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Review launched into prescription drug dependency

Patients need ‘better access’ to psychological therapies

Jo Carlowe

Wednesday, 24 January 2018

The Government has announced plans to review the ‘growing problem’ of prescription drug addiction.

Stark figures show that last year alone, one in 11 patients were prescribed a potentially addictive drug.

Public Health minister, Steve Brine, has commissioned Public Health England (PHE) to undertake ‘a thorough evidence review’ along with recommendations on how to address it.

The review will consider why:

  • Prescribing of addictive medicines has increased 3% over five years.
  • One patient in 11 (8.9%) is prescribed one of these medicines.
  • Antidepressant prescriptions in England have more than doubled in the past 10 years.
  • A recent survey also found that 7.6% of adults had taken a prescription-only painkiller not prescribed to them.
PHE will assess the scale of the problem, the harms caused by dependence and withdrawal, how they may be prevented and the best way to respond.

Commenting, Public Health minister, Steve Brine said: “We know this is a huge problem in other countries like the United States—and we must absolutely make sure it doesn’t become one here.

“While we are world-leading in offering free treatment for addiction, we cannot be complacent—that’s why I’ve asked PHE to conduct this review.

“PHE has an excellent track record in robust evidence reviews, and this will help us understand the scale of this issue here and how we can address it.”

Director of Drugs, Alcohol and Tobacco at PHE, Rosanna O’Connor, said: “It is of real concern that so many people find themselves dependent on or suffering withdrawal symptoms from prescribed medicines. Many will have sought help for a health problem only to find later on they have a further obstacle to overcome.

“PHE very much welcomes this opportunity as it is vital that we have the best understanding possible of how widespread these problems are, the harms they cause, as well as the most effective ways to prevent them happening and how best to help those in need.”

The review will cover benzodiazepines and z-drugs, pregabalin and gabapentin, opioid pain medicines and antidepressants.

It will be a broad, public-health focused review of commonly prescribed medicines for adults who have pain (excluding pain from cancer), anxiety, insomnia or depression. Patient and prescription data, peer-reviewed published evidence and guidance will be analysed to determine:
  • Prevalence and prescribing.
  • The nature and likely causes of dependence or withdrawal. 
  • Effective prevention and treatment responses.
PHE will also consult with health professionals. The findings of the review will be published in early 2019.

Doctors’ organisations have welcomed the announcement, but say greater provision is needed of alternative community treatments — in particular psychological therapies — to help resolve the problem.

Professor Helen Stokes-Lampard, chair of the Royal College of GPs, said: “Addiction to any substance can have a devastating impact on a patient’s health and wellbeing – and that of their family and friends. We welcome this independent review as a means of better understanding the complex reasons behind addiction to prescription medication, and to shape our approach to tackling it.

“Many addictive medications, when prescribed and monitored correctly, and in line with clinical guidelines, can be very effective in treating a wide range of health conditions. But all drugs will have risks and potential side-effects.

“It is important not to automatically jump to the conclusion that more drugs being prescribed is always a bad thing. Advances in medical research mean that more medications are constantly becoming more available for patients, and they can increasingly be used to improve their health – and the nature of our NHS is that these medications are available to anyone who could benefit from them.

“GPs will always prescribe in the best interests of the individual patient in front of us, taking into account the physical, psychological and social factors that might be impacting their health. We will only prescribe medication after a frank conversation with the patient about the potential risks and benefits, and we will also conduct regular medication reviews in partnership with the patient.

“However, we know most patients would rather not be on long-term medication and where appropriate we will explore non-pharmacological treatments, but these – and this is particularly so for psychological therapies - are often scarce at community-level.

“We hope that conclusions from this review will include highlighting the need for greater provision of and access to alternative treatments in the community – and for those patients who do become addicted to prescription medications to have easy, consistent, but also confidential access to appropriate, high-quality support.”

British Medical Association GP committee clinical and prescribing lead, Dr Andrew Green, said: “We welcome this important review into prescription drug dependence, which can have a devastating impact on the lives of those affected.

“Doctors see first-hand the need for greater action and support to tackle this problem, and in 2016 the BMA outlined a number of recommendations aimed at ensuring those affected by prescription drug dependence has access to trusted, expert advice and guidance.

“One of the recommendations calls for a national helpline, similar to the FRANK service, which could be set up relatively quickly. This would give individuals suffering with dependence to drugs like benzodiazepines vital, timely support.

“We would also like to ensure that the local services provided are suitable for patients with dependence on prescription drugs, whose needs can be different to those obtaining drugs from other sources, and clear guidance on withdrawal management for GPs.”

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