Antipsychotics in Kids Skyrocketing in BC

Several articles explore dramatically rising rates of antipsychotic prescribing in BC children. Watch out for a mixed bag in terms of who’s being quoted and numbers getting muddled up and incomprehensible at times, but the overall message is clear that the rates are going up dramatically and it’s extremely dangerous. An article in the Victoria Times Colonist discusses a study in the Canadian Journal of Psychiatry that reports huge increasing in the use of antipsychotic drugs in children, even though Health Canada has not approved them for children. This Postmedia article is more critically thoughtful with a wider variety of sources. This article reports on child deaths from antipsychotics.

Addendum: Below is the abstract for the study that helps clarify some of the key numbers.

A Population-Based Study of Antipsychotic Prescription Trends in Children and Adolescents in British Columbia, From 1996 to 2011

Rebecca Ronsley, BSc; David Scott, MA; William P Warburton, PhD; Ramsay D Hamdi, MBA; Dianna Clare Louie, MD; Jana Davidson, MD, FRCPC; Constadina Panagiotopoulos, MD, FRCPC

Objectives: To establish prevalence rates of antipsychotic (AP) prescriptions for children 18 years of age or younger in British Columbia (BC) from 1996 to 2011 by age, sex, AP type, and primary diagnosis; and to identify the predominant AP prescribers for children by specialty training.

Methods: BC Ministry of Health administrative data were used to describe AP prescriptions for youth aged 18 years or younger. Comparisons were made using population prevalence based on sex; age group; AP; International Classification of Diseases, Ninth Revision, diagnosis; and prescriber specialty.
Results: From 1996 to 2011, overall AP (both first and second generation) prescription prevalence rate increased 3.8-fold (1.66 to 6.37 per 1000 population); second-generation AP (SGA) prescriptions increased 18.1-fold (0.33 to 5.98 per 1000 population). The highest increase in all AP prescriptions occurred in males aged 13 to 18 years (3.3 to 14.4 per 1000 population; 4.4-fold), followed by similar increases in males aged 6 to 12 years (2.3 to 8.6 per 1000 population; 3.7-fold) and in females aged 13 to 18 years (2.8 to 10.7 per 1000 population; 3.8-fold). Overall, the 3 most common diagnoses associated with all AP prescriptions were depressive disorders (12.8%), hyperkinetic syndrome of childhood (11.7%), and neurotic disorders (11.1%); however, variation was observed by prescriber specialty training. Among all new AP prescriptions in 2010/11, 38.6%, 34.3%, and 15.6% were provided by psychiatrists, family physicians, and pediatricians, respectively.
Conclusion: There has been an exponential rise in SGA prescriptions in BC secondary to extensive off-label use, not only by psychiatrists but also by family physicians and pediatricians. Knowledge translation initiatives promoting evidence-based prescribing and monitoring practices related to SGA treatment need to target all 3 prescriber groups and be tailored for age subgroups.