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Saturday 22nd October 2016

Prescription drug addiction addressed

12th May 2011

A GP summit today examined how to address addiction to prescription and over-the-counter drugs following publication of two new reports into the scale of the issue commissioned by the Department of Health.

The two studies, which were conducted by the National Addiction Centre and National Treatment Agency for Substance Misuse, provide important insights  into the issue of addiction to medicines. They will inform future guidance and policy such as the development of new Royal College of GPs guidelines for the use of benzodiazepine and similar drugs in general practice.

People can become dependent on tranquilisers, sleeping pills and opiate based painkillers, such as codeine, particularly if taken at high doses for prolonged periods. Long-term dependence on substances such as benzodiazepines has been identified as a particular issue. Today’s reports reveal that the overall prescribing of benzodiazepines is falling but that prescription of benzodiazepines to treat anxiety continues to increase as do the sale and prescription of opioid painkillers.

The findings suggest:

  • most prescribing falls within current guidelines;
  • long-term prescribing increases the likelihood of dependency but this is not inevitable;
  • over the last 19 years dispensing of benzodiazepines has decreased but there has been an increase in the prescribing of anxiolytic benzodiazepines and the sale and prescription of opioid painkillers;
  • dependence may be overcome if individuals are supported to reduce gradually  their medication;
  • of the 32,510 people in drug treatment who reported problems with prescription or over-the-counter medicines only 3,735 were not also using illegal drugs; and
  • most local areas provide some treatment for people who develop problems in relation to medicines.

GPs at the Substance Misuse Management in General Practice conference will now consider what the implications of these two studies are for local practice and how best to prevent and manage addiction to medicines.

Public Health Minister Anne Milton said:

“Addiction to prescription drugs can be every bit as damaging and distressing as addiction to illegal drugs.

“For the first time we have a national picture of what is happening in the community and how we can address addiction to painkillers and tranquillisers.

"Most areas in the country have services in place to support people who develop problems but there is regional variation coupled with a paucity of knowledge on the issue. We want local health professionals to pay close attention to the report so that they meet the needs of their populations.”

 A National Addiction Centre spokesperson said:

"The National Addiction Centre in collaboration with colleagues from the University of Bristol, has conducted a review on the changing use of prescribed benzodiazepines and z-drugs and of over-the-counter codeine-containing products in England.

“This structured review of published English and international evidence and available data informs consideration of the extent of dependence and harm.  The review is published online from today, 11th May 2011, and may be updated or revised by the National Addiction Centre and collaborators as new data and new evidence become available."

RCGP Chair Dr Clare Gerada said:

“GPs are all too aware of the damage that addiction to drugs – prescription and non-prescription – can do to the lives of an addicted person and their family, and the RCGP welcomes this renewed focus from the Department of Health.

“GP prescribing is guided by good standards, as laid out, for example, by the British National Formulary and DH National Clinical Guidelines on Substance Misuse. GPs are aware of the importance of not creating dependence on prescription drugs, and make sure they prescribe responsibly and according to good practice guidelines.

“The RCGP has worked for over two decades to improve GPs’ knowledge and skills in the management of substance misuse and much of this work as been led our own RCGP Substance Misuse Unit. We are pleased with how well GPs have responded to the advice issued by the RCGP over the years.”


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John Perrott

Thursday 12th May 2011 @ 11:49

These reports are complete rubbish and have fulfilled their purpose by providing the usual massaged statistics and non-specific terms and spinning myths that there is no problem. It is in the interest of the government and its departments and the RCGP to assert that the bad old days are behind us and in fact there is no significant problem with addiction to prescribed medicine, especially benzodiazepines.

In these reports they have airbrushed Clonazepam out and state that it is indicated for epilepsy and therefore would distort the figures despite the fact that it has been mis-prescribed for other indications including insomnia and muscle spasms, is twenty times stronger than diazepam and has caused addiction and long term harm; the reports also recommend a maximum of 6 months for benzo withdrawal which is too little in the case of high dose withdrawal and may cause protracted symptoms by too abrupt discontinuation; that w/d symptoms do not occur for 2-3 days in short acting benzos when they occur after only a few hours e.g. lorazepam half life 8-20 hours; that long term use is OK for recurrent anxiety when the BNF guidelines are for 2-4 weeks; that there is no evidence of anatomical or functional damage after long term use which they have not even researched (research too costly); that there are no problems withdrawing from zolpidem or zalepon which is untrue; that there is no optimum rate for tapering or duration when this is clearly documented in Prof Ashton’s work who thy have completely ignored apart from one token consultation; that a 8-10 week withdrawal schedule is recommended even though it is acknowledged that after long term use this can take over a year; that they still do not know the scale of the problem even though they have said they needed to know as far back as Panaorama in 2001 – it is estimated that 1.5 million patients are currently addicted to benzos; that they need more research even though this “review” commenced in 2009 was supposed to be the answer to the shed load of patients who have written to the DoH and their MPs; that they need to do more research on prevalence, GPRD prescribing data and pharmacy prescribing even though these were the review’s objectives; that they need to carry out ongoing scrutiny of the problem which means doing nothing.

The NTA whose failure with opiates including 1.2 billion spent in 2009 with a 1.5% long term quit rate, high death rates, drug free meaning on drugs, abstinence meaning maintenance and describing addiction as a “chronic relapsing disease did the same with this report; could not quantify the number of patients addicted to prescribed benzos (it’s on a redacted DoH document dated 2009); suggest that patients find help (why are the handful of voluntary help lines inundated?); have mixed up opiates, benzos and codeine products in the same statistics watering down the facts; mixed up iatrogenic and illicit drug problems; have stated they were unable to consult service users as it “would have necessitated ethical research” .

So the government, DH and to some extent the RCGP (with whom I had a meeting recently about this non existent problem) have the desired result asserting that there isn’t really a problem. The results of these long awaited reports for those suffering from prescription drug addiction and resulting damage are no action and no specialist help to get off these medications.

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