GPs should offer alternatives including psychotherapy, sleep clinics and social activities or clubs before prescribing addictive painkillers or antidepressants, an action plan from NHS England has recommended.
NHS England data shows GPs and pharmacists have already helped cut opioid prescriptions by 450,000 in under four years.
This progress which equates to an 8% drop is estimated to have saved nearly 350 lives and prevented more than 2,100 incidents of patient harm.
The detailed framework has been published following a 2019 review by Public Health England, which found one in four adults were prescribed medications associated with dependence, including opioids, benzodiazepines and antidepressants.
In the action plan, NHS England notes this is a complex issue that needs a ‘whole system approach’ with personalised and innovative support for those at risk of withdrawal or dependence.
Where appropriate GPs should offer social prescribing, health coaching, peer support as well as psychotherapy before prescribing a potentially addictive medicine.
The framework also tasks commissioners with providing services for patients who wish to stop taking addictive medicines.
And it states to help reduce prescribing in the first place: ‘Systems should ensure that alternative treatment options are available and that prescribers are aware of them.’
The framework also recommends developing systems to identify all patients taking medicines associated with dependence or withdrawal and prioritising those who may be at risk at need a review.
Audits should be done of prescribing for adult patients ideally involved a PCN lead or clinical pharmacist, it adds
The action plan for all health and social care providers aims to further reduce inappropriate prescribing of high-strength painkillers, opioids, benzodiazepines, z-drugs and antidepressants, where they may no longer be clinically appropriate.
It will support GPs and clinical pharmacists to provide patients with a personalised review of their medicines and make a shared decision about whether a change in treatment is needed, the framework said.
The numbers of benzodiazepines and z-drugs prescribed in England has also fallen by 170,000 (13.9%) and 95,000 (10.2%) since the 2019 review was published.
In April, NICE guidance on safe prescribing and withdrawal management for addictive drugs concluded that antidepressants were not ‘dependence-forming’ drugs, although they can cause withdrawal symptoms.
It also rubber-stamped recommendations that GPs should provide regular reviews for patients on antidepressants and drugs for chronic pain that may be addictive.
Professor Sir Stephen Powis, national medical director for NHS England said: ‘We know that patients who require prescriptions for potentially addictive drugs can become dependent and struggle with withdrawal, and this new action plan helps NHS services to continue positive work in this space having already slashed opioid prescriptions by almost half a million over the last four years.’
‘The plan gives clear guidance to support patients who no longer need these drugs to provide them with routine medicine reviews and move them on to other, alternative therapies where appropriate, saving both lives and taxpayer money in the process.’
Professor Tony Avery, a GP and national clinical director for prescribing at NHS England said: ‘Medicines offer a fantastic range of tools for NHS staff to provide patient care and treatment that can be positively life-changing, or even life-saving.
‘However, we need to be alert to the risks of some medicines, particularly when used over a long period of time, and the framework we are publishing today empowers local services to work with people to ensure they are being effectively supported when a medicine is no longer providing overall benefit.’
Changes in prescribing of drugs associated with dependency or withdrawal
- The number of patients dispensed an opioids is continuing to fall with an 11.5% drop from 6.1 million patients in 2017/18 to 5.4 million in 2020/21
- Between 2017/18 and 2020/21 the number of patients prescribed a benzodiazepine fell by 20% from 1.4 million to 1.1 million (20%)
- Z-drug prescribing has also seen a 2.3% reduction over this three year period
- But figures show a steady increase in the number of patients prescribed a gabapentinoid, increasing by about 11,000 (0.7%) a year, to just under 1.5 million patients since 2017/18. This may be linked to reduced opioid prescribing as patients are offered an alternative but levels have stabilised over time
- In 2020/21, 7.9 million adults were prescribed at least one antidepressant, an 8% increase from 2017/18
READERS' COMMENTS [8]
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It is a laudible aim to seek to reduce over-prescription. Healthcare services cannot reasonably be expected to compensate for the declines in civic participation and family life. It’s up to civil society, not medicine, to create the opportunity in people’s lives for meaning, purpose and companionship. As long as people keep seeking these things from healthcare, then the fundamental problems driving overprescription won’t change.
Is suicide due to chronic pain and medication stopped a harm?
So, GP decides to offer psychotherapy, rather than an antidepressant of low dependence risk;
We refer to CMHT in order to get psychotherapy, but are not allowed to indicate which treatment modality we wish to refer for, any more;
CMHT allocate to a non-counsellor route, and recommend a highly addictive antidepressant with z-drug or BZD alongside; then as soon as prescription issued, they dump them, addicted, back in GP lap as ‘not suitable for talking therapies because on addictive medication’, or something similar, with no further follow-up.
How about a project to have secondary care ‘primary care mental health services’ teams tackle the addiction problem?
Or is mental health and addiction not a mental health issue?
Waiting time for those clinics?
In past CBT was answer to every thing. We wait a while to get them seen . Some will come back and say it did not help..
A lot if reduction already so let’s not be obsessive and cruel to patients who need adequate pain relief
Perhaps the work should focus practices with higher prescribing for addictive drugs
These are likely to be areas of high deprivation so an investment of additional trading and resources needed
10 years ago in my old practice we reduced benzo prescribing dramatically but it took a whole practice and pharmacy approach
Our blue print is available
Antidepressants don’t even cause dependence? Read above NICE guidance.
What exactly do NHSE expect us to prescribe?
Paracetamol for pain and homeopathy for mental health.
We explain the risks to patients.
Opiates cause rapid tolerance as do benzos so they are always a bad idea unless a very short course or very occasional use can be guaranteed.
Gabapentinoids when they work are brilliant. They don’t cause tolerance so they continue to work long term, you don’t have to keep upping dose. Amitriptyline can be excellent too.
Antidepressants can transform people’s lives too.
Everything needs follow up and proper discussion with the patient so they can choose.
How does NHSE square this up with patient centred health.
It’s very baby out with the bathwater.
Besides the dumbest thing of all is its all the grannies on the benzos and opiates and they are not giving them up. They go crazy cross and point blank refuse when you try and take away the temazepam.
Meanwhile the poor young buggers with sciatica get the talk to the hand and take some paracetamol.
Anyway. I’m on sertraline, found it a life saver, will come off it when I am bloody ready too and thank God my GP didn’t try and persuade me to take up the NHSE CBT robot or mindfulness app instead.
Give me strength.
Anyway. On we go.
Huge numbers of people addicted to drugs from which the only benefit is relief of withdrawal symptoms.
Sadly many still in denial about the harms done.
How about NICE taking a full page advertisement in the tabloids explaining their guidelines on chronic pain, back pain and osteoarthritis management?