Psicofármacos y gasto en la prisión de Madrid III (Valdemoro) / Psychoactive drugs and costs in the Madrid III (Valdemoro) prison

El gasto farmacéutico en el medio penitenciario está aumentando exponencialmente y la partida en psicofármacos contribuye especial-mente a este incremento. Con bastante frecuencia estos tratamientos se prescriben buscando utilidades terapéuticas en relación con trastornos de personalidad, dependencias y conductas disfuncionales, que no figuran entre las indicaciones autorizadas (uso compasivo). El presente estudio ha permitido una descripción pormenorizada del uso de psicofármacos en el Centro Penitenciario Madrid III, uno de los centros con menor gasto farmacéutico de la comunidad autónoma. Durante 2 semanas se registraron todas las prescripciones de psicofármacos junto con diversos parámetros que pudiesen resultar condicionantes. Un 20,5% de la población recibía algún psicofármaco; el 76% de los pacientes con tratamiento recibía 1 o 2 medicamentos, un 65% tenía prescritos ansiolíticos, un 38%, antidepresivos, y un 27%, antipsicóticos. El consumo total de psicofármacos ascendió a 9.840 dosis diarias de mantenimiento, un 46% de las cuales correspondía a ansiolíticos, un 17% a antidepresivos y un 14% a antipsicóticos. En 2 semanas, el gasto total sumó 5.379 ¿ y la solicitud y selección de ofertas por la farmacéutica supusieron hasta 611 ¿ de ahorro. Los antipsicóticos acumularon un 72% del gasto (3.857 ¿) y, en general, los nuevos psicofármacos, con un 66% de las prescripciones, supusieron un 98% del coste total. Los resultados del estudio apuntan al médico prescriptor como agente primordial, por encima incluso de variables epidemiológicas de los internos (..) (AU)

Abstract: Annual pharmaceutical expenditures in prisons increases dramatically and the rising costs of psychoactive drugs have especially contributed to this. These drugs are often prescribed in order to find therapeutic uses in the field of personality disorders, addictions, and dysfunctional behaviours that are not included in the authorized indications (compassionate use). This study has enabled a detailed description of the use of psychoactive drugs at the Madrid III prison, a centre with one of the lowest levels of pharmaceutical expenditure in this autonomous community. During a two-week period, all prescriptions of psychoactive drugs were collected and registered along with data of several possible conditioning factors. 20.5% of the population was receiving some kind of psychoactive drug; 76% of those inmates undergoing treatment were receiving one or two substances; 65% were taking anxiolytics, 38% antidepressants and 27% antipsychotics. The total amount of psychoactive drugs consumed was 9,840 defined daily doses, 46% of which were anxiolytics, 17% antidepressants and14% antipsychotics. The total cost of the fortnight’s treatment was euros 5,379 with a saving of € 611 due to requesting and selecting offers carried out by the pharmacist. 72% of the costs were spent on antipsychotics and the newer psychoactive drugs, representing 66% of the prescriptions, accounted for 98% of expenditure. The prescriber was one of the key influential factors over the amount, type and cost of the treatments. There are signs that compassionate use of current antipsychotics and antiepileptics, and newer antidepressants are a main cause of the dramatic increase in the costs, with cost-efficiency not always clearly demonstrated. These results are not an isolated fact restricted only to prisons, as demonstrated by consumption data published by the National Health System in the same year(AU)

[Psychoactive drugs and costs in the Madrid III (Valdemoro) prison]. / Psicofármacos y gasto en la prisión de Madrid III (Valdemoro).

Annual pharmaceutical expenditures in prisons increases dramatically and the rising costs of psychoactive drugs have especially contributed to this. These drugs are often prescribed in order to find therapeutic uses in the field of personality disorders, addictions, and dysfunctional behaviours that are not included in the authorized indications (compassionate use). This study has enabled a detailed description of the use of psychoactive drugs at the Madrid III prison, a centre with one of the lowest levels of pharmaceutical expenditure in this autonomous community. During a two-week period, all prescriptions of psychoactive drugs were collected and registered along with data of several possible conditioning factors. 20.5% of the population was receiving some kind of psychoactive drug; 76% of those inmates undergoing treatment were receiving one or two substances; 65% were taking anxiolytics, 38% antidepressants and 27% antipsychotics. The total amount of psychoactive drugs consumed was 9,840 defined daily doses, 46% of which were anxiolytics, 17% antidepressants and 14% antipsychotics. The total cost of the fortnight's treatment was euros 5,379 with a saving of euro 611 due to requesting and selecting offers carried out by the pharmacist. 72% of the costs were spent on anti-psychotics and the newer psychoactive drugs, representing 66% of the prescriptions, accounted for 98% of expenditure. The prescriber was one of the key influential factors over the amount, type and cost of the treatments. There are signs that compassionate use of current antipsychotics and antiepileptics, and newer antidepressants are a main cause of the dramatic increase in the costs, with cost-efficiency not always clearly demonstrated. These results are not an isolated fact restricted only to prisons, as demonstrated by consumption data published by the National Health System in the same year.

[The use of psychotropic drugs in prison (CP Madrid III)]. / Uso de Psicofármacos en prisión (CP Madrid III).

The use of psychotropic drugs in primary care has exponentially increased and prisons are no exception. These drugs are often prescribed in order to find therapeutic uses in the fields of personality disorders, addictions, and dysfunctional behaviours that have not been accepted as indications (compassive use). This study enabled us to make a detailed description of the use of psychiatric drugs at the Madrid III prison, a centre with one of the lowest levels of pharmaceutical expenditure in the region. For a two-week period, all prescriptions of psychotropic drugs were collected and registered along with data of several possible conditioning factors. 20.5% of the population was receiving some kind of psychiatric drug; 76% of those inmates undergoing treatment were receiving one or two psychotropic drugs; 65% were taking sedatives, 38% antidepressants and 27% antipsychotic medication. The total amount of psychotropics consumed was 9,840 DDDs, 46% of which were sedatives, 17% of those being antidepressants and the other 14% antipsychotics. The total cost of the fortnight's treatment was 5,379 euros, 72% of which was spent on antipsychotic medication. There are signs that compassive use of the latest generation of antipsychotics and antiepileptics, and the newer antidepressants are a main cause of the dramatic increase in cost, and cost efficiency has not always been clearly demonstrated. One of the key influencing factors on amount, type and cost of treatment was the prescriptor. An unexpected result was that of finding no relationship between age, nationality, grade or other individual variables and prescription of different kind of medication, with the exception of benzodiazepines.

Uso de Psicofármacos en prisión (CP Madrid III) / Theuse of psychotropic drugs in prison ()CP Madrid III)

El uso de psicofármacos en el entorno de atención primaria está aumentando exponencialmente y el medio penitenciario no constituye una excepción a esta tendencia. Con alguna frecuencia estos tratamientos se prescriben buscando utilidades terapéuticas en relación con trastornos de personalidad, dependencias y conductas disfuncionales que no han sido aceptadas como indicaciones (uso compasivo). El presente estudio ha permitido una descripción pormenorizada del uso de psicofármacos en el Centro Penitenciario (CP) Madrid III, uno de los centros con menor gasto farmacéutico de la Comunidad Autónoma. Durante dos semanas se registraron todas las prescripciones de psicofármacos junto con diversos parámetros que pudiesen resultar condicionantes. Un 23,46% de la población recibía algún tipo de psicofármaco; el 76% de los internos a tratamiento recibía uno o dos psicofármacos, un 65% tenía prescritos ansiolíticos, un 38% antidepresivos y un 27% antipsicóticos. El consumo total de psicofármacos ascendió a 9.840 Dosis Diarias de Mantenimiento, un 46% de las cuales correspondían con ansiolíticos, un 17% con antidepresivos y un 14% con antipsicóticos. En dos semanas, el gasto total sumó 5.379 euros y los antipsicóticos acumularon un 72% del coste (3.857 euros). Hay indicios de que el uso compasivo de nuevos antipsicóticos y antiepilépticos supone un porcentaje sustancial del incremento del gasto con dudosa utilidad. Los resultados del estudio apuntan al médico prescriptor como agente primordial en relación con qué, cuánto y con qué coste se prescribe. Al contrario de lo que cabía esperar, no se encontró asociación entre variables como la edad, nacionalidad, grado o tipo de condena de los internos y la prescripción de los distintos subgrupos de psicofármacos con la excepción de las benzodiacepinas

The use of psychotropic drugs in primary care has exponentially increased and prisons are no exception. These drugs are often prescribed in order to find therapeutic uses in the fields of personality disorders, addictions, and dysfunctional behaviours that have not been accepted as indications (compassive use). This study enabled us to make a detailed description of the use of psychiatric drugs at the Madrid III prison, a centre with one of the lowest levels of pharmaceutical expenditure in the region. For a two-week period, all prescriptions of psychotropic drugs were collected and registered along with data of several possible conditioning factors. 20.5% of the population was receiving some kind of psychiatric drug; 76% of those inmates undergoing treatment were receiving one or two psychotropic drugs; 65% were taking sedatives, 38% antidepressants and 27% antipsychotic medication. The total amount of psychotropics consumed was 9,840 DDDs, 46% of which were sedatives, 17% of those being antidepressants and the other 14% antipsychotics. The total cost of the fortnight’s treatment was 5,379 euros, 72% of which was spent on antipsychotic medication. There are signs that compassive use of the latest generation of antipsychotics and antiepileptics, and the newer antidepressants are a main cause of the dramatic increase in cost, and cost efficiency has not always been clearly demonstrated. One of the key influencing factors on amount, type and cost of treatment was the prescriptor. An unexpected result was that of finding no relationship between age, nationality, grade or other individual variables and prescription of different kind of medication, with the exception of benzodiazepines