Gainesville leads nation in antipsychotic drug use


Target employees assists customers at the pharmacy at Target in Gainesville, Fla., Tuesday, January 17, 2012.

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Published: Monday, March 4, 2013 at 10:02 p.m.
Last Modified: Monday, March 4, 2013 at 10:02 p.m.

Gainesville has the highest antipsychotic drug use in the country, but that doesn't reflect higher rates of psychosis in the community, according to a Yale University study.

The study, which looked at drug usage rates of stimulants, antidepressants and antipsychotics across the country, reported that 4.6 percent of people in Gainesville use antipsychotics, which is significantly higher than the national average of 0.8 percent.

"I can't say why in particular Gainesville had such a high rate of utilization," said Connor Essick, co-author of the study, which was published in the journal Health and Place last September. Essick added that "non-medical factors such as marketing dollars and physician density are sort of fueling the utilization."

The study also mapped marketing expenditures of pharmaceutical companies and found that parts of the country in the top quartile of companies' expenditures had a 10 percent higher rate of prescriptions for antipsychotics.

The Southeast in general showed high usage of all three types of drugs, which correlates with what's known as the "stroke belt," an 11-state region with a high incidence of stroke and cardiovascular disease.

Essick said the correlation might have something to do with the fact that people already being treated in the health care system for other conditions could be more susceptible to being prescribed the medications, or they are more proactive about seeking care.

"For me, knowing that Florida tends to be a high user of health care resource, it's not surprising to find that Florida is a high user of a particular drug," Essick said.

Alexandria, Va., has the country's highest number of antidepressant prescriptions, at 40 percent of the population, compared to a national average of 10.4 percent, and Cape Cod has the highest prescription rate for stimulants, at 16 percent, compared to the average of 2.6 percent.

"We normally would assume that the use would be driven by medical need, but only stimulants was partially explained by the underlying prevalence of ADHD (attention deficit hyperactivity disorder)," Essick said, adding that the findings beg the question of whether or not the drugs are "medically necessary."

"You have these really high prescription rates, you know that these drugs have large side effects, so why is a larger percentage of people in Gainesville taking more of them?"

According to Bruce Stevens, a professor of physiology at the University of Florida and a board member of the National Alliance on Mental Illness in North Central Florida, "The use (of antipsychotics) has in fact increased slightly over the past few years."

The misuse of the drugs also occurs in nursing homes, Stevens continued. "Up to 25 percent of nursing homes receive antipsychotics for behavioral control and some of this is inappropriate because they are contraindicated for certain kinds of dementia."

But what is probably driving a lot of the prescriptions is the Veterans Affairs hospital, Stevens said. Gainesville's Malcom Randall VA Medical Center is a regional hub for a large swath of the Southeast, so patients living elsewhere might be given prescriptions in Gainesville. Experts at Meridian Behavioral Healthcare and Shands at the University of Florida agreed that the VA has a lot to do with high prescription rates for people who don't necessarily live here, along with elder facilities.

VA officials could not be reached for comment after multiple attempts to reach them.

Stevens said most of the care for patients using antipsychotics in the area is likely outpatient, since statistics show little hospitalization for mental illnesses in Alachua County, due to limited resources. This, combined with the fact that the county has a low rate of Baker Acts, or involuntary examination of mental illness — 0.7 percent compared to a state average of 0.8 percent — leads Stevens to believe that the 4.6 percent of prescriptions mostly reflect people who are taking the drugs on a voluntary, outpatient basis.

"Antipsychotics are actually effective in spite of potentially unfavorable side effects," Stevens said, namely weight gain. But, "Many people choose to stay on them because they feel the benefits outweigh the negative effects," Stevens said, adding that the drugs are roughly 60 percent effective.

Antipsychotic drugs are also sometimes prescribed as add-ons to antidepressants, meaning depression in some cases is the underlying condition to treat, not psychosis.

If psychosis is being treated, however, a high drug turnover rate is common until patients find the right drug for them, Stevens said, adding that Gainesville residents have a wide range of drugs to choose from because the preferred drug list — of drugs covered by Medicaid — is extensive.

"Treating psychosis in a community is notoriously difficult to treat with a narrow list of available drug options," Stevens said. "Gainesville enjoys a fairly wide antipsychotic med option list."

Pressure from pharmaceutical company representatives has something, but not everything, to do with that, Stevens said, adding that advocacy groups, NAMI included, have also lobbied on behalf of patients to have a wide range of treatment options.

So the Yale study's 4.6 percent of antipsychotic prescriptions in Gainesville is caused by many factors, but also tends to reinforce stigmas about mental illness, Stevens said.

"The degree of interest in antipsychotic meds …implies the stigma associated with psychiatric medicine," he said. "The whole character flaw aspect is sort of stuck and we haven't shaken that. So there's a fascination with anything to do with it, including medications."

Contact Kristine Crane at 338-3119 or kristine.crane@gvillesun.com.

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