Health: Addiction to Prescribed Drugs

Earl of Sandwich Excerpts

Wednesday 6th October 2010 Lords Chamber

Tabled By

[The Earl of Sandwich]

To ask Her Majesty’s Government what progress they have made with their review of dependence on, and withdrawal from, benzodiazepines and other prescribed drugs.

[The Earl of Sandwich]

My Lords, this dinner hour debate is about the damaging effects of drugs that are legally prescribed. It is a sad story that has been told in the media for decades, but it needs retelling today because there is some chance that the Government are now listening. I declare a personal interest, since a member of my family continues to suffer after 19 months of painful withdrawal from benzodiazepines. He seems a little better and has contributed to this debate, but he still has to endure dreadful withdrawal symptoms, which prevent him from working or leading an active life.

I warmly thank all those who have come to contribute to this debate. I speak as vice-chair of the All-Party Parliamentary Group on Involuntary Tranquilliser Addiction and am grateful to Jim Dobbin MP and Michael Behan, among others, for their research on and knowledge of this issue. The authorities were first alerted to it by research by Professors Tyrer and Lader in the 1970s and Heather Ashton in the early 1980s, but manufacturers were already doing clinical trials identifying problems as far back as the 1950s. Benzodiazepines such as Valium, Librium, Ativan and Mogadon were first touted as miracle cures because of their immediate benefits following prescription, but the benefits are often short-lived. Tolerance develops and the drugs then turn and cause symptoms often much worse than the original problem and even worse than those of illegal drugs. Patients enter a vicious cycle in which more drugs may be prescribed to combat the side effects and withdrawal symptoms, and so the process goes on. This is at great cost to the health of the individual and, of course, to the health service.

According to the current Association of the British Pharmaceutical Industry website:

“Benzodiazepines … have a potential for addiction, but are considered acceptably safe for short-term use”.

Huge overprescribing continues by doctors who are ignoring the British National Formulary guidelines. While drug labels contain warnings for patients, those warnings are inadequate and need to be much more prominent, like cigarette warnings. Current NHS recommendations state that the drugs should not be given for more than two weeks, yet people suffer withdrawal effects even within this short time period. Professor Steve Field, chair of the Royal College of General Practitioners, said in March 2009:

“We now try to prescribe”—

benzodiazepines—

“only for a few days because we know that it’s very difficult to get people off these drugs ... in some people, it can be three or four days of the drug before they get hooked”.

These drugs are dangerous. Why do doctors prescribe them so freely if they provide temporary relief for so little time and never cure the original problem? I wonder whether this category of drug should be prescribed by doctors at all, considering the uneven benefits and the tremendous risks. There should be stricter controls and these drugs should be rescheduled and reclassified as class A. There are many proven non-drug alternatives for anxiety and sleep disorders, such as CBT, but these are subject to long waiting periods. They should become the first available line of treatment if we are to avoid the devastation that these drugs cause.

Psychological symptoms that persist after sudden withdrawal include anxiety, agoraphobia, panic attacks, depression, fatigue and lack of concentration. Common physical symptoms are muscle pain, insomnia, dizziness, blurred vision, tinnitus, sweating and nausea. These symptoms often last for months and years after withdrawal. For some people, the damage may even be permanent. In one support group, several members have had debilitating symptoms for over five years. Often these are physical symptoms and cannot be considered a resurfacing of the original psychological issue. Yet, perhaps because pharmaceutical research is inevitably profit-led, no research has been funded into long-term or permanent damage. This leads most doctors to believe erroneously that such damage does not exist. This research is essential if patients are to be rehabilitated and their condition properly managed during and after withdrawal.

It is pitiful that a problem of this severity, and on this scale, has been allowed to get worse over so many years when so much has been known empirically for so long. Back in April 1984, Professor Heather Ashton of Newcastle University published an article in the BMJ entitled Benzodiazepine Withdrawal: An Unfinished Story, which summarised the problem. As a result of this and other reports, GPs and NHS staff became more aware of the dangers, clinics were opened and prescriptions fell from about 32 million to 18 million per year—a significant fall. However, by November 2000—16 years later—Heather Ashton, who was in regular contact with patients, noted that things had not really changed. In many ways they had got worse. A “Panorama” survey at that time estimated that there were as many as 1.25 million long-term benzodiazepine users in the country, an average of over 180 for every GP.

We need to act urgently to ensure that these accidental addicts are provided with appropriate support from the NHS to help them to withdraw, yet today there is only one NHS-funded support centre—in Oldham—despite the fact that all these patients have become addicted as a result of drugs prescribed via the NHS. That brings me to the Labour Government’s welcome, if belated, review. I believe that the new Government are equally sincere, but I wonder whether they will now seriously consider the true costs of doing too little, too slowly. At a time of cuts and savings, have they estimated the social costs—the loss of earnings and tax, the cost of benefits and the drain on the NHS—incurred by these prescribed drugs if they do nothing? Do they even know how many people are long-term users?

Another concern is that the National Treatment Agency may be given responsibility for treating these addictions. The NTA has no expertise in this field. I understand that tranquilliser addicts whom it has treated in the past have been withdrawn abruptly over three weeks as if they were illegal drug users. This is wholly inappropriate and dangerous, as successful and safe tranquilliser withdrawal requires a timescale of between six months and two years.

What is the timetable for this review? Will the department move swiftly to encourage the many voluntary initiatives that already exist in the absence of any NHS programme? We are dealing with a daily emergency in the lives of many patients. Instead of further consultation within the institutions, why not immediately set up a working party to develop best practice and to set up pilot projects, using the expertise already in place in many areas? When, for example, will the Government support the largely voluntary services in Liverpool, Bristol, Newcastle, Belfast and elsewhere that are already helping victims of these drugs and bring them within the range of the NHS? Some services depend entirely on heroic individuals such as Pam Armstrong, director of CITA in Liverpool. David McKeown in Belfast, a NHS prescribed medication nurse, is another professional who not only understands the needs of these patients and the properties of these drugs but actually leaves people drug-free.

The answer that I and others have received to these questions so far—that nothing can be done this year—is simply not satisfactory when you think of the scale of the emergency and the silent suffering of so many people. I hope that the coalition will come up with some more urgent interim solutions pending the outcome of the review. As to the pharmaceutical companies and the regulators—I have not had time to cover them today—will the Government revisit and if possible implement the conclusions of the 2005 Health Select Committee report, volume I, which recommended a review of the activities of the Medicines and Healthcare Products Regulatory Agency? These are serious and urgent matters and I hope that the department and the Minister will give them their fullest attention.