WebMD reported last week on a new study in the journal Sleep. The study found that doctors are widely prescribing sleeping pills and other drugs to children having sleep problems. An astonishing 81% of the 18.6 million doctor visits studied included a prescription being written. By contrast:
They found that diet and nutritional counseling were advised for 7% of children and that 22% were prescribed behavioral therapy such as psychotherapy and stress management to relieve the sleep problems. For 19% of children, both behavioral therapy and medication were advised.
The data studied only go til 2004. Advertising for sleep drugs has exploded since 2004. Both Lunesta and Rozerem were introduced after that time, and have been extremely heavily advertised. Ambien CR was also widely advertised in that time period, both to compete against these new drugs, and to get patients to switch from Ambien to Ambien CR before generic versions of Ambien came on the market. (In 2006, we gave one of our coveted Bitter Pill Awards to the makers of both Lunesta and Ambien/Ambien CR - the "The While You Were Sleeping Award: For Overmarketing Insomnia Medications to Anyone who's ever had a Bad Night's Sleep") It is likely that the enormous promotion of prescription sleep aids in the past 2 and 1/2 years has increased the number of kids being prescribed drugs for sleep even more.
Several things about these findings are disturbing:
- It suggests that doctors are rushing to medications, and not adequately addressing underlying causes, or emphasizing behavioral changes and "sleep hygiene."
- Many of the drugs being prescribed have not been tested on children, and are not FDA-approved for use in children -- this is so-called "off-label" usage. While off-label prescribing is quite common (one study found that 1 in 7 prescriptions was for an off-label use), it is potentially more troubling when it is done for children. Children are not "little adults" -- it cannot be assumed that a drug will work the same, or that side effects and risks will be similar for children as they are for adults. The effects of drugs on children's growth and development is unclear if the drug has not been studied in children and is not approved for use in children.
- It exposes children to the risk of addiction or dependency. Many drugs used for sleep problems have these risks, even those that are not specifically approved for insomnia.
- It introduces children at an early age to the dangerous idea that there is a pill for all their problems, and that taking prescription drugs is "no big deal," and just a routine part of everyday life. This cultural attitude has contributed to the extremely troublesome and widespread trend of teenagers and young adults misusing and abusing prescription drugs.
For some children, the use of a prescription drug may be the appropriate route for addressing a sleep problem. Insomnia and other sleep problems can and do interfere with children's growth, learning and behavior, and need to be addressed. But it is a sad commentary that millions of children are being prescribed prescription drugs, when for many of them, changes in diet, routine and schedule would work just as well and not expose them to the risks, known and unknown, that come with these prescription drugs.
The Sleep study can be found here.
Postscript:
In a bit of irony, the article on WebMd was bordered on two sides by an ad for Rozerem. See screen shot below:
