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GPs go forth

Government launches major review into prescription drug addiction

The Government has tasked Public Health England with undertaking a 'landmark' review into prescription drug addiction and dependence.

The Department of Health and Social Care said this comes on the back of NHS Digital data revealing that one patient in 11 (8.9%) has been prescribed an addictive medicine - an increase of 3% over the past five years.

It has tasked PHE to assess the scale of the problem of prescription drug addiction, reviewing why such an increase in prescribing has occurred and providing recommendations by early 2019.

It will look especially at benzodiazepines, z-drugs, gabapentinoids, opioid pain medicines and antidepressants.

DHSC said that although many of the prescribed medicines are effective in treating conditions such as pain, anxiety and insomnia, some are also highly addictive, causing dependence and, if stopped, withdrawal symptoms.

PHE will analyse patient and prescription data, alongside peer-reviewed published evidence and guidelines. It will also consult healthcare professionals and patients affected by the problem.

The DHSC noted that while antidepressants are not usually labelled as dependence forming, ‘discontinuation syndrome’, which can occur when patients stop taking them, can be severe.

Public health minister Steve Brine, who commissioned the review, 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.’

PHE’s director of drugs, alcohol and tobacco Rosanna O’Connor said: ‘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.

‘Many will have sought help for a health problem only to find later on they have a further obstacle to overcome.’

It comes as the Home Office consultation into proposals to make pregabalin and gabapentin class C under the Misuse of Drugs Act closed yesterday - with BMA calling for any measures not to add an unnecessary burden on GPs.

The DHSC clarified that the two are completely separate reviews and that PHE will look at the evidence on health outcomes for dependency and addiction, as opposed to whether or not specific drugs should be controlled substances.

The review comes as Pulse revealed last year that the BMA had written to health ministers calling for an inquiry into drug dependency, while the RCGP’s lead for pain had been discussions with MPs around his proposals for GPs to conduct annual reviews of patients on these medicines.

In response to the news of the review, BMA GP Committee clinical and prescribing policy lead Dr Andrew Green said the move comes as ‘doctors see first-hand the need for greater action and support to tackle this problem’.

But he added: ‘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.’

RCGP chair Professor Helen Stokes-Lampard said: '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.'

However, she added that 'all drugs will have risks and potential side-effects' and it was 'important not to automatically jump to the conclusion that more drugs being prescribed is always a bad thing'.

She said: '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.

'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.'

Readers' comments (19)

  • “World leading in offering free treatment for addiction”, are we Minister? Ever tried referring anyone for codeine dependency?

    Thought not.

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  • If the whole complaints procedure was not so heavily weighted in favour of demanding patients, perhaps GPs would be encouraged to say "no" more often.

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  • Let’s wait the GPs are overprescribing and generally useless and nothing to do with patient responsibility

    It would be good if instead of appropriating blame for headlines - they come up with sensible suggestions and addiction units where patients can be referred

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  • PHE will analyse patient and prescription data, alongside peer-reviewed published evidence and guidelines. It will also consult healthcare professionals and patients affected by the problem.

    It will not of course require that any of the bearded worthies get out of the library and actually try doing a surgery to see how they manage

    It will absolutely never under any circumstances remotely consider requiring them to try using their own guidelines

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  • Is this sensible use of PHE's time, when their budgets are being slashed and drug & alcohol services are being decommissioned across the board. Where are we supposed to refer all these new "addicts"? Silly me! this is just something else for overburdened GP's to deal with without any additional resources!

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  • This problem reflects appallingly resourced services with long waits (physio / pain clinics etc.). Addicted before they see anyone. We also have a pain intolerant clientelle following badly judge pain management programs in the 1990s and 2000s.
    Hope they put some resources into managing this. GPs don't have the time and patients complain when I try to cut and stop their cocodamol / diazepam/ gabapentin etc.etc etc

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  • How about starting by banning Consultants, Hospital Doctors, and CMHTs from starting patients on highly addictive drugs in preference to better treatments in the first place!

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  • First figure out if we really are overprescribing these drugs and bench mark us (yes, with France and America) and then only if there is a problem should we be doing anything about it. Resources too scarce. This shouldn’t be an extra task for overburdened Primary Care.

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  • I agree with anonymouse3. The main issue is with the SPECIALISTS!

    I say this as a specialist myself!

    In my opinion it is mostly specialists who facilitate unrealistic medicine.

    Dr Peter J. Gordon
    Psychiatrist for Older Adults
    NHS Scotland.

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  • David Banner

    In theory this review is right and long overdue. But the reality will simply be another stick to beat GPs caught between demanding patients and diminishing addiction services. If these drugs could only be started by secondary care, then kept on a “shared care” basis with primary care, then the number of new scrips would dramatically decrease as the backlog in OPD grew. But of course it’s far easier to change nothing and blame incompetent GPs......

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