Citizens Committee on Human Rights

The Mental Health Watchdog

Australian National Office

Use Of Antipsychotics At The Center Of Multi-Billion Dollar U.S. Lawsuits Are Soaring, Prompting Concerns Pharmaceutical Companies And Psychiatrists Are Unduly Influencing Treatment Manuals And Government Policy

Pill with Dollar Sign on Pale Blue BackgroundObtaining statistics on psychiatric drug usage, especially by age group is now (July 2012) a lengthy and costly affair—upwards of $4,000. The following is a breakdown of statistics that were not readily available to the general public, but which Citizens Commission on Human Rights obtained in 2011 from the Department of Health and Ageing. There is a shockingly low level of transparency regarding psychiatric drug use and conflicts of interests between the pharmaceutical industry and psychiatrists. Medicare has informed those seeking such statistics that they now must provide a detailed explanation for wanting the information and how it will be used. This is information that should be provided annually in health care statistics as a matter of transparency.

CCHR makes this information known in the public interest and in the interests of informed consent.

CHILDREN AND YOUTH

Based on PBS figures, there’s been a 69% increase in 2-15/16 year olds prescribed antipsychotics between 2007/08 (5,727) and 2009/10 (9,683).

Of the total number of 2-16 year olds taking antipsychotics in 2009/10 (9,683) 79% were prescribed risperidone, towering over quietapine at 9% and olanzapine at 7%.

NSW tops the list of 2-16 years old on antipsychotics, representing nearly a third (3,448) of the nationwide consumption of them in this age group. Queensland ranks second (2,777) and Victoria third (1,881).

THE ELDERLY

Of all elderly aged 72 and above in 2009/10, 48% were taking risperidone, 24% were taking olanzapine, and 11% quietapine.

In 2007/08, the number of elderly prescribed risperidone at age 80 was 1,688 and soared an inexplicable 1,433% (to 25,893) among those aged 81 and older.

Federal reporting of these statistics changed in subsequent years, showing aged groups broken down more generally to 72-76 and 77 plus. Even then, in 2009/10, 5,220 72-76 year olds were taking risperidone, increasing 613% in the age group 77 plus (37,258).

Olanzapine was taken by 4,915 elderly aged 72-76 in 2009/10 and 16,184 aged 77 and over.

Quetiapine was taken by 2,577 elderly aged 72-76 in 2009/10 and 7,629 aged 77 and over.

RISK OF DEATH

The Australian Therapeutic Goods Administration (TGA) clearly warns of the increased risk of strokes and death in elderly dementia patients, seizures, major weight gain, onset of diabetes and potentially fatal high blood sugar.1

The U.S. Food and Drug Administration (FDA) also warns that the death rate in the elderly taking antipsychotics is nearly double (1.6 – 1.7 times) that in those taking placebo.2 The Australian National Prescriber Service (NPS) reports an increased death rate was found in an analysis of placebo-controlled trials of aripiprazole, olanzapine, quetiapine and risperidone in dementia patients, mostly due to cardiovascular events (e.g. heart failure, sudden death) or infections (e.g. pneumonia) One death was associated with antipsychotic use for every 100 patients treated over 10–12 weeks.3

A Canadian study found that 5.2% of the nursing homes residents studied died within a month of being given one of the newer classes of antipsychotic drugs, compared to 3.3% of residents who did not take the drugs who died within a month. Among community-dwelling patients, nearly 14% taking the drugs suffered a “serious health event” within 30 days, compared to about 4% not on the drugs.4

DEATHS ASSOCIATED WITH ANTIPSYCHOTICS

Based on Adverse Drug Reports to the TGA

Up to 2007 Up to 2011 (including earlier figure)
TOTAL 440 629 (22 suicides) – 43% increase
Clozapine 248 433 (13 suicides) – 74% increase
Olanzapine 40 62 (2 suicides) – 5% increase
Risperidone 27 38 (3 suicides) – 41% increase
Quetiapine 10 27 (2 suicides) – 63% increase

“Patients ages 30 to 74 who took atypical antipsychotics such as risperidone (sold as Risperdal), quetiapine (Seroquel), olanzapine (Zyprexa) and clozapine (Clozaril) had a significantly higher risk of sudden death from cardiac arrhythmias and other cardiac causes than patients who did not take these medications, according to a study funded by the US Department of Health & Human Services (HHS) Agency for Healthcare Research and Quality (AHRQ) in 2009. The risk of death increased with higher doses of the drugs taken. Especially among children and demented elderly patients for whom there is little evidence of the drugs’ efficacy, their use “should be reduced sharply.”5

NB: The total number of people PBS reports who take clozapine is low: 894 in 2007/08, 952 in 2008/09 and 1003 in 2009/10, compared to olanzapine for the same period, 101,012; 105,337 and 104,407 respectively. This means the risk of death could be 87,000 greater for those taking clozapine.

The Medical Observer reported in February 2012 that Australia’s monitoring requirements for clozapine are some of the least stringent in the world and have not changed since 1992. The TGA noted that the rate of moderate leukopenia [decrease in white blood cells which places individuals at risk of infection] was “very significant” at 11.8 per 1,000 between weeks 19 to 52, and 6.1 per 1,000 after one year’s use. A psychiatrist and member of the RANZCP complained to the TGA that the monitoring requirements were “unnecessarily onerous.”6

The expenditure on clozapine increased steadily over the 2004-05 – 2008-09 period—from $30.1 to $39.4 million.7

TOTAL ANTIPSYCHOTIC DRUG USAGE AUSTRALIA WIDE

ALL AGES

2007/08: 288,701
2008/09: 312,467
2009/10: 329,920

14% increase from 2007/08 – 2009/10

MAIN ANTIPSYCHOTICS CONSUMED

2007-08

Olanzapine (Patent drug Zyprexa by Eli Lilly) 101,012
Risperidone (Patent drug Risperdal by Janssen- Cilag) 89,955
Quetiapine (Patent drug, Seroquel) AstraZeneca) 52,782
Haloperidol, older antipsychotic 25,399
Aripiprazole (Abilify–Bristol-Myers Squibb) 14,257

2008-09

Olanzapine 105,337
Risperidone 98,422
Quetiapine 69,093
Haloperidol 25,001
Aripiprazole 15,604

2009-10

Olanzapine 104,407
Risperidone 100,410
Quetiapine 87,036
Haloperidol 23,872
Aripiprazole 16,340

 

NUMBER OF AUSTRALIANS TAKING ANTIPSYCHOTICS – BY AGE GROUP

Aged 2 – 16

2007/08: 5,727
2008/09: 8,433
2009/10: 9,683 – 69% increase

Aged 2-6

2007/08: 528
2008/09: 660
2009/10: 759

Aged 7-11

2007/08: 1,694 (aged 7-10 – not possible to work out 7-11 for this year)
2008/09: 2,952
2009/10: 3,481

Aged 12 – 16

2007/08: 3,505 (aged 11-15 – not possible to work out 12-16 for this year)
2008/09: 4,821
2009/10: 5,443

Aged 17 – 21

2007/08: 3,642 (16-18 years only reported)
2008/09: 9,463
2009/10: 10,547

Aged 72 – 77 Plus

2007/08: 14,672 – 72-76
67,305 – 77 plus
Total: 81,977
 (Age 80 – 3,987 – Age 81 plus – 52,303)
2008/09: 15,353 – 72-76
71,079 – 77 plus
Total: 86,432
2009/10: 15,869 – 72-76
72,042 – 77 plus
Total: 87,911

7% increase in elderly on antipsychotics since 2007/08

STATES – ANTIPSYCHOTIC USE

2007-08

2-15

2-18

NSW 2,033 3,351
VIC 1,090 1,963
QLD 1,679 2,433
SA 469 738
WA 287 559
ACT 80 150
TAS 73 146
NT 16 29

2008-09

2-16

2-21

NSW 2,986 6,198
QLD 2,457 4,340
VIC 1,595 4,021
SA 731 1,485
WA 426 1,190
TAS 112 315
ACT 103 288
NT 23 59

2009-10

2-16

2-21

NSW 3,448 7,039 13% increase over 2008/09
QLD 2,777 4,937 13%
VIC 1,881 4,574 14%
SA 820 1,624 9%
WA 496 1,376 15%
TAS 115 321 2%
ACT 105 278 -3%
NT 41 81 37%

 

MAIN ANTIPSYCHOTICS PRESCRIBED CHILDREN & TEENS

Risperidone:

2007/2008

2008/2009

2009/2010

(Patent: Risperdal)
Total 2 -16 4,464 (2-15) 6,597 7,640
Total 2- 21 6,022 9,705 10,906
Ages 2-6 425 559 675
Ages 7-11 1,459 (7-10yrs) 2,654 3,147
Ages 12-16 2,580 (11-15 yrs) 3,384 3,818
Ages 17-21 1,558 (16-18 yrs) 3,108 3,266

Quetiapine

2007/2008

2008/2009

2009/2010

(Patent: Seroquel)
Total 2 -16 245 (2-15) 660 908
Total 2- 21 1,196 3,816 4,994
Ages 2 -6 4 15
Ages 7-11 30 (7-10 yrs) 53 72
Ages 12-16 256 (11-15 yrs) 592 836
Ages 17-21 906 (16-18 yrs) 3,156 4,086

Olanzapine

2007/2008

2008/2009

2009/2010

(Patent: Zyprexa)
Total 2 -16 390 (2-15) 659 646
Total 2- 21 1,391 3,803 3,774
Ages 2-6 14 13
Ages 7-11 41 (7-10 yrs) 61 66
Ages 12-16 349 (11-15 yrs) 584 567
Ages 17-21 1,001 (16-18 yrs) 3,144 3,128

 

ANTIPSYCHOTICS PRESCRIBED THE ELDERLY

TOTAL STATISTICS

2007/2008

2008/2009

2009/2010

Ages 72-76 14,672 15,353 15,869
Ages 77 + 67,305 71,079 72,042
81,977 86,432 87,911 – 7% increase

Of all elderly aged 72 and above in 2009/10, 48% were taking risperidone, 24% were taking olanzapine, and 11% quetiapine.

Risperidone:

2007/2008

2008/2009

2009/2010

Risperdal
Ages 72-76 4,646 5,063 5,220
Ages 77 + 31,870 35,927 37,258
36,5I6 40,990 42,478

Olanzapine

2007/2008

 2008/2009

2009/2010

Zyprexa
Ages 72-76 4,656 4,880 4,915
Ages 77 + 16,380 16,674 16,184
21,036 21,554 21,099

Quetiapine

2007/2008

2008/2009

2009/2010

Seroquel
Ages 72-76 1,712 2,170 2,577
Ages 77 + 5,196 6,320 7,626
6,908 8,490 10,203

  1. “Johnson & Johnson fined $1.1bn in Risperdal case”, Herald Sun, 12 April 2012.
  2. Warning: Increased Mortality in elderly patients with dementia-related psychosis, drugs.com, http://www.drugs.com/pro/seroquel.html
  3. NPS Prescribing Practice Review 37: “Role of antipsychotics in managing behavioural and psychological symptoms of dementia”, http://www.nps.org.au/health_professionals/publications/prescribing_practice_review/current/role_of_antipsychotics_in_managing_behavioural_and_psychological_symptoms_of_dementia
  4. ”Antipsychotic drugs dangerous for the elderly”, Agedcarecrisis.com, 27 May 2008, http://www.agedcarecrisis.com/dementia/dementia-and-antipsychotics-medication-or-management/2773-antipsychotic-drugs-dangerous-for-the-elderly
  5. “Antipsychotics Increase Risks for Sudden Cardiac Death,” Pharmacology Corner, Jan 2009, http://pharmacologycorner.com/atypical-antipsychotics-and-sudden-cardiac-death-medical-media-coverage/
  6. ”Clozapine monitoring least stringent in Australia,” Medical Observer, 28 Feb 2012.
  7. Mental Health Services in Australia, 2007-08 (August 2010), Aust. Institute of Health and Welfare, Mental Health Series 12, p. 189.