By Maria Reyes, RN, Ecumen Awakenings Manager
Dangerous uses of antipsychotic medications in dementia care are now coming under intense government scrutiny and beginning to draw significant punitive action. Along with this approach, we must redesign how we provide dementia care in America and beyond.
Last week, according to the U.S. -Justice Department, Johnson & Johnson agreed to pay more than $2.2 billion in criminal and civil fines to settle accusations that it improperly promoted the antipsychotic drug Risperdal to older adults, children and people with developmental disabilities.
Risperdal was marketed as a way to control dementia in nursing homes. As part of the settlement, Johnson & Johnson agreed to plead guilty to a criminal misdemeanor, acknowledging that it improperly marketed Risperdal to older adults for unapproved uses. Even though the Federal Drug Administration rejected repeated efforts by Johnson & Johnson to expand the drug’s use to people with dementia, Johnson & Johnson went ahead anyway.
According to The New York Times, the company created a dedicated sales force, ElderCare, to promote the drug and others to doctors who primarily treated older patients. And through their approach, they promoted a dangerous status quo: the use of antipsychotics to “quiet” behaviors of people with dementia.
The drug, the company claimed, could address symptoms that made treating these patients a challenge, especially in a nursing home setting, including agitation, confusion, hostility and impulsiveness. The company’s sales brochures highlighted these symptoms and minimized the fact that the drug was approved to treat schizophrenia, according to federal documents.
Federal officials said the company knew that Risperdal posed serious health risks for older adults, like an increased risk of strokes, but it played them down. The drug’s label was later updated to warn against the use of the drug in older patients with dementia.
During this period, Risperdal was among the company’s top-selling drugs. In 2004, for example, Risperdal brought in $3.1 billion in sales, accounting for about 5 percent of Johnson & Johnson’s total revenue that year, according to company filings.
Johnson & Johnson was not the only company marketing drugs to older dementia patients and the nursing homes where they were treated. Within the last five years, federal officials have reached similar agreements regarding Zyprexa, made by Eli Lilly; Seroquel, made by AstraZeneca; and Depakote, by Abbott, which is now AbbVie.
One way that pharmaceutical companies could be extremely helpful in helping the world change its dementia care for the better is to help highlight when not to use antipsychotics and to support a national campaign on more holistic, integrated dementia care. A small portion of that $2.2 billion settlement could go a long way in that effort. Until we have a cure, we must provide the absolute best care.