(Photo: PHILIPPE HUGUEN/AFP/Getty Images)
According to two major news reports released this week, Canadians in various institutions are being given powerful drugs they might not need.
A joint CBC News and Canadian Press investigation revealed that mood-altering drugs were being given to female inmates in Canadian prisons at an alarming rate, for purposes other than what the drugs are typically prescribed for — "raising concerns the drug was being used to 'subdue' or 'sedate' inmates." Prescribing practices at Correctional Service Canada are now under review.
One of the major concerns of the investigation is a drug called quetiapine, or Seroquel as it's more commonly known. The drug is prescribed for treating bi-polar disorder and schizophrenia, but the investigation revealed it's often handed out off-label (that is, for uses other than the drugs are approved for) as a sleep aid.
"That's just bad medicine," said Dr. David Juurlink, head of clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre in Toronto. "These are drugs that used even in the right indications, have side effects that can be lethal. [Quetiapine] is an anti-psychotic drug, and when it’s used indiscriminately it can kill people."
A 2008 report by the University of Ottawa claimed that quetiapine was used wrongly in prisons for years. CBC News and the Canadian Press obtained an internal memo from Correctional Services Canada that shows the drug was given to inmates for unapproved purposes until at least 2011. And quetiamine is just one drug currently in question. The investigation also revealed that prescriptions of psychotropic drugs in general — that is, drugs that affect brain function and alter moods and behaviour — are increasing among female inmates. In 2013, 63 per cent of female prisoners were prescribed a psychotropic drug.
Correctional Services Canada responded to CBC News and the Canadian Press in a statement, saying: "As part of our ongoing process of quality improvement, medications provided by CSC are regularly reviewed and additional criteria are occasionally put in place. Effective June 2011, quetiapine was listed with limited use criteria to further ensure its safe use. CSC respects Health Canada's standards when providing prescription medications to inmates."
You can watch the CBC News report here:
Meanwhile, the Toronto Star released a story today investigating similar patterns of off-label drug use in Ontario nursing homes.
The Star investigation revealed that some nursing homes regularly give patients psychotropic drugs to "restrain" them from wandering or becoming agitated. At almost 300 nursing homes included in the investigation, the Star found that more than a third of residents were on the drugs — which included quetiapine and about a dozen others. None are approved by Health Canada for elderly people with dementia.
It's legal for doctors to prescribe medications off-label, but the investigation found there's little oversight, and it's often done as a routine.
“There is a role for these medications, but probably not at the rate that they’re routinely prescribed in nursing homes,” Dr. Dallas Seitz, a geriatric psychiatrist and professor at Queen’s University, told the Star. "What’s . . . available and acceptable to clinicians is medications, which may not be the best thing for the resident but may be the only thing easily available."
In many cases, the drugs were found to be used to subdue patients due to a lack of staff and other resources.
"We’ve been advocating for more resources, for more skilled staff, more training. We think it’s very timely for the [health] ministry to make this investment,” Candace Chartier, CEO of the nursing home association, told the Star.
And on a similar theme, a recent article in Esquire magazine suggests that misused behaviour-altering drugs are not the sole domain of prisons and nursing homes. In "The Drugging of the American Boy," writer Ruan D'Agostino reveals that almost 20 per cent of boys in the United States are diagnosed with ADHD, many of them given drugs like Ritalin and Adderoll to "normalize" them. But, he argues, the diagnoses aren't always accurate, and medication not always the best course of action. You can read the whole piece here.