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Alison Evans Cuellar, PhD; Kelly J. Kelleher, MD, MPH; Sheryl Kataoka, MD, MSHS; Steven Adelsheim, MD; Joseph J. Cocozza, PhD

Arch Pediatr Adolesc Med. 2008;162(3):219-224.

Objective  To determine changes in psychotropic medication use before and after juvenile justice incarceration, contrasting stays in long-stay commitment facilities and short-stay detention facilities.

Design  Statewide administrative data (July 1, 1998, through June 30, 2003) from the Florida Department of Juvenile Justice and Florida Medicaid. Medication prescriptions filled before entry and after release from facilities were determined based on paid claims. Psychotropic medication was categorized by drug class based on the National Drug Code.

Setting  General community services.

Participants  All of the Medicaid-enrolled youth aged 11 to 17 years identified as having a stay in a juvenile justice facility. The total sample included 67 819 detention stays and 59 918 commitment stays.

Main Exposure  Incarceration in juvenile commitment and detention facilities.

Main Outcome Measure  Filled prescriptions for psychotropic medication by class 30 and 90 days before and after incarceration.

Results  Ninety days prior to detention, 3666 youth (5.4%) had psychotropic drug claims. Among these, 2296 (62.6%) had any psychotropic medication claims in the 30 days after release. Among commitment cases, 29.6% continued medication use after release. Onset of medication use after release from detention and commitment facilities was relatively uncommon (1.7% and 1.9%, respectively). Youth in commitment facilities were less likely than youth in detention facilities to resume their medication use across drug classes after 30 days (²₃ = 6.28; P = .04) and after 90 days (²₂ = 7.62; P = .02).

Conclusions  The results find greater support for a disruption effect than a discovery effect from incarceration. The findings suggest several areas for further investigation and improvement of services for incarcerated youth.

Author Affiliations: Department of Health Policy and Management, Columbia University, New York (Dr Evans Cuellar) and Policy Research Associates, Delmar (Dr Cocozza), New York; Department of Pediatrics, Ohio State University and Columbus Children's Research Institute, Columbus (Dr Kelleher); Health Services Research Center, University of California, Los Angeles (Dr Kataoka); and Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque (Dr Adelsheim).

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Psychotropic Medications in Incarcerated Juveniles: Overprescribed or Underprescribed?
Joseph V. Penn
Arch Pediatr Adolesc Med. 2008;162(3):281-283.
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