More kids, young adults are using sleeping pills

Few of the prescriptions OK'd by FDA

October 19, 2005|By NEW YORK TIMES NEWS SERVICE .

NEW YORK -- The use of sleeping pills among children and very young adults rose 85 percent from 2000 to 2004, a study shows, in yet another sign that parents and doctors are increasingly turning to prescription medications to solve childhood health and behavioral problems.

Also, about 15 percent of people under age 20 who received sleeping pills were also being given drugs to treat attention deficit and hyperactivity disorder, according to the study, by Medco Health Solutions, a managed-care company that makes estimates about medication use in the whole population based on extrapolations from its own data. Drugs used to treat attention disorders can cause insomnia.

Few of the prescriptions given to children and young adults have the approval of the Food and Drug Administration because no sleep medication has been approved for use in children under 18. Still, doctors commonly use medications for patients and disorders for which the drugs have never received formal approval, particularly when those patients are children.

Dr. Robert Epstein, Medco's chief medical officer, said, "It leads you to wonder whether these children are being treated for insomnia caused by hyperactivity or whether the medication itself causes the insomnia."

The use of sleeping medicines among adults doubled from 2000 to 2004, Medco found.

To perform its study, Medco took the prescription data from 2.4 million of its customers, a fraction of the more than 55 million Americans for whom it oversees drug plans. In 2000, of the 340,124 patients in this sample age 10 to 19, 554 took sleeping medicines. In 2004, of 342,568 patients age 10 to 19, 1,032 took sleeping pills, according to Medco. After adjusting statistically for the difference between the sample sizes, the jump in sleeping pill use was 85 percent, the company said.

The company found that the older the person, the more likely they were to use sleeping pills. Of those age 20 to 44, nearly 3 percent - or 2.8 million people - received prescriptions for sleep medicines in 2004, Medco found. More than 5 percent of those age 45 to 64, or 3.3 million people, used the pills that year, while more than 6 percent of those age 65 and older, or more than 2.2 million people, took sleeping pills, said Medco.

At every age, girls and women were more likely than boys and men to take sleeping pills. Among those 65 and older, for instance, roughly twice as many women as men got the drugs in 2004, Medco found.

"Although the elderly are still the most frequent users of sleeping aids, the evidence found in this study shows that younger adults and children are starting to use these medications with even greater frequency," Epstein said.

The increase is part of a broader rise in prescriptions for children, particularly for behavioral medicines, said Ann Smith, a Medco spokeswoman.

Expensive marketing campaigns by makers of sleeping pills were an important factor behind the rising drug use, experts said. And because those campaigns expanded in 2005 after the introduction of a new pill, Lunesta, experts said the drugs' use quite likely increased even faster this year. Medco did not have data for 2005.

Executives for Sepracor, Lunesta's maker, have said that their advertising spending would initially rival that of McDonald's. Experts were divided about whether all these pills helped or hurt those taking them.

Dr. Andrew D. Krystal, director of the insomnia and sleep research program at Duke Medical Center, said that insomnia had long been undertreated, and that few doctors recognized how much insomnia could worsen other medical problems.

Long-term medication can help relieve these problems, he said.

Krystal said he consulted for and did research paid for by several drug companies.

Gregg Jacobs, an assistant professor of psychiatry at Harvard Medical School, said the trends reported by Medco were unfortunate because "too many prescriptions are being written for people who don't need a prescription or who would do just as well or better with cognitive behavioral therapy, which doesn't have the side effects of medication."

Jacobs said drug companies exaggerated their pills' beneficial effects and underplayed their deleterious ones.

For instance, Sepracor's own studies of Lunesta show that the drug reduces the time that insomniacs take to fall asleep by just 15 minutes - from a little more than an hour to about 50 minutes, Jacobs said.

And insomniacs who take Lunesta still sleep only about six hours a night, he said.

"Lunesta doesn't work that much better than a sugar pill; it impairs your cognitive performance the next day, and as soon as you stop taking the drug your insomnia comes right back," said Jacobs, who said he did not consult for drug makers.

David Southwell, Sepracor's chief financial officer, responded, "The drug clearly puts you to sleep, and clearly our drug keeps you asleep longer not only than placebo but longer than other shorter acting drugs."

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