Drugs: Prescribed Drug Addiction
Earl of Sandwich Excerpts(12 years, 5 months ago)
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The Earl of Sandwich
To ask Her Majesty’s Government whether they plan to develop separate treatment programmes for those suffering from acute symptoms of addiction to and withdrawal from legally prescribed drugs, distinct from programmes for illegal drug addiction.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, treatment should be based on individual need, not the legal status of a drug. The Health and Social Care Act places responsibility for commissioning services to treat dependence at the local level. My honourable friend Anne Milton is leading work to improve the prevention and treatment of addiction to medicines, and has visited local areas where support for dependence on prescription drugs is an integral part of the local treatment system.
The Earl of Sandwich
My Lords, I thank the Minister and I know that he and his fellow Minister are fully aware of the problem. However, there are only a handful of voluntary organisations and one or two primary care trusts dealing with this. The basic question is surely the control of prescription drugs. Does the Minister recognise that the British National Formulary guidelines are being routinely breached? Is there nothing that the Government can do effectively to control and monitor these prescription drugs, separately from illegal drugs?
Earl Howe
My Lords, the report commissioned by the Department of Health from the National Addiction Centre brought together published evidence on the scale of the problem. That report suggested that while some GPs prescribed for longer than the recommended period, most prescribing in fact falls within current guidelines. I say to the noble Earl that what matters most in these circumstances is that patients should be treated according to the level of their need, regardless of what the dependence is and where it has come from.
Health and Social Care Bill
Earl of Sandwich Excerpts(12 years, 9 months ago)
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Lord Newton of Braintree
My Lords, perhaps I may briefly intervene, although not in any way to differ from my noble friend Lady Williams of Crosby; I am much too diffident to dare to do that. In fact, I want to raise a few nitpicking points that occur to someone who has had a bit of ministerial experience over a fairly long period. They occur in relation to several of these amendments. First, it is far from clear, in light of the exchange with my noble friend Lord Mawhinney, just what “resident” means in this context. Someone needs to answer that clearly before we go down the path of the amendment. Secondly, on a related matter, does the proposal mean—whatever “resident” means—that people would be entitled to free NHS services, regardless of their status? Under existing law, a lot of people living in this country are liable to be charged for NHS services. That is not clear in some of these amendments.
In particular, it is not clear whether illegal immigrants are liable to be charged. I do not know the answer to that, and I probably ought to. If, however, they are liable, it is another factor to be taken into account when looking at what all this means. If we really mean that clinical commissioning groups must provide services—and I shall come back in a moment to the term “provide”, which also occurs in another of the amendments—to everyone resident in their area, how are the CCGs to establish that? Illegal immigrants, along with a number of other people, go to great lengths to stay beyond the radar. They will not be on the electoral register. They will not be registered with doctors. They will be trying to make sure that no one knows they are there. Do CCGs have to set up an immigrant police investigation team to find out who is resident in their area? These may sound like nitpicking points but they would be real issues if an amendment along these lines were passed, even though I am sympathetic to the aim. Parliamentary draftsmen would need to do some work.
What does “provided by” mean? Clinical commissioning groups will not provide many services; they are essentially commissioning groups. Do we mean “any services commissioned by” commissioning groups, many of which will involve secondary services—certainly—tertiary hospitals, and a whole range of other people? The amendment and several others in the group, however worthy their purpose, require a lot of careful drafting before we can accept them as amendments to an actual piece of legislation. My noble friend may care to comment on that.
Lastly, this rather curious group also includes the amendments of my noble friend Lady Cumberlege relating to HealthWatch England. I cannot see any problem with them. I support her entirely. It seems to be a no-brainer that if we are to set up a healthwatch system, people should have to take account of what their local healthwatches have to say.
The Earl of Sandwich
My Lords, before the noble Lord sits down, may I correct him on the question of illegal immigrants? There is no question of illegal immigrants having access to the health service. Certain vulnerable categories, such as mothers and children and so forth, are given access, but it is quite wrong to suggest that that is what is generally happening.
The Earl of Sandwich
“14YA Duty as to addiction to benzodiazepines, selective serotonin reuptake inhibitors and Z-drugs
(1) Each clinical commissioning group shall have a duty to provide services to those suffering from addiction to and withdrawal from benzodiazepines, selective serotonin reuptake inhibitors and Z-drugs.
(2) In fulfilling this duty, clinical commissioning groups must co-operate with and take account of the good practice of specialised agencies in this field.”
The Earl of Sandwich
My Lords, this is a non-political amendment. However, by the end of our discussion, it may become more political; it depends on what happens in this short debate.
I am very grateful for the support and encouragement I have received from my noble friends and noble Lords on all sides of the House in raising this issue now and on previous occasions; that is, prescribed drugs such as sleeping pills and antidepressants. I moved a similar amendment after midnight on 30 November. In that debate the noble Lord, Lord Alderdice, said:
“I hope my noble friend the Minister will be able to give some reassurance that this is regarded seriously as an iatrogenic disorder that the health service is in some cases responsible for bringing into play through absence of proper monitoring and, in some cases, errant prescribing”.—[Official Report, 30/11/11; col. 372.]
If the health service does carry responsibility for iatrogenic disorder—as I believe it does—surely this makes it imperative that it moves faster on the issue than it otherwise would, even during a recession. The Minister did not respond to that point on that occasion. I would be grateful if he could acknowledge it today, if he can.
It may be helpful to remind the House that the singer, Whitney Houston, may have been under the influence of Xanax, which is a popular benzodiazepine, when she died. Without it, she may have survived. She had also taken Ativan and valium—drugs which I am sure are familiar to all noble Lords. Amy Winehouse took Librium. I mention them as two prominent recent examples of what is happening. Many thousands of people—not drug addicts but ordinary, mainly young, people living ordinary lives—are suffering from a diet of benzodiazepines, selective serotonin reuptake inhibitors called SSRIs, and z-drugs that all may initially have been prescribed for very good reasons and for a limited period of between two and four weeks as standard, but now blight their lives to the point of dark despair.
The Centers for Disease Control and Prevention in the US reported 37,485 deaths from prescribed medication in one year, 2009. It is recognised as a leading cause of death, in front of deaths from road traffic accidents, from firearms and from all illegal drugs put together. This information came only in the past few days, and we now hear from the British Medical Journal that sleeping pills, even taken lightly, can treble the risk of an early death.
The Earl of Sandwich
My Lords, as the noble Baroness, Lady Thornton, implied, we are moving to the fast-track of this Bill, and I do not want to hang around for too long. I thank my noble friend Lady Masham for bringing to our attention the issue of early death, and my noble friend Lord Williamson, who has a lot of experience, for his support. My noble friend Lady Finlay made the important point that the responsibility falls within primary care, and I am encouraged by what she said about guidance. However, the Minister did not even pick that up. One might have thought that he could have just said, “Yes, we are going to do something in the guidance”, but I do not know whether he actually heard the point.
Earl Howe
I am happy to pick that up, because it was a point that arose in connection with an intervention from the noble Baroness, Lady Finlay, in the previous group of amendments. Of course, we will be relying on the NHS Commissioning Board to issue guidance in a number of clinical areas. Again, when the noble Earl and I meet, I will update him to the extent that I am able to on the thinking in that regard. The point of such guidance—which will relate to numerous areas of care and services—is that it should inform joined-up commissioning in local services, so that we really do get a step change in the quality of commissioning in local areas.
The Earl of Sandwich
It is quite true that the CCGs are going to be overwhelmed with guidance from all directions, but I maintain that this is an important aspect.
I thank my noble friend Lady Hollins for the very important point that she made. I did not even talk about prescribing today but I hope to come back and talk about it later—the whole question of training and what young doctors are being told. “Rational prescribing” is a phrase that I will now be able to repeat.
I know that the Minister accepts the arguments, and of course there are many things that we have in common—good practice and the use of the voluntary sector. I take the point about the duty that falls on local authorities, but I still maintain that we have to separate this out from the mainstream of drug addiction and alcohol treatment. It is the kind of treatment that only the very careful, experienced volunteers can describe. I do not think that I can begin to describe the actual treatment. However, the NHS will soon get to grips with what is happening. I welcome the chance of having a meeting. I will of course come to talk, and I hear that there is to be a range of experts. I feel that the Minister has given a little bit of a Civil Service answer, because there are only but one or two people who follow this subject in the department. I do not mind talking only to two people—it will be a very good opportunity to take this further. Meanwhile, I beg leave perhaps to consider this again at a later stage of the Bill, and to withdraw the amendment.
Health and Social Care Bill
Earl of Sandwich Excerpts(12 years, 9 months ago)
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The Earl of Sandwich
My Lords, having worked in the voluntary sector for many years, I could not resist saying one word in support of my noble friend. The only word that I missed from his speech and that of the noble Baroness, Lady Tyler, was “innovative”. The voluntary sector is ahead of the National Health Service in so many ways, as are other sectors.
We are coming to an amendment, if not tonight then probably on Wednesday, regarding addiction to prescribed drugs. This is a field where we have practitioners who are the people who do it; they are not the bureaucrats behind. It is an area where the Bill needs strengthening. The noble Lord, Lord Rooker, and I tabled a very important amendment on this matter last time around. I can hear him saying, “Let us take every opportunity to strengthen the Bill when it comes to the voluntary sector and bureaucracy”.
Lord Beecham
My Lords, I warmly congratulate the noble Lord, Lord Mawson, not only on the substance of his amendments but on his sense of timing, because we are now very familiar with complaints from the voluntary and community sector in relation to the welfare-to-work programme. It was anticipated that the sector would be heavily involved in helping to place people into work, but, in practice, we have seen most of that endeavour carried out by much larger companies, with the sector playing a very limited role. It is precisely to avoid that outcome that the noble Lord has tabled his amendments. In particular, I am attracted to and wholly support subsection (2) of the new section proposed by Amendment 64A, which would confer on the board the capacity to,
“take specific action to support the development, including capacity building, of the voluntary sector, social enterprises, co-operatives and mutuals”.
That seems to me the kernel of the two amendments, which we very much endorse. In a mixed economy of provision, that sector needs to be developed and supported.
A further potential opportunity is raised by new Section 13W, on page 23 of the Bill, which confers on the board a power to,
“make payments by way of grant or loan to a voluntary organisation which provides or arranges for the provision of services which are similar to the services in respect of which the Board has functions”.
That may be implicit in subsection (2) of the amendment, although new Section 13W appears to limit that power to grant or loan to a voluntary organisation, which would not necessarily include the social enterprises, co-operatives and mutuals referred to in the noble Lord’s amendment. Perhaps the Minister, if he is sympathetic to the amendment, will look at whether the provision about grants and loans in new Section 13W might be expanded.
It is never too late for a little pedantry. I want to raise with the noble Lord, Lord Mawson, a couple of questions about the wording of parts of his amendments. Proposed subsection (1) of the new section proposed by Amendment 64A refers to the board exercising its functions,
“so far as it is consistent with the interests of the health service”.
I think that he means the interests of patients, rather than the service as such, which I would have thought more consistent with the general approach.
There is also a potential problem with subsection (3), which seeks, understandably, to provide that the board should take such steps as might produce,
“a level playing field between providers … meaning that one sector of provision is not more disadvantaged than another and relative benefits can be taken into account”.
That seems potentially to conflict with Clause 146 of the Bill, which would appear to rule out such a deliberate adjustment in favour of the sector. That is one good reason why my noble friend Lady Thornton will move an amendment to delete that clause and I hope that the noble Lord will support it.
A further question concerns a matter touched on by the noble Lord, Lord Newby, and relates to the second amendment, which, I confess, I do not quite understand. The amendment provides that the board may promote the inclusion of weightings in the procurement process,
“which reflect wider social, economic and health outcomes for each local health area”.
Does that relate to the conditions that exist at the time of the procurement rather than outcomes? I do not see how outcomes would fit and I am not clear what the weightings are. They cannot be only financial weightings. Is it to be a consideration to encourage the letting of contracts to the voluntary and social enterprise sector because of the particular nature of the locality? It is not clear and perhaps when the noble Lord replies he will—at least for my benefit— touch on that.
Interestingly, the two amendments relate to the part of the Bill dealing with the functions of the National Commissioning Board but purely to the health service provision, whereas proposed new Section 13M on page 19 refers to both health and social care provisions. I can understand why the amendment is limited in the way that it is, but I assume—again perhaps the noble Lord will confirm this—that he would envisage ultimately the same principle being applied to the provision of social care services. Is it not an illustration of the failure to develop the social care part of the Bill, which we touched on earlier?
Having said that, I strongly support the thrust of the noble Lord’s amendment and repeat my congratulations to him.
Drugs: Prescribed Drug Addiction and Withdrawal
Earl of Sandwich Excerpts(13 years, 5 months ago)
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The Earl of Sandwich
To ask Her Majesty’s Government what action they propose following the latest two reports from the National Addiction Centre and National Treatment Agency on prescribed drug addiction and withdrawal.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, my honourable friend the Minister for Public Health, Anne Milton, has discussed the findings of the reports with the All-Party Parliamentary Group on Drug Misuse and the All-Party Parliamentary Group on Involuntary Tranquiliser Addiction at a meeting chaired by my noble friend Lord Mancroft on 14 June. She wrote to my noble friend yesterday setting out the collaborative action that she will be taking in the light of that helpful discussion. She will be convening a round table meeting to discuss the key issues.
The Earl of Sandwich
My Lords, I thank the Minister for that information. Does he accept that this is an emergency for the victims of withdrawal from prescribed drugs and their families? Cannot the Government recognise the good practice that is already out there, set up withdrawal clinics and spread the word that no longer are these prescribed drugs but that they are turning into dangerous substances which can cost lives? These people cannot wait for further reports and consultation.
Health: Addiction to Prescribed Drugs
Earl of Sandwich Excerpts(14 years, 2 months ago)
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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.