Characteristics of Youths Treated With Psychotropic Polypharmacy in the United States, 1999 to 2015

Abstract

than deaths involving opioids alone. Of the polysubstanceinvolved opioid overdose deaths, stimulants were most commonly involved.Our results are consistent with data from the general adult population, which shows stimulant-involved opioid overdose deaths increasing over the past decade. 3 Moreover, our study is consistent with data demonstrating that cocaine is now the substance most commonly coinvolved in opioid overdose deaths. 5 Limitations of this study include potential death misclassification, inaccurate identification of substances, and nonspecific reporting on death certificates causing undercounts of specific drug classes. The CDC WONDER data set is unable to stratify further deaths from psychostimulants other than cocaine, a category that includes methamphetamine and prescribed stimulants. Future studies should further delineate the age-related and geographic differences in polysubstance overdoses over time. 6 These results underscore the evolving heterogeneity of the overdose epidemic among youth. Treatment and harm reduction models for opioid use disorders among youth must recognize and address the co-occurrence of other substance use disorders.

Psychotropic Polypharmacy in the US Pediatric Population: A Methodologic Critique and Commentary

“…Table 1 identifies key characteristics for comparison of polypharmacy outcomes in 6 studies with increased growth starting in the early ‘90s ( 28 ). Major conclusions include: First, Zhang, dosReis et al ( 19 ) showed that across 22 years, the continued growth of regimens of 3 or more concomitant psychotropic classes through 2015 was unmistakable, affecting nearly 300,000 youth treated with complex psychotropic medication regimens ( 19 ). Treatment for ADHD, even without comorbidities, is common among complex regimens of U.S. youth ( 25 ), often with an antipsychotic and stimulant, a combination with questionable pharmacologic rationale ( 51 ).…”

“…Overall, the trends are clear, although study designs are varied and metrics are imprecise so that their implications can be missed. Nonetheless, we appreciate that some studies demonstrate clear, complete and precise profiles of prescribing patterns (19,24,40,46). The decision to limit analysis to U.S. studies was based on the authors' knowledge of the literature broadly in the past 30 years.…”

“…1) Increase precision in the outcome of polypharmacy beyond "2 or more concomitant drugs" so that 3, 4, and 5 or more class (drug) regimens are reported in terms of the number and percent of youth as a proportion of psychotropic medicated youth in a year (19). 2) Standardize methods to:…”

Inter-class Concomitant Pharmacotherapy in Medicaid-Insured Youth Receiving Psychiatric Residential Treatment

“…Our finding that significant proportions of youth in the most intensive level of care receiving 2, 3, and 4 or more classes of psychotropics provides data for future studies to evaluate the benefits and risks of common combinations. We endorse the call for additional research on complex inter-class regimens that has been made repeatedly (1,4,5,7,30). Research studies on the benefits and risk of combined treatment would address the evidence gap challenging psychiatrists providing clinical care, provide data regarding the effectiveness for populations, and tackle questions regarding the safety of chronic exposure to concurrent psychotropics.…”

“…retrospective cohort study using 2012-2015 claims data found 38% of youth on psychotropic medication for at least 90 days were prescribed two or more psychotropic medications during the study period (1). A cross sectional study used national household survey data, and found the number of youths younger than 18 years treated with three or more psychotropic classes increased from 101,836 (1999)(2000)(2001)(2002)(2003)(2004) to 293,492 (2011-2015) (5).…”