Patients dependent on prescription medication need more support, finds government review

The Prescribed Medicines Review assesses the scale and distribution of prescribed medicines and makes recommendations for better monitoring, treatment and support for patients.

Why did this need to be done?

The review was commissioned by the government amid concern that many patients were dependent on prescription drugs.

Five classes of medicines were included in the review:

• Benzodiazepines ( mostly prescribed for anxiety)
• Z-drugs (sleeping tablets with effects similar to benzodiazepines)
• Gabapentin and pregabalin ( together called gabapentinoids and used to treat epilepsy, neuropathic pain and anxiety)
• Opioids for chronic pain

The review found that one in four adults in England, almost 12 million people, had been prescribed at least one of these classes of medicines in the year ending March 2018. Half of those patients had been continuously prescribed the medication for at least the previous 12 months with about a quarter having used them for at least three years.

What were the causes of these prescribing rates?

The review found a significant link between prescribing rates and deprivation, with some of the highest rates occurring in the most deprived areas.

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.”

Whilst England isn’t yet facing an opioid crisis like the US, the findings are clearly of great concern to both healthcare professionals and patients.

In April this year, Secretary of State for Health and Social care, Matt Hancock announced that all opioid medicines in the UK must carry prominent warning signs on labels to highlight the risk of addiction. He recently tweeted:

“We are in the grip of an over-medication crisis. I’m incredibly concerned by @PHE_uk’s review showing impact of over-medicalisation- so we are acting to make sure we put an end to this crisis before it goes any further”.

What problems can these drugs cause?

The review highlighted that opioids are ineffective for most people when used long-term (over 3 months), while benzodiazepines are not recommended to be used for longer than 28 days.  Long-term prescribing is, however, likely to result in dependence or withdrawal problems. People who had experienced problems from prescription medications also reported that they felt uninformed before they started them, and unsupported when they experienced problems.

Professor Paul Cosford, Emerits Medical Director at PHE said:

“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.

This report shows that while the vast majority of new prescriptions for these medicines are for short term use, within clinical guidelines, it also highlights significant numbers have been taking these medicines for a long time. It is vital that clinical guidelines for prescribing are followed and regular reviews with patients take place to address this.

We also know how difficult it is for some people to come off these medicines and more research is needed for us to understand better how we help people to stop using them when they are no longer clinically helpful.”

His views were echoed by Keith Ridge, Chief Pharmaceutical Officer at NHS England, who said:

“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.”

It is clear that these medicines can provide valuable relief for patients with pain, mental health issues and anxiety. However, they are also associated with side effects and the risk of dependence, harm and prolonged withdrawal. To minimise the risk of harm to patients, it is imperative that the prescribing guidelines are followed and that patients are closely monitored and supported.

What should be done?

Many patients with addiction issues feel embarrassed or ashamed to speak to their GP due to the perceived stigma associated with addiction. Additional measures are required to help and support those patients and to break the stigma of addiction.

Further investment needs to be made into alternative treatments, such as talking therapies and “social prescribing” which is described by the NHS as “ a means of enabling GPs, nurses and other health and care professionals to refer people to a range of local non-clinical services” and involves treating conditions in a holistic way. Examples include volunteering, arts activities, group learning, gardening and sports.

I am concerned about my prescription medication. What should I do?

Patients with concerns about their medicines should not stop taking then but should speak to their GP for support and advice.