A shocking CBC/Canadian Press investigation has again confirmed how powerful anti-psychotic drugs are being abused. This time, the news is about quetiapine, marketed under the brand name Seroquel, being given to female inmates in Canadian prisons.
The problem is not that the drug is being administered to inmates who have been diagnosed with schizophrenia or bipolar disorder, which are its only approved uses. It is that it is being given as a sedative. Even bigger news is that this same kind of abuse is occurring every day in Canadian hospitals and long-term care facilities. And it is putting patients at risk of being harmed by the drug's side effects, which include sudden death.
I learned about the dangers of this drug the hard way when my elderly mother was hospitalized following a severe brain injury. She was given multiple doses of Seroquel each day. The family's consent for the use of the drug was never sought. The side effects and risks of the drug were never discussed. This in itself was a breach of Ontario's Health Care Consent Act. The drug was given to sedate her, as it is with so many elderly patients across Canada.
Over-sedation can pose a serious problem to patients, especially the elderly and those with cognitive impairment. One day early in her three-month stay, Seroquel was given to my mother, along with morphine. This volatile combination is known to depress the respiratory system. Within a few hours, exactly what has happened to other patients given Seroquel occurred to my mother: she had a respiratory arrest followed immediately by a cardiac arrest. When she was found by nursing staff, she was without vital signs. By some miracle she was revived. But she was left permanently disabled and has required 24/7 care ever since.
What is astonishing is that this did not happen in a prison or an old-age home. The misuse of this drug, even with all the adverse events that have been documented throughout the world, occurred at one of Canada's largest teaching hospitals. The hospital refused to explain why it used the drug in this unapproved fashion, why it never sought my family's permission or why it did not discuss the drug's known risks before it was used.
In fact, the hospital produced a report by a team of clinicians headed by its chief of trauma services that actually resorted to lies. They insisted my mother never received any sedating medication. When we provided them with copies of her chart that showed the dates, times and dose levels for the medication, they admitted it was "possible." There was no indication that the hospital intended to change its policies about the circumstances under which it would administer this drug in the future.
Long-term care facilities are no better. The Canadian Institute for Health Information reports that one-third of long-term care residents in Canada are receiving anti-psychotic drugs, like Seroquel, even though they have never been diagnosed with schizophrenia or bipolar disorder. Seroquel is well known as a favourite form of chemical restraint for the elderly. The CBC/CP investigation revealed that the drug is favorited for the same purpose in the prison system.
For at least a decade, warnings about the improper use of this drug have been mounting. It has also been connected with sudden deaths in the U.S. military.
Corporate greed has been a factor in the misuse of Seroquel. The drug's maker, AstraZeneca, found that it could make millions more by marketing the drug for its "off-label" uses than for its actual approved benefits. With growing evidence of the cost of this abuse, the U.S. justice department finally took enforcement action. In 2010 the company paid $520 million to settle federal allegations that it intentionally pushed the drug to be used for unapproved uses, including insomnia. Thousands of lawsuits still remain before U.S. courts alleging injuries from the drug over its improper use and promotion.
Canadian officials seem tone death to these facts, however, as the most recent CBC/CP story shows. My experience is that even when a family declines consent for the drug, it is still used. By the time my mother was transferred to a hospital closer to her Muskoka home, I had become aware of the dangers of Seroquel and its adverse effects on her.
I specifically told nursing staff on admission that the drug was never to be given. The hospital went ahead and administered the drug anyway. One nursing note cited my mother's "fidgeting" as justification for the use of the drug. That's hardly a sound reason to administer such a powerful anti-psychotic. But when these incidents were drawn to the attention of the hospital's CEO and board, they denied any errors ever occurred and declared my mother's care to be appropriate. Eventually, they threatened legal action if we publicly suggested anything to the contrary.
In addition to the epidemic of hospital harm that is occurring across Canada and the U.S. as a result of medical errors, there is clearly an epidemic of misuse and abuse of chemical restraints like Seroquel for the most vulnerable in our society. It is time Canada's ministers of health sent a strong message that this must stop. They can begin with the big teaching hospital that has some important lessons to learn about drug safety and informed consent, as well as honesty and transparency in the way it deals with families.
Patient Protection Canada has posted an informative video on the dangers of Seroquel on its web site.