Psychotropic Polypharmacy Trends Rise Among Child, Adolescent Medicaid Beneficiaries

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The results of a study examining trends in psychotropic polypharmacy among youths enrolled in Medicaid indicated that there has been a rise in the concomitant use of multiple psychotropic medications in this patient population.

According to the study’s investigators, psychotropic polypharmacy—which refers to the concurrent use of medications for attention-deficit/hyperactivity disorder, antipsychotics, mood-stabilizing anticonvulsants, and antidepressants—has raised safety concerns over the past 2 decades,¹ as it increases the risk of adverse medical outcomes.²

In this study, they aimed to analyze trends in psychotropic polypharmacy among youths 17 years or younger who were enrolled in Medicaid, in order to identify temporal shifts and associated characteristics linked to psychotropic polypharmacy.¹

In the study, which was conducted from 2015 to 2020 in a single US state, investigators aimed to analyze the prevalence and characteristics associated with psychotropic polypharmacy in this patient population. The investigators utilized Medicaid eligibility files and medical encounter claims, identifying 126,972 youths who had received at least 1 prescription for psychotropic medication and had continuous Medicaid enrollment for 90 days or more.¹

Among youths using psychotropic medications, the prevalence increased from 4.2% in 2015 to 4.6% in 2020. This increase was particularly pronounced among youths with Medicaid eligibility from foster care (from 10.8% to 11.3%), those enrolled in the Children’s Health Program (from 2.2% to 2.8%), and those from low-income households (from 2.1% to 2.8%).¹

The study also highlighted disparities in psychotropic polypharmacy, with youths who were disabled (adjusted OR [AOR], 3.68; 95% CI, 3.34-4.05) and those in foster care (AOR, 3.31; 95% CI, 2.93-3.74) having significantly higher odds of receiving multiple psychotropic classes compared with those from low-income backgrounds.¹

Age also played a role, with youths aged 10 to 14 years (AOR, 1.94; 95% CI, 1.80-2.10) and aged 15 to 17 years (AOR, 2.41; 95% CI, 2.22-2.6) showing higher odds of psychotropic polypharmacy than children younger than 10 years.¹

Racial disparities were evident, with Black individuals (AOR, 0.47; 95% CI, 0.43-0.51) and those identifying as other races (AOR, 0.54; 95% CI, 0.50-0.59) having lower odds of psychotropic polypharmacy compared with White individuals.¹

The investigators emphasized the importance of monitoring psychotropic medication combinations, especially among vulnerable populations such as youths who are enrolled in Medicaid, may have complex medical conditions, may have received fragmented care, and may have experienced early-life trauma.¹

Medicaid beneficiaries represent a vulnerable patient population in general. Research results show that in 2020 nearly 40% of nonelderly Medicaid beneficiaries—or 13.9 million enrollees—had a mental health disorder or a substance use disorder.³

The investigators did note the study’s limitations. They acknowledged that the study’s focus on a single US state’s Medicaid population may limit the overall generalizability of the results in other states, populations, and health care systems.¹

The investigators concluded, “The findings emphasize the importance of monitoring the use of psychotropic combinations, particularly among vulnerable populations, such as youths enrolled in Medicaid who have a disability or are in foster care.”¹

References

1. Chiang YY, Amill-Rosario A, Tran P, dosReis S. Psychotropic polypharmacy among youths enrolled in Medicaid. JAMA Netw Open. 2024;7(2):e2356404.

2. Halli-Tierney AD, Scarbrough C, Carroll D. Polypharmacy: evaluating risks and deprescribing. Am Fam Physician. 2019;100(1):32-38.

3. Saunders H, Corallo B, Moreno S. Medicaid coverage of behavioral health services in 2022: findings from a survey of state Medicaid programs. KFF. March 17, 2023. Accessed May 14, 2024. https://www.kff.org/mental-health/issue-brief/medicaid-coverage-of-behavioral-health-services-in-2022-findings-from-a-survey-of-state-medicaid-programs/#:~:text=Nearly%2040%25%20of%20the%20nonelderly,because%20of%20their%20low%20incomes