More support needed to tackle prescription drug dependence

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A review into the scale and causes of prescription drug dependence has highlighted the need for more support services and alternatives to medication, such as improved access to mental health services.

Public Health England found a quarter of adults in England had been prescribed at least one of five classes of medicines – including anti-depressants, opioids for chronic non-cancer pain, and medication for anxiety, epilepsy and insomnia – which the government believed had high rates of dependency, in 2017-2018.

Between 2015-2016 and 2017-2018, the rate of prescribing for antidepressants increased from 15.8% of the adult population to 16.6%, and for gabapentinoids (used to treat epilepsy, neuropathic pain and anxiety) from 2.9% to 3.3%. The other classes of medicine looked at in the Prescribed medicines review saw a small decrease in prescribing rates.

The review noted that there was a higher rate of prescribing of these drugs, which PHE said had a risk of “dependence and withdrawal” among women and older adults.

It concluded that regular reviews of whether treatment is working are needed, while patients who wished to stop using a medicine must be able to access advice and treatment to help them do so.

The review also said that limiting the use of such medicines would increase harm and might lead some people to source medicines by illicit or less-regulated means, such as online pharmacies.

PHE recommended that clinical guidance should be enhanced, the availability and use of data on the prescribing of medicines that can cause dependence should be increased, and information for patients on such medicines and alternative treatments needed to be improved.

Support for patients experiencing dependence should also be bolstered, PHE said, while further research into the prevention and treatment of prescription drug dependence should be undertaken.

Rosanna O’Connor, director of alcohol, drugs, tobacco and justice at PHE, said: “We know that GPs in some of the more deprived areas are under great pressure but, as this review highlights, more needs to be done to educate and support patients, as well as looking closely at prescribing practice, and what alternative treatments are available locally.

“While the scale and nature of opioid prescribing does not reflect the so-called crisis in North America, the NHS needs to take action now to protect patients.”

NHS England’s chief pharmaceutical officer Keith Ridge added: “As PHE rightly say, these medicines have many vital clinical uses and can make a big difference to people’s quality of life and for some their long-term use is clinically necessary, particularly antidepressants, which can take longer to have their full effect.

“But for many patients they may not be the best option – with talking therapies and social prescribing often more appropriate.”

The British Medical Association’s Dr Andrew Green, who was involved in the review process, said social deprivation, poor access to mental health care, rising demand for GP services and an ageing population were all likely to be significant contributing factors to increasing rates of prescription drug dependence.

“While there remains a place for prescribing the kinds of drugs this report covers – including, in some circumstances, for long-term use – we need many more alternatives to medication, such as pain clinics, improved access to mental health services, and physiotherapy – the universal provision of which are all lacking,” said Dr Green.

“The BMA has for a long time called for tailored services to support people with dependence to prescription drugs, including a national helpline – and we are pleased to see this reflected within the report’s recommendations.”

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