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On February 5, 2018, Human Rights Watch published an in-depth report on antipsychotic drug use in U.S. nursing homes. The Report, entitled “‘They Want Docile’: How Nursing Homes in the United States Overmedicate People with Dementia,” finds that over 179,000 nursing home residents are given off-label antipsychotic drugs every week.[1] The Report notes that most residents on antipsychotic drugs have Alzheimer’s disease or other forms of dementia.[2] However, as the Report emphasizes, the Food and Drug Administration (FDA) issued a “black box” warning against the use of antipsychotics drugs for those with dementia based on reports linking use to higher rates of death.[3]

The Report finds that the rampant and inappropriate use of antipsychotic drugs among nursing home residents could constitute “abuse under domestic law and cruel, inhuman, and degrading treatment under international law.”[4] Furthermore, the Report identifies key issues of concern that not only perpetuate the continued use of inappropriate antipsychotic drugs but also weaken the overall quality of care and quality of life for nursing home residents. These concerns include inadequate staffing, lack of informed consent, and weak enforcement of the federal standards of care.

Notably, the Report features statements from nursing home residents and their families. As one resident told Human Rights Watch, “I ask them not to [give me the antipsychotic drugs]. When I say that, they threaten to remove me from the [nursing] home. They get me so I can’t think.”[5] A resident at another facility told Human Rights Watch that she does “not mess with Seroquel [an antipsychotic drug] . . . It knocks you out. It’s a powerful, powerful drug. I sleep all the time. I have to ask people what the day is . . . That Seroquel: that’s going to kill me.”[6] A family member of another resident, noting the resident’s condition after discontinuing an antipsychotic drug, stated that “ . . . she can talk again. She can read again . . . she’s conversing . . . it’s not just that she can walk now . . .  it’s her personality. She came back.”[7]

The Report concludes by providing key recommendations to the Centers for Medicare & Medicaid Services (CMS), to Congress, and to federal and state governments. Human Rights Watch calls for these entities to stop the inappropriate use of antipsychotic drugs, establish a right to informed consent prior to the administration of an antipsychotic drug, ensure nursing staff numbers and training levels are adequate, and strengthen enforcement.[8]

D. Valanejad, February 2018

[1] See Hannah Flamm et al., “They Want Docile”: How Nursing Homes in the United States Overmedicate People with Dementia, Human Rights Watch (Feb. 2018), (noting that “[t]he drugs are often given without free and informed consent . . . .”).
[2] See id. (“According to the US Government Accountability Office (GAO) analysis, facilities often use the drugs to control common symptoms of the disease.”).
[3] See id. (“Studies find that on average, antipsychotic drugs almost double the risk of death in older people with dementia.”).
[4] Id.

[5] Id.
[6] Id.
[7] Id.
[8] Id.


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