5_Medications and the Pharmaceutical Industry - Cohen et al

5_Medications and the Pharmaceutical Industry - Cohen et al...

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Unformatted text preview: cacy, since considerable evidence has failed to establish that the newer antidepressants are any more effective than the old or are better toler- ated by users (Agency for Health Care Policy and Research, 1999). Furthermore, research has also failed to establish more than very modest support in short- and medium—term studies for antidepressants’ effectiveness in comparison with psychotherapy (Fisher and Greenberg, 1997; Antonuccio et al., 1999; Spiegel, 1999). In North America, the 1990s have brought unprecedented growth in prescriptions to chil- dren, one sector of the population that appears to have been previously spared major exposure to prescribed psychotropics—though use of over-the‘counter analgesics has long been signif- icant (Kogan et al., 1994). Medical visits in the USA resulting in psychostimulant prescriptions (most of which were for children) increased by more than 300 percent between 1985 and 1995 (Pincus et al., 1998). Psychotropic drugs are now being consumed by younger and younger Children, for What are clearly unevaluated, “off label” uses. In the USA such prescriptions to 2— to 4—year—old children tripled between 1991 and 1995 (Zito et al., 2000). In that country, citing IMS Health, Diller (2000) reports the use of SSRIs in the 7- to 12—year—old group to be up 151 percent between 1995 and 1999; for those under 6 years, the increase is 580 percent. For Children under 18 years, the use of ‘mood stabi— lizers’ other than lithium—mostly anticonvul— sant drugsm-has grown 4000 percent and the use Of newer neuroleptics such as risperidone has grown nearly 300 percent. One may confidently estimate that 4 million American youths receive stimulants, 1 million receive antidepressants, and nearly another million receive various other pSychotropics. Ironically, the growth in the consumption by children of prescribed stimulants has coincided With an escalation of the “war on drugs” which especially publicizes the dangers of illicitly used Stimulants. In the USA, even amphetamine, still VICWed as a scourge in the drug abuse field (Baberg et al., 1996), is simultaneously one of :he fastest—growing prescribed medications for attention deficit—hyperactivity disorder” in Children and adults. This is indicated by the popularity of Adderall, a mixture of pure am— Medications and the Pharmaceutical Industry 279 phetamine salts. Made widely available on the US market in 1996, almost 3 million prescrip~ tions were dispensed during the first nine months of 1999 only (Witte, 1999). This recalls but does not equal the huge popularity of pre— scribed stimulants in that country during the 1950s and 19603, though consumers were mostly adults and “weight loss” was a principal indication, until stimulants’ powerful potential to provoke dependence became widely recog- nized (Grinspoon and Hedblom, 1975). The possible relationship between the resurgence of medical prescription of stimulants and the resur— gence of illicit stimulant use (Baberg et al., 1996) has not been explored. The mass use of behaviorvaltering drugs with children remains confined essentially to two countries in the worldwCanada and the USA— where it may represent an unprecedented experi— ment in social engineering. To our knowledge, no researchers have investigated the sociocul— tural determinants of these practices. Rapid growth in stimulant use is now occurring in some other developed countries, especially the UK, though the differences between the USA and Europe remain very large (International Narcotics Control Board, 2000). Interestingly, While the use of stimulants with children in France is extremely rare, studies have shown that the prescription of various tranquilizers to children for “sleep problems” reached preva— lence hovering around 10 percent in the 19803 in some regions of that country (Kopferschmitt et al., 1992). The increased popularity and moral legiti— macy of psychotropic drugs as treatments for emotional distress have also sparked develop— ments such as the drive among psychologists (at least in the USA and Canada) to obtain prescrip- tion privileges, similar to physicians, but for psychiatric drugs only. This move represents a novel departure for psychology and has led to intense debates within that profession (Adams and Bieliauskas, 1994; Gutierrez and Silk, 1998) as well as fierce opposition from psychiatrists. With cardiovascular and gastrointestinal med— ications, psychotropics are among the three most prescribed drug classes is most post—indus— trial societies.3 This popularity, and the phenom- enal financial returns on investments from a few ...
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