I can tell you this. From what I was able to gather last week, they're handing Seroquel out in jail like it's candy.
The original is behind a paywall or something now. But I was able to find the text of a report published in the Rio Grande Sun in a forum. Can't find part 2 though.
Jail's Drug Program Spun Out of Control
(SUNfoto by Bryant Furlow) Rio Arriba County Jail Administrator Bidal Candelaria took over management of the jail in Spring 2006 as inmate drug prescriptions were rising sharply. Candelaria has worked at the jail for 27 years.
First of Two Part Series on Rio Arriba County's practice of spending thousands of dollars on powerful, and controversial, anti-psychotic drugs for inmates from 2004 to 2008
By Bryant Furlow
SUN Staff Writer
Published:
Thursday, May 14, 2009 1:02 PM MDT
The Rio Arriba County Jail spent more than $140,000 over five years to keep inmates sedated with dangerous and addictive psychiatric drugs, according to a Rio Grande SUN investigation.
The most commonly prescribed psychiatric drug was Seroquel, a powerful and possibly addictive anti-psychotic tied to increased risks of diabetes, seizures, nerve damage, hypothyroidism and blood clots, Jail Administrator Bidal Candelaria acknowledged and County documents show.
Jail documents, including staff memoranda and hundreds of pages of pharmacy billing records show that between 2004 and 2008, University of New Mexico psychiatrist Richard Barendsen was responsible for prescribing more than 20,000 doses of Seroquel and thousands of doses of Xanax and other psychiatric drugs to the inmates he saw at La Clinica del Pueblo de Rio Arriba in Tierra Amarilla. During those five years, the jail paid Rio Drugs of Chama $146,000 for Seroquel purchases alone, billing records show.
By late November 2007, nearly a third of the jail’s inmates were on Seroquel, Xanax or other psychiatric medications, according to a Jail staff memo.
But Barendsen wasn’t treating an epidemic of severe mental illnesses such as schizophrenia or bipolar disorder, the two brain diseases for which Seroquel is a federally approved treatment.
Instead, Barendsen readily admits, he was using the drug to sedate inmates and help them sleep.
At first, jail officials encouraged inmates to meet with Barendsen, according to former inmates, a former guard and Barendsen. But by late 2007, jail officials were growing concerned over mounting drug costs and “zombied” prisoners who slept for days at a time, according to former jail supervisor Lydia Garcia and a 2007 staff memo.
Costs were not the only concerns. Seroquel is a powerful and potentially dangerous drug. Just last month, a U.S. Food and Drug Administration panel deemed Seroquel too dangerous to approve its use as a first-line treatment for depression. But Barendsen said the clinic did not closely monitor inmates for side-effects (see sidebar).
Barendsen said he did not order blood tests to monitor inmates’ liver enzymes, which can become elevated by Seroquel, for example.
One inmate to whom Barendsen prescribed Seroquel, Lawrence Kaiser, died in February 2007 in a holding cell, of deep vein thrombosis and pulmonary embolism, potential risk factors of the drug, although it is unclear whether Seroquel caused his death. His wife has filed a lawsuit against Barendsen and the County over its alleged negligence in monitoring his medical condition (see story on Kaiser's death under the County tab on this web site).
DRUGMAKER DOWN-PLAYED RISKS
More than 15,400 patients are suing AstraZeneca in state and federal courts, claiming that Seroquel caused diabetes or other serious health problems, according to the firm’s 2008 annual report.
The federal Food and Drug Administration ordered AstraZeneca to more prominently list risks at the top of Seroquel labels in February, instead of burying safety warnings at the bottom of multi-page inserts. Among the risks AstraZeneca acknowledges for Seroquel are hyperglycemia, hypoglycemia, diabetes, seizures, hypothyroidism, suicidal thoughts, irreversible muscle tics, elevated cholesterol and loss of appetite. Seroquel can also cause Neuroleptic Malignant Syndrome, the drug’s warning label states — a potentially fatal disorder that can cause deep vein thrombosis and thromboembolisms, the types of blot clots noted in Lawrence Kaiser’s autopsy.
Despite those risks, the company has aggressively marketed the drug and sought federal Food and Drug Administration approval for its use as a treatment for additional disorders, like depression. But citing safety concerns and insufficient evidence that Seroquel is any more effective than other medications for depression, a panel of Administration scientists ruled against approving the drug as a stand-alone treatment for depression, last month.
First marketed in 1997, Seroquel has been prescribed to more than 22 million patients worldwide, according to AstraZeneca’s web site.
Under Administration regulations, drug companies are supposed to report evidence of side effects in a timely manner.
AstraZeneca did not return a call for comment. Another inmate who overdosed in the jail reported that he had ground up Seroquel pills and snorted them, Garcia said. Yet another developed diabetes while taking Seroquel — one of the drug’s leading known risk factors.
But none of the former inmates who were prescribed Seroquel and other drugs at the jail and who were contacted for this story were warned of potential side effects, they said.
One former inmate admitted that he buys Seroquel on the street in Española, and claimed he was not the only one to do so. Another former inmate, Jerome Abeyta, 45 — who jail records list as having been prescribed Xanax while an inmate — died of a drug overdose just weeks after his April 2008 release. Abeyta died of an overdose involving a lethal mixture of Xanax, alcohol, morphine, codein and methadone, a toxicology report states.
Abeyta’s death was one of four Xanax-involved overdose deaths in the County in 2008. (There have been no confirmed Seroquel overdose deaths in the County, according to data from the state Office of the Medical Investigator, but elsewhere in New Mexico, at least 43 accidental overdose deaths involving Seroquel are listed in an Office database. See sidebar in story on Kaiser's death under the County tab on this web site)
“Jerry said some of the best drugs he ever got were in that Jail,” Abeyta’s brother Jeffrey recalled. “The drugs he was prescribed didn’t help him. They made things worse. It was easy for him to get them and stay high. He didn’t get clean during his time in the Jail.”
Barendsen refused to discuss individual cases, but expressed regret that La Clinica had not more closely monitored his patients.
“I think we could’ve avoided some situations if we did a better job of seeing people,” Barendsen said.
At least some of Barendsen’s patients at the jail didn’t really need Seroquel at all, Barendsen said. Instead, Barendsen believes they were trying to obtain pills for abuse or trade in the jail, he said.
Still, he continued to prescribe powerful anti-psychotics to more patients each year.
The University abruptly ended Barendsen’s work with the jail in August 2008 without explanation. Barendsen would not explain why his work was halted; but Candelaria said the University had become nervous about Kaiser’s lawsuit. The County hired two Santa Fe-based psychiatrists to work with inmates starting in August 2008.
But by Barendsen’s own admission, he continues to prescribe Seroquel to many La Clinica patients through a deal with pharmaceutical giant AstraZeneca. AstraZeneca provides free prescriptions of Seroquel to low-income patients.
The jail’s new psychiatrists, Jonathan Beamer and E.J. Neidhardt “occasionally” prescribe Seroquel to inmates, but only after other medications fail, Beamer said. This is supported by a recorded drop-off in Seroquel purchases since Barendsen’s departure, County documents show.
But Barendsen has an explanation for why he prescribed so many powerful drugs to inmates.
Some are skeptical of that explanation, but it just might deserve serious consideration, a critic conceded, because — if true — Barendsen’s prescriptions represent a damning indictment of Northern New Mexico’s culture of violence.
Worried
On October 26, 2007, Rio Arriba County jail Administrator Bidal Candelaria was worried.
He had just received a memo from Assistant Administrator Larry DeYapp. The cover letter’s subject line read, “Research you requested.”
Of the 112 inmates in the jail that month, 48 were on prescription medications, DeYapp reported in the memo.
Of those, 33 inmates — close to a third of the inmate population — were taking psychiatric medications, in most cases Seroquel or Xanax, the memo states. Fourteen inmates had been prescribed both drugs.
Xanax’s side effects can include suicidal thoughts, aggression and rage, slurred speech and hallucinations, according to the federal Food and Drug Administration.
At least one inmate, Manuel Gutierrez, was prescribed Xanax, Seroquel and Valium — three powerful sedatives, jail documents state.
Three other inmates were prescribed Hydrocodone, an addictive opiate.
Seven former inmates who were prescribed Seroquel and other drugs – and Garcia, whose job included dispensing the pills — said the jail was awash in powerful prescription drugs.
“I kept thinking, the whole jail’s on this stuff,” Garcia said.
Garcia was the target of a state narcotics task force jail raid in September 2007, leading to her firing by Candelaria. No charges were ever brought against Garcia. The raid had resulted from a series of inmate overdoses, including one in which an inmate said he had ground up and snorted Seroquel pills.
“Every hand at the TA jail had Xanax or Seroquel or Valium,” Gutierrez said. “A guard told me if I had problems sleeping or anything to go to Dr. Barendsen.”
Gutierrez refused to say which guard made the comment. But inmates needed little coaxing to seek out Barendsen. Former inmates described Seroquel-induced vivid and colorful dreams.
“It’s definitely very habit-forming,” said one former inmate who was prescribed Seroquel and requested that his name not be used for this story. “In between prescriptions everybody had insomnia and withdrawals.”
One former inmate said he developed diabetes after six months of taking Seroquel. Like all of Barendsen’s patients contacted for this story, the inmate said Barendsen never warned him of Seroquel’s dangers; he only learned that Seroquel can cause diabetes after his release, while surfing the Internet, he said.
Another former inmate readily admitted that he now buys Seroquel on the street in Española.
“Barendsen had me on 60 mg of Valium a day plus 300 mg of Seroquel and 50 mg of Wellbutrin,” Jason Armenta, 28, said. “I gained 20 pounds. He never warned me about any diabetes risks. He just said I’d be hungry and prescribed extra snacks from the kitchen.”
Candelaria acknowledged that Barendsen would prescribe extra meals to inmates taking Seroquel.
“Hey, that happens,” Candelaria said. “As long as there’s a prescription, I don’t have a problem with it.”
Before ending his work for the jail in August, Barendsen slowly weaned the inmates off Seroquel, according to Candelaria.
“The University pulled him out of the jail after they learned they were being sued (over Kaiser’s death),” Candelaria speculated.
Once Barendsen stopped seeing inmates, Seroquel prescriptions fell off sharply. By November 2008 — just a year after DeYapp’s memo — only seven orders for Seroquel were made by the Jail.
Diversion
Standing in the jail’s small pharmacy dispensary, DeYapp showed how prisoners are watched by a guard as they swallow their pills, and then show the guard that both their mouth and the cup in which they were given the pills, are empty.
“We track the pills because they’re highly in demand,” DeYapp said. “Only shift supervisors have a key to the medicine (cabinet). They see ‘em take it.”
DeYapp then pulled his cheeks open using his index fingers, like a child making a face out the school bus window.
“Then mouth, fingers, they show that they swallowed the pills,” DeYapp said.
But the system’s far from perfect, DeYapp admitted.
“Some of these guys are real slick,” DeYapp said. “One guy, I thought he’d swallowed and was good to go, but he’d dropped the pill onto his toe. They’re magicians. We try to get two guards to watch them, but we can’t do everything.”
And the video camera mounted on the ceiling in the dispensary’s ceiling only documents which inmates were given medications, DeYapp and Candelaria said. The videotaping of security cameras cycles through all of the jail’s 44 cameras each second, leaving video images from each individual camera choppy and unlikely to catch a split-second sleight-of-hand that allowed inmates to smuggle medicines out of the dispensary.
Former inmates confirmed that guards were routinely tricked.
“We started fake fights,” Armento said. “All you need is two seconds for the guard to look away and you pocket the pills. Everybody kept them. Kept them in the cup, in your cheek. People would trade for Seroquel.”
Some inmates who are on medication are forced to smuggle pills out to others or face physical abuse, DeYapp said.
“They get punked out for pills when they get back,” DeYapp said.
Asked how frequently pills are discovered in contraband searches known as shakedowns, DeYapp looked to Candelaria, his boss, before answering.
“We tend to find them,” DeYapp said. “A lot of them show up in blankets.”
Not Safe
AstraZeneca reported Seroquel sales of nearly $4.5 billion in 2008, according to Securities and Exchange Commission filings, and tried in April to expand its government-approved uses to include depression. But citing safety concerns, a U.S. Food and Drug Administration panel refused April 10, 2009, to approve Seroquel’s use as a first-line treatment for depression.
Two and a half years after DeYapp delivered his memo, Candelaria was still reluctant to talk about it. Asked about the memo and hundreds of pages of jail pharmacy bills he had disclosed in response to a public records request, Candelaria paused to sigh before answering.
“Listen, I don’t practice law or medicine,” Candelaria said. “I don’t second-guess our doctors. Dr. Barendsen is a great guy, a good doctor. But was I worried? Yes.”
Candelaria is proud of the jail’s substance abuse recovery program. But inmates who are on narcotics couldn’t participate, he said.
And each year, it seemed to Candelaria that more of them were taking powerful – and expensive — psychiatric drugs. That’s why he had asked DeYapp and jail staffers to tally how many inmates had such prescriptions.
“At one point, Seroquel was 80 percent of our pharmacy cost,” Candelaria said.
In 2004, the jail purchased Seroquel from Rio Drugs in Chama just 76 times, jail records show, at a cost of $8,300. But by 2007, there were 899 Seroquel purchases, costing the jail more than $47,000, records show (See graphs).
Calls to Rio Drugs Pharmacist Sandra Abeyta and AstraZeneca were not returned.
When the University told Barendsen to stop seeing inmates during his weekly one-day visits to La Clinica, the doctor began weaning patients off Seroquel, Candelaria said.
“Our costs went way down,” Candelaria said.
Barendsen would neither confirm nor deny that he had weaned patients off the drug.
Asked whether all of those Seroquel prescriptions he prescribed to Rio Arriba County Jail inmates had been for seriously mentally ill individuals with schizophrenia or bipolar disorder — the disorders for which the U.S. Food and Drug Administration has approved Seroquel as a treatment — Barendsen offered a surprising response.
In final part of this series, Barendsen provides a surprising explanation for why he prescribed Seroquel so frequently to County Jail inmates. The second part also takes a look at the use of Seroquel in jails across the state.
