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Off-Label Medication Use Still Rampant in California Nursing Homes

The improper use of antipsychotic drugs on nursing home patients with dementia has been well-documented for decades but continues to be a problem.

A recent study by California Advocates for Nursing Home Reform (PDF) found that close to 1 in 4 California nursing home residents are given antipsychotic drugs and that the “vast majority” of these drugs are given for “off-label” uses, such as treating patients with dementia.

Antipsychotic medications such as Risperidone (Risperdal) contain an FDA-mandated “Black Box Warning” which indicates that these medications have serious side effects for people dementia. In particular, antipsychotic medications are shown to double the risk of death and triple the risk of stroke in this population, according to the Daily Telegraph.

Studies have shown that the vast majority of nursing home residents with dementia are never informed of the black box warning or otherwise made aware of the serious risks associated with these medications. There is also a serious lack of informed consent from residents or their guardians before the drugs are administered.

The Leading Form of Elder Abuse in California

Researchers from California Advocates for Nursing Home Reform call the misuse of antipsychotic medications the “leading form of elder abuse in nursing homes.” These medications are typically administered as a first resort for dementia patients with behavioral issues, which is against federal and state laws.

Some progress has been made in reducing the rates of off-label antipsychotic administration in nursing homes. In 2013, Johnson & Johnson agreed to pay $2.2 billion for improperly marketing antipsychotics for off-label uses, but findings from the Centers for Medicare & Medicaid Services indicate that misuse of these medications is still rampant.