Doctors are under fire for overprescribing elder patients Neudexta, a controversial medication created to treat a rare disorder called pseudobulbar affect (PBA). PBA is characterized by bouts of uncontrollable laughing or crying, is commonly found in patients with ALS or multiple sclerosis, and only affects less than 1% of the country, according to a CNN report. However, Neudexta, also known as the “little red pill,” is making its way to patients with dementia and Alzheimer’s disease in nursing homes throughout the country.
Why? Because Neudexta sedates it’s users thereby making them easier to manage in a clinical or nursing setting; in addition, doctors are being paid to promote the drug and are encouraging colleagues to do the same without regard to their patients’ safety and care. In California, this is a clear form of elder abuse, among other violations of a patient’s bill of rights.
Not surprisingly, nursing homes are ground zero for the abuse, even though many geriatric physicians, dementia researchers and other medical experts have reported that PBA is rarely found in dementia patients. A CNN report further found that state regulators are discovering physicians who inappropriately diagnosed nursing home residents with PBA to justify using Nuedexta to treat patients whose confusion, agitation, and unruly behavior made them difficult to manage.
The disturbing trend of prescribing unnecessary and potentially harmful drugs to nursing home patients first became apparent when a Los Angeles nursing home was under investigation for elder abuse. The nursing home in question started prescribing Nuedexta to more than a quarter of its residents after a facility psychiatrist, who was paid by Avanir, gave a talk about the drug to the facility’s employees. CNN’s report uncovered numerous doctors who are prescribing Nuedexta while receiving benefits from Avanir. In fact, between 2013 and 2016, 500 physicians were paid to promote the drug, and of those 500, about a dozen were disciplined by state medical boards for inappropriately prescribing Nuedexta to nursing home residents.
Avanir claims they only work with skilled physicians in furthering effective treatments for patients suffering from central nervous system disorders, like Alzheimer’s disease. However, one doctor, who was paid over $20,000 in various benefits in one year to promote Nuedexta to prisons and other medical facilities or providers, has not only been banned from working with prisoners, but has at least four malpractice lawsuit settlements.
CNN reports that the City of Los Angeles has launched a probe into the manufacturer to determine if they have broken any federal or state laws in the sales, marketing or prescribing of Nuedexta, and that part of this investigation will be an examination of the doctors paid by the company. This review follows another incident that took place in a Los Angeles nursing home where three residents were given Nuedexta without a doctor’s prescription or approval. As stated earlier, part of the reason for prescribing this drug to patients not suffering from PBA is to help control unruly behavior that may occur due to diseases such as Alzheimer’s and dementia. While the three residents at this home were known to weep when family members left the facility, and yell out for help, employees acknowledged they were never seen crying or laughing involuntarily, therefore not showing signs of PBA, which raises ethical, moral and legal concerns when it comes to the treatment of elder patients.
Legally, Title 42 of the Code of Federal Regulations, §483.12, prohibits the use of chemical restraints imposed for purposes of discipline or convenience and that are not required to treat the resident’s medical symptoms.