

As with most trends in the U.S., other countries like Canada, the U.K. and Australia tend to follow suit. For instance, despite the guidelines set forth by the National Institute for Health and Clinical Excellence, the number of prescriptions written in the U.K. for Ritalin is up 33% and, in Canada, the use of ADHD drugs increased almost 50% between 1999 and 2004, according to IMS Health Canada. Although no current figures are available, there are very real concerns regarding the continued rise in the number of prescription drugs being given to Canadian children.

Big Bucks

National Center for Health Statistics reports that the percentage of Americans taking at least one prescription drug each month increased from 44 to 48% from 1999 to 2008. Those taking two or more increased from 25% in 1999 to 31% in 2008 and, in that same time period, the percentage of Americans who took five or more prescription drugs per month increased from 6% to 11%. So, is it any wonder that almost $300 billion is spent in the U.S. each year on pharmaceuticals?

The bigger problem could be that it is impossible to find any record of what portion of that amazing dollar amount is being spent on prescriptions for children, although a Medco study in 2002 reported that spending on prescription drugs for those under 19 grew 28% in 2001. Yet, despite being unable to find out exactly how much American’s are spending to drug their children, we do know that last year the pharmaceutical industry spent $189 million dollars lobbying congress and other important law makers to pass legislation that has allowed for pmore advertising and the increased amount of drugs available on the market.

In Summary

Prescription drugs have their place, but what parent wants to see their child begin to rely on chemicals so early in life? Many of these drugs are attempting to treat conditions that could be related to small lifestyle changes. The number one reason for the growing use of pharmaceuticals is that we are not living a wellness lifestyle that includes healthier nutrition, exercising and decreasing stress for ourselves and our families.