The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, I join other speakers in thanking the noble Earl for having called this debate, which has prompted some excellent contributions from all speakers. This is an issue of considerable importance and I am well aware that it is of great concern to the noble Earl’s own family. I know that he made a moving statement on this question to the All-Party Parliamentary Group on Drug Misuse last December. I commend the all-party group for its report on dependence on prescribed and over-the-counter medicine.
When most people consider the harmful effects of drugs and drug addiction, they will tend to think of illegal drugs such as cocaine and heroin. They will be less likely to think of the drugs that are available perfectly legally from their GP or over the counter at their local pharmacy. The harmful effects of addiction to medicines for pain relief, anxiety or insomnia do not make for lurid headlines. People assume that if your doctor has prescribed a drug, or if you can buy it at the local chemist, it must be safe. In most cases, it is, but this is not the whole story. Unfortunately, some people suffer the consequences of dependence on medicine. At the Department of Health, we receive a steady stream of letters from people whose lives, or the lives of their loved ones, have been badly affected by addiction to tranquillisers or other prescribed medicines. To them, I say that we acknowledge the problems that they face and are working systematically to understand how services can be improved.
I should also like to pay tribute to the NHS and voluntary organisations that are already doing so much to help people withdraw from prescribed and over-the-counter drugs, but we need to know more about how well placed these services are to meet the needs that exist and what support might improve them.
To tackle this problem properly, we must first understand it. The Department of Health has asked the National Addiction Centre to conduct a literature review to identify and assess the existing medical and scientific evidence about the scale and nature of the problem and how it can be treated. We also need reliable information about how many people are dependent on medicine and how many need help to withdraw.
The true scale of the problem is hard to quantify. I will say a little more about that in a minute, although I recognise that the APPG offered an estimate. To a large extent, the misuse of prescribed and over-the-counter drugs is a hidden problem. Some people do not realise that they need help, so do not ask for it; others do not know where to go for advice and support; some will not admit that they have a problem and need help, and as a result are simply not counted. We need to gauge the true extent of clinical dependence and the need for help in withdrawing from dependence on legal medicine. The Department of Health has asked the National Treatment Agency for Substance Misuse to conduct an audit of GP prescribing which, I can tell my noble friend Lord Mancroft, will indeed be thorough.
The department has also asked the NTASM to map the extent of current service provision to help people withdraw from dependence on legal medicine. We have asked to see the results of this work by the end of this year. After Ministers have had an opportunity to consider the findings, we will share them with interested individuals and organisations to inform a debate about where we go from here. In advance of their publication, I shall set out how the initiatives already announced will help to improve services for this group of people. The Secretary of State for Health plans to create a new, integrated public health service to promote public health and encourage behaviour change to help people live healthier lives. The treatment of dependency will be a priority of a public health service. The public health White Paper, due for publication later this year, will set out the service’s role in the rehabilitation of people whether they are dependent on illicit drugs, alcohol or legal medicines.
Later this year, we will publish a new drugs strategy; the consultation on that closed last week. We are now looking at the responses received to inform the development of that strategy, but we are clear that we want to achieve a closer integration of services to help people, regardless of the substances on which they are dependent, to live full lives, participating actively in society. I mention those forthcoming policy statements because they will set the context for our future work.
I referred to the letters we received from those affected by addiction to medicines. The letters are often heartbreaking. If there are more people affected in the same way, we need to know and to act. Equally, if we are to intervene and make this a priority for the health service, we need to ensure that we provide the right help in the right way. We all know that funding is extraordinarily tight; there will be difficult choices to make. Before local commissioners commit resources to dedicated medicine addiction services, they need the evidence that that spending will be effective.
There are good examples of areas where local commissioners have recognised a need in the area and have commissioned dedicated services. Bristol's Battle Against Tranquillisers, or BAT, is working with primary care trusts and mental health trusts across the West Country to provide dedicated counselling group therapy and telephone advice for people dependent on medicines. It is also educating GPs about the risks of tranquillisers and safe and effective methods of withdrawal. BAT also provides advice and counselling sessions at a number of prisons where benzodiazepine use is particularly high among older inmates. I commend the hard work of local NHS and third-sector organisations like BAT, and similar organisations across the country, in helping to deliver these vital services.
There may be a greater role for chemists and practice nurses to help in planning and delivering withdrawal programmes. There was already a great deal of advice available to GPs about the risk of addiction in prescribing benzodiazepines, sleeping pills and painkillers. Advice is also available to help clinicians manage patients’ safe withdrawal, and is set out in the British National Formulary, in clinical knowledge summaries and on the Patient UK website.
I was asked by more than one noble Lord about the scale of the problem of people addicted to benzodiazepines. Evidence to the All-Party Group on Drug Misuse estimated that 1.5 million people were so addicted. However, further work is needed to reach a more statistically reliable estimate of the scale of dependence on these medicines. That estimate was worked out by researchers for a television programme broadcast 10 years ago using prescribing figures for one primary care trust, which were then extrapolated to arrive at a national estimate. It can easily be seen that we need to revisit this question.
In any event, overall numbers of prescriptions do not by themselves show the scale of the dependence. Many prescriptions, including long-term prescripts, are clinically appropriate: that is, they are based on the doctor’s full knowledge of their patient’s condition and deemed by the doctor to be beneficial. In some cases, tranquillisers are prescribed as part of a full package of medication for conditions such as epilepsy or multiple sclerosis. It is also important to note that prescription numbers overstate the true numbers of patients, as those figures will include repeat prescriptions for the same patients.
A number of noble Lords questioned whether the NTASM was the appropriate body to be commissioning the services for people who become addicted. In fact, as I am sure your Lordships will know, the NTASM does not directly provide treatment services. NHS drug and alcohol services are there to do that job. I do not agree that drug and alcohol action teams are not best placed to help people addicted to drugs. DAATs commission to provide help for a wide range of drug users, including people dependent on medicines such as tranquillisers. In many cases, services for people hooked on such drugs are provided at different sites than those for people hooked on illicit drugs. Case workers are fully qualified to advise people who need advice on withdrawing from prescribed and over-the-counter drugs. Services for people trying to withdraw from benzodiazepines are offered in a sympathetic way, with sessions held at separate sites or at different times by some PCTs to make users feel more comfortable. When I asked about this, the advice was that treatment providers would typically treat each case on its individual clinical merits, both psychosocially and pharmacologically. Examples of these services are established in specialist clinics to treat those with addiction to medicines such as benzodiazepines.
Mention was also made of the 2004 Health Select Committee report. The previous Government published a response to that report in 2005, replying to all the recommendations in it. As a result, the MHRA has made a number of improvements given the concerns in the report. Time prevents me from reading them out, but they are significant. Noble Lords also asked me what the timetable for this review was. I have already indicated when Ministers have asked for the report to be on their desks. The review is considering services across the board, both in the NHS and the third sector. As regards the latter, the Government will allocate funding centrally for third-sector organisations only from the third-sector investment programme.
The noble Baroness, Lady Thornton, criticised the Government for not involving people directly affected by dependence on benzodiazepines. In fact, the review under the previous Government, which as she knows was not a formal public consultation—there was therefore no formal requirement to consult external stakeholders—nevertheless included a programme in which officials contacted most of the main patients’ organisations and obtained their views on the way forward. That was very helpful background to the work that we are now doing.
The noble Earl asked about support for the voluntary services in Liverpool, Oldham, Bristol, Belfast and elsewhere. He will know that decisions about funding of local services for people dependent on medicine are based on local needs. We are aware of several PCTs that fund withdrawal counselling.
Time prevents me from going further, although I do have further information and will write to noble Lords whose questions remain unanswered. I apologise for not being able to do so now. Contributions made in today’s debate illustrate graphically the concern felt by this House on the issue, which I and my ministerial colleagues take extremely seriously. I look forward to sharing the results of our reviews with noble Lords as we develop policies and services in the light of evidence.