Do most nursing home residents who are prescribed the drug Nuedexta need it? It turns out, probably not. But many elderly nursing home residents are being given the drug, with potentially deadly consequences.
What’s Nuedexta for?
Nuedexta is a little red pill that is approved for a rare condition that causes sudden, uncontrollable, and inappropriate laughing and crying. It’s called pseudobulbar affect, or PBA. You may have seen Danny Glover in the commercials for the drug.
But few people have this condition. In fact, fewer than 1% of the population has this condition. And almost all people who do have pseudobulbar affect have neurological conditions called ALS (Lou Gehrig’s disease) or multiple sclerosis.
According to a recent report conducted by CNN, “[t]here has to be a diagnosis for every drug prescribed, and that diagnosis has to be real … it cannot be simply made up by a doctor,” said Kathryn Locatell, a geriatric physician who helps the California Department of Justice investigate cases of elder abuse in nursing homes. “There is little to no medical literature to support the drug’s use in nursing home residents (with dementia) — the population apparently being targeted.”
Last year, regulators found that more than 25% of nursing home residents in a In Los Angeles nursing home were being prescribed Nuedesta. Not surprisingly, this jump in prescribing occurred after the nursing home’s psychiatrist had attended a talk from the drug manufacturer’s reps.
At another Southern California nursing home, an employee admitted to regulators that a diagnosis of PBA was given to a nursing home resident because they had to “somehow justify the use” of Nuedexta, even though its intended purpose was to control the resident’s “mood disturbances” and yelling out. Mood disturbances and yelling out, however, are not appropriate uses of the drug.
Why is Nuedexta prescribed to people in nursing homes?
A high pressure marketing campaign driven by an aggressive sales force and big money has convinced doctors to prescribe Nuedexta to patients with Alzheimer’s and dementia. But Alzheimer’s and dementia are completely different conditions fromhttp://www.cnn.com/2017/10/12/health/nuedexta-nursing-homes-invs/index.html PBA and they probably don’t need this medication.
Recent investigations have shown that “Since 2012, more than half of all Nuedexta pills have gone to long-term care facilities. The number of pills rose to roughly 14 million in 2016, a jump of nearly 400% in just four years, according to data obtained from QuintilesIMS, which tracks pharmaceutical sales. Total sales of Nuedexta reached almost $300 million that year.”
“Thousands of the doctors prescribing Nuedexta have received money, or at least a meal, from its maker — a legal but controversial practice in the industry. Between 2013 and 2016, Avanir and its parent company, Otsuka, paid doctors nearly $14 million for Nuedexta-related consulting, promotional speaking and other services, according to government data. The companies also spent $4.6 million on travel and dining costs, both for speakers and for doctors being targeted by salespeople.”
We previously reported on the use of chemical restraints in the elderly with Alzheimer’s and dementia. Doctors and nursing homes have been giving people with dementia and Alzheimer’s drugs to sedate them for generations. Alzheimer’s and dementia patients can be difficult to work with and require more time, attention, and patience than other patience.
Time, attention, and patience are rare commodities for nursing home aides and nurses due to frequent staffing concerns. Sedating these patients is an easy fix.
Nuedexta’s chemical makeup is a perfect fit for chemical sedation. Nuedexta is dextromethorphan, or DXM. This is the active ingredient in cough syrup that causes drowsiness and fatigue. But Nuedexta is not just the active ingredient in cough syrup. It is mixed with a drug called quinidine. This slows the metabolizing of the drug, which means that it packs a punch and lasts a long time in the body.
How would this medication improve the thought process of people with dementia and Alzheimer’s? That much is unknown. What is known is that it is sedating. And sedating medications in the elderly have proven dangerous time and time again resulting falls, heart and breathing problems, and many other problems.
Regardless of the drug used, the result is the same: sleepy, lethargic patients who fall and get injured, sometimes fatally. And this practice is not only dangerous but illegal!
Federal law prohibits the use of medications for “discipline” or “convenience” of staff, which is considered a “chemical restraint.” A chemical restraint can only be used as a last resort to prevent an agitated patient from harming himself or others. Ohio law also prevents the use of chemical restraints except in extreme circumstances. Ohio’s Nursing Home Bill of Rights states that nursing home residents have the following rights:
“The right to be free from … chemical restraints … except to the minimum extent necessary to protect the resident from injury to self, others, or to property and except as authorized in writing by the attending physician for a specified and limited period of time and documented in the resident’s medical record.”
The manufacturer of Nuedexta – a company called Avanir Pharmaceuticals – admits that it has never fully addressed the consequences of the drug on the elderly in its prescribing information. This has led critics to conclude that the drug manufacturer is conducting an uncontrolled experiment on a captive elderly population.
“The one study the company conducted solely on patients with Alzheimer’s (a type of dementia) had 194 subjects and found that those on Nuedexta experienced falls at more than twice the rate as those on a placebo,” according to a recent report.
Who is paying for Nuedexta in the elderly?
In large part, the federal government is footing the bill to inappropriately prescribe Nuedexta to elderly people without PBA. Why is that? Because Medicare Part D and Medicaid (a program shared by the federal and state governments) pay the vast majority of medical care in the elderly.
This means that not only is the government paying for the drug but also for any harm the patient suffers from the side effects of the medication.