by Michael Connors, CANHR Advocate
A Harvard Medical School study published in the British Medical Journal (BMJ) on February 23, 2012 reports that U.S. nursing home residents who took Haldol had double the risk of death as those who took most types of atypical antipsychotics. The risks were highest during the first 40 days of treatment.
According to a BMJ press release, the study was the largest ever taken among U.S. nursing home residents. It looked at 75,445 older nursing home residents from 45 states between 2001 and 2005.
An ABC news story quotes study author Krista Huybrechts as writing that “the evidence provided in our study reinforces the important risks associated with the use of these drugs and underscores the need to try alternative means of dealing with behavioral problems in older patients with dementia.” Huybrechts said the use of Haldol “cannot be justified because of the excess harm.”
To put the study’s finding in context, the FDA black box warning for all antipsychotics says they nearly double the risk of death for elders with dementia. If Haldol is twice as deadly as other antipsychotics, it underscores how lethal it is compared to the non-drug option.
In May 2011, Dr. Louis Caplan, a neurology professor at Harvard Medical School, said he would like to see Haldol banned from use in hospitals.
Haldol is a “conventional” antipsychotic, meaning it is a first-generation antipsychotic. It predates by decades the newer “atypical” antipsychotics such as Risperdal, Zyprexa and Seroquel that were introduced in the 1990s.
An editorial this past weekend by Mike Masteron of ArkansasOnline titled “Our Most Easily Abused,” serves as a reminder that concerns about nursing home abuse of Haldol are almost as old as the drug itself. Reflecting on nursing home abuses he investigated throughout his career, Masterson described a late-1980s investigation by the Arizona Republic that revealed how elderly nursing home residents were being overmedicated. He wrote:
One drug of choice was Haldol, a powerful antipsychotic medication that left them continually stunned into headdrooping, drooling submission. Misusing a Haldol pill was much cheaper than paying for an adequate care staff. Just slip ’em a pill and forget about ’em.
Although Haldol continues to be a favored form of chemical restraint in nursing homes, its well-known dangers have not received much attention since the HHS Office of Inspector General issued its well-publicized report in May 2011 about the misuse of atypical antipsychotics in nursing homes. Hopefully this new study will help correct that oversight and serve as the latest of seemingly endless reminders that antipsychotic drugs given to elders with dementia generally do more harm than good and are a very dangerous substitute for actual care.