Wednesday, August 4, 2010

Of Saphris®, And "The Nation's Medicine Chest" -- New Jersey

I am sorry -- but I find it more than "just coincidental" that New Jersey (the home state of much of big pharma) is the only state in the nation where a psychiatric patient has no meaningful right to appeal forced psycho-tropic medication orders. The New York Times has done an excellent job with this story this morning, detailing a federal lawsuit filed yesterday on behalf of New Jersey psychiatric patients. [Cue the erstwhile Asenapine Chronicler -- Salmon.]

The notion that a prisoner in New Jersey has a more meaningful right to refuse medication, than a patient in a private mental ward, is simply jaw-slacking. This suit will ultimately succeed, as it is certainly true that the due process clause of the 14th amendment requires meaningful rights of appeal be available -- appeal to an independent tribual, at a minimum -- for such forced, and life altering, abridgments of fundamental personal freedoms and liberties.

Here's a snippet -- but do go read it all:

. . . .Twenty-nine states require a judge’s ruling for involuntary medication, according to the suit, including New York, Connecticut and other large states, like California, Florida and Texas. Five other states leave the decision to an individual or panel outside the hospital. Some states also provide an advocate to represent a patient in a hearing on forced medication.

But in New Jersey, state rules allow a patient in a state hospital to appeal medication decisions only to people in the hospital. The lawsuit contends that the internal appeal process is routinely ignored and that psychiatric patients in private hospitals lack any opportunity to appeal medication regimens at all.

The suit, filed in Federal District Court in Trenton by the group Disability Rights New Jersey, seeks a court order requiring the state to provide judicial review of involuntary medication. It notes that a prison inmate has more power to contest treatment decisions than a psychiatric patient. . . .

Of course, we have discussed the over-prescription of legacy-Schering Plough's asenapine before -- it is now called Saphris® (a New Merck's drug), in the US and Sycrest® in Europe. [Paging Salmon. . . it seems another installment of "The Asenapine Chronicles", is now due.]

Here is a full-text pdf file (80 pages; 276 Kb) of the New Jersey federal complaint at law.


Anonymous said...

Would you please explain this further to me ... is it true that you are stating that a hospital patient (say in a psych ward) does NOT have rights to refuse medication in certain states? I find that incredible. That can't possibly be true, could it?

Anonymous said...

What most people do not understand is that a diagnosis of schizophrenia or bi-polar indicates a very high IQ. These diseases are so misunderstood it just boggles my mind. Instead of putting these people into a "crazy" box, why not try vitamin therapy. I know that it has been extremely helpful for many. Here's a link -

(Imagine how many could be 'saved' from this diagnosis if vitamin therapy was started early.)

Anonymous said...

Thanks for the call out.

This is a problem in many states. The best source of information on this problem is from PsychRights in Alaska. A public interest law firm.

A major player in this area is another non-profit, The Treatment Advocacy Center (TAC), which advocates forced medication and changes in state laws to make it easier to forcably medicate patients.

TAC was funded by the Stanleys (Founder of the Danbury Mint, Stanley Foundaton, Stanley Institute, worth $0.5 Billion). The Stanleys also started and provided funding for NAMI which has come under Congressional scrutiny for taking huge amounts from drug companies and other shenanigans to promote medication. The Stanley's involvement with psychiatric drugging appears to have began after their son Jon (a former lawyer at the TAC) had a psychotic break due to mania and was forcably medicated in the 1980s.

According to documents on Psychrights, E. Fuller Torrey, MD, the founder of the TAC has publicly advocated that psychiatrics (and I believe admitted to) lying in court in order to medicate patients against their will.

In actuality patients seldom have any effective rights during commitment or forced medication proceedings much less appeal rights. Anyone can be placed in a psychiatric institute for 3 days for observation with a court hearing for commitment and forcable medication after that. Not taking medication or even refusing to talk is used as evidence that the patient is sick and a danger (catch 22 - I've seen it happen). Psych wards are a stressful place girls come in and get raped. Staff are afraid to go into bathrooms but patients are forced to go. Of course if you are already sick stress makes things worse.

A patient should be forcably medicated only if they truly are dangerous and not if someone simply has a concern that they might be or if they believe forcable medication would be beneficial to them (e.g. prevent suicide). (Based on FDA documents some of these drugs actually make the psychosis worse in some patients or in the case of asenapine induce suicide). Patients may or may not go to the court, there is a prosecutor against them, one or more institutional psychiatrists whose bias is to medicate no matter what and if even allowed a young inexperienced public defender who is overworked and doesn't even know what questions to raise. Court ordered forcable medication is routine and if a patient is ill bue not needing of forcable medication. It works against him.

Appeal rights are one thing, but for a small percentage of patients they will have already been harmed or even killed by the drugs before they can get to that stage.

I have personally seen dramatic improvement in some patients with medication. However drugs only work well (i.e. better than placebo) in a small percentage of patients and they kill or maim a similar or higher percentage and this mainly occurs in the majority of patients where you can't tell if the drug is working or if it's the normal waxing and waning of the psychosis. So without clear cut dangers from not medicating I believe in supporting the rights of patients to provide consent.

Children and the elderly are in an even worse predicament as their caregivers consent to forcable medication based on corrupt marketing practices by drug companies. (4% of children in foster care are on antipsychotics with more than half less than 12 years old yet the only illness they are typically being treated for only occurs in 1% of adults and symptoms don't tend to start until late teens (0.3% start at 15 - 18 yo virtually none less than 12 yo). Plus it takes an average of 8 years until symptoms are so severe that drugs might even have a chance of working.

Plus companies design their studies and labeling to intentionally overdose children and the elderly. (less strengths to manufacture and more profits).

There are no good answers.


condor said...

First -- Thanks again, Salmon -- yours will run as a separate post, later this afternoon.

Next, to the first commenter, above:

Yes -- I am saying that. In New Jersey, you may refuse your meds, but once you do, and the doctor re-orders them, your only avenue for an appeal is inside the hospital.

Once the hospital sides with the doctor -- as it does in over 90 percent of the cases -- you are forcibly medicated. Game over.

This is simply an unconstitutional scheme -- for one's liberty interests to be abridged in this fundamental way, our Constitution requires a meaningful notice and opprtunity to be heard by an independent tribunal.

The New Jersey law will fall. It is wrong. And more importantly, it is decidedly un-American.

[Housekeeping Glitch: The link to the PDF complaint is dead -- I'll re-source it, later this afternoon.]

Thanks, all!


Anonymous said...

I personally know of a patient diagnosed with schizophrenia. The past year plus this individual has been on vitamin therapy (along with clozaril as prescribed by md). After a year of vitamins, this person recently picked up several books and started reading again. Miraculous in my opinion ... after 25 years of not being able to track. I suspect there is more to the vitamin therapy than any physician would want to admit. So my next question ... is there any way to hold a doctor accountable or to demand that the patient be treated with an increased level of vitamin therapy? And even more details ... what happens if they've been a 'ward of the state' for several years?