Interstate variation in trends of psychotropic medication use among Medicaid-enrolled children in foster care

Background: High rates of treating children in foster care with second-generation antipsychotics, both singly and concomitant with other psychotropics, have focused public interest on the use of these medications.

Objective: To estimate any antipsychotic use and psychotropic polypharmacy among children in foster care during the last decade and to characterize interstate variation in these trends.

Methods: Centers for Medicare and Medicaid Services Medicaid Analytic Extract data files for 47 states and the District of Columbia for years 2002–2007 were analyzed for 686,080 children annually aged 3–18 years of age with foster care Medicaid eligibility. Repeated cross-sectional design with multilevel logistic regression was clustered at the state level and controlling for patient demographics. Main outcomes were rates of filled prescriptions for any antipsychotic medication and for concurrent use of 3 or more psychotropic classes for at least 30 days. State-level rate trajectories were classified as increased, decreased, or stable.

Results: Antipsychotic use increased from 8.9% in 2002 to 11.8% in 2007 (P<.001). In contrast, the rate of psychotropic polypharmacy was 5.2% in 2002, peaked in 2004 at 5.9%, and fell to 5.3% in 2007 (P<.001). State-specific rates of any antipsychotic use were significantly increased in 45 states over the period, while rates of psychotropic polypharmacy increased in only 18 states and declined in 19.

Conclusions: Antipsychotic use and psychotropic polypharmacy among children in foster care remained high. Psychotropic polypharmacy began to abate during the last decade, as rates of antipsychotic use continued to rise.