The use of psychotropic medications is a common and often effective treatment for individuals with various types of mental health disabilities. Individuals on various types of prescribed medications may enter and remain in Job Corps as long as their condition is stabilized and they are medication compliant. There is no differentiation between the requirements regarding the use of prescribed psychotropic medications and that of other types of prescribed medications in terms of eligibility for enrollment.

• Psychotropic Medication Issues on Job Corps Centers
• Medication Management & Monitoring
  • Who Usually Prescribes Psychotropic Medications?
  • Alternative Prescription Options
  • Medication Management
• Psychotropic Medications Available for Use in Job Corps
• Side Effects & Treatment
• Risks of Addiction or Dependence
• Symptom of Withdrawal
• Placement & Participant in Vocational Training
• Costs

Psychotropic Medication Issues on Job Corps Centers

1. Need a physician comfortable monitoring students on chronic psychiatric medications, preferably with consulting psychiatrist available, as well. Staff training can help.
2. Need a CMHC and TEAP specialist familiar with psychoactive medications and their use as well as limitations in Job Corps setting, to help guide other center staff as well as consulting psychiatrist and center physician.
3. Need cooperation of center health and wellness staff, particularly nursing staff, to dispense medications, especially drugs that are addictive or have overdose potential.
4. Need to check and monitor costs of medications, which vary widely. Arrangements to have costs covered by student’s health insurer, including Medicaid, are desirable.

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Medication Management & Monitoring

There are multiple options for medication monitoring of students in Job Corps, including those who are taking multiple psychotropic medications.

• Nursing staff usually monitors all students taking chronic medications (not only psychiatric medications), usually only dispensing enough medication for one day or one weekend at a time.
• The center physician, CMHC, and consulting psychiatrist (if any) serve as back up to center nursing staff and counselors for monitoring medication use and effectiveness.
• When the center is close enough to the student's home, arranging for the student to periodically have clinical visits with the prescribing psychiatrist (e.g. on monthly or bi-monthly basis) is encouraged, especially if the student has Medicaid or health insurance coverage for those visits.

Who Usually Prescribes Psychotropic Medications?

Medications can be prescribed by primary care practitioners or by specialists. The following chart outlines general practice for most physicians. The licensure of a medical doctor allows him/her to prescribe any medication listed in the Physician’s Desk Reference (PDR) within the state of his/her licensure. The following list shows medications by major classes and which physicians usually prescribe each.

Who Usually Prescribes Psychotropic Medications in Job Corps?

Alternative Prescription Options

When the center physician elects not to prescribe necessary medications or monitor prescribed medications for reasons other than patient need, center health and wellness staff may need to seek outside supports such as:

• Community outreach residency programs
• Local area mental health system
• Secure services of a physician comfortable prescribing medication

Note:  When first prescribing many psychotropic medications, most primary care practitioners prefer that a psychiatrist diagnose and provide initial treatment.  Once the student is stable on the medication, generally the primary care practitioner is willing to continue the prescribing most categories of medications.

Medication Management

It is important that health and wellness center staff have some familiarity with the various management issues for each of the classes of psychotropic medications.  In general, most medications in the antidepressant and antipsychotic categories do not need special monitoring, since they are safe if taken as directed.  Three medications in the mood stabilizer category, specifically, Lithium, Carbamazepine, and Divalproex, require periodic blood levels to make sure toxic levels are avoided.  Occasional checks of laboratory tests of liver and kidney function are also needed.  Other drugs which can be abused, including certain antianxiety agents, especially Benzodiazepines, such as Ativan or Klonopin and stimulants such as Ritalin and Adderall, etc. need careful monitoring to keep them away from other students who may abuse them. Students taking medications for symptom relief usually do not abuse those drugs.

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Psychotropic Medications Available for Use in Job Corps

Job Corps' List of Preferred Medications contains recommended psychotropic medications that are available through Perry Point. The purchase of medications Perry Point is not mandatory and serves only as one potentially cost-effective resource.

Because of the amount of time it takes to get a student stable on a given medication, typically the center physician will try to keep the student on the medication prescribed by the student’s personal physician.

• Psychotropic Medication Class Characteristics
  • Mood Stabilizing Agents
  • Antipsychotic Medication
  • Antidepressant Agents
  • Antianxiety Agents

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Side Effects & Treatment

The Side Effects of Anxiety Drugs table lists the various categories of drugs used to combat anxiety and describes the side effects of each.⁴

Students taking antipsychotic medications, particularly those that contain phenothiazines, should be monitored for such side effects as tardive dyskinesia (e.g., involuntary movements). If these side effects do arise, then consult with a psychiatrist.

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Risks of Addiction or Dependence

• Benzodiazepines and other anti-anxiety agents are generally safe from a medical standpoint. The main drawback of these drugs is the development of physical dependence on the drugs, and subsequent withdrawal symptoms.⁵
• The relative risk of dependence is greater for benzodiazepines and sedatives (not including buspirone).
• The risk of dependence is not present for antidepressants, antipsychotics, mood stabilizers or buspirone.

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Symptoms of Withdrawal

Symptoms of withdrawal from benzodiazepines occur when the drug is abruptly stopped, rather than tapered. The symptoms which occur, ranked from most common to least common, are as follows: ⁶

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Placement & Participation in Vocational Training

Students who are taking prescribed medication for the management of a disorder cannot be prohibited from entering or be removed from any program offering without the recommendation and approval of the center’s physician or mental health consultant.

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Costs

Payment options are the same for psychotropic medications as for all other medications for students enrolled in Job Corps. If there are no resources to obtain the prescribed medication(s), then Job Corps remains responsible for the costs.

In addition to the Job Corps list of recommended medications available from the Department of Health and Human Services Medical Supply Catalog, Perry Point (released yearly as an information notice), centers can explore other avenues to obtain low cost medications:

• Medicaid—If the student is not currently enrolled in Medicaid, explore feasibility of coverage
• Private health insurance—Some students under the age of 22 may still be covered by private, third party insurance maintained by parent/guardian

  The following websites provide information about patient assistance programs:

  • Needymeds.com
  • Medicare Prescription Drug Coverage
  • Partnership for Prescription Assistance
• Patient assistance programs—Most pharmaceutical companies offer programs to individuals who have no other health coverage. These programs often require documentation that shows how the individual’s condition will deteriorate or worsen without the medication. Typically the application is sent directly to the physician for completion and if approved, medications are usually provided in 90-day supply increments. Many pharmaceutical companies have renewal programs so qualified individuals can continue to obtain medications through these programs as long as they meet eligibility requirements.

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⁴ Gorman, J.M., The Essential Guide to Psychiatric Drugs, New York, St. Martin’s Press, 1995.

⁵ Ibid.

⁶ Ibid.