Health: Addiction to Prescribed Drugs

Baroness Bottomley of Nettlestone Excerpts

Wednesday 6th October 2010 Lords Chamber

[Baroness Bottomley of Nettlestone]

My Lords, I warmly congratulate the noble Earl, Lord Sandwich, on raising this matter of great importance. I think that all of us greatly respect his commitment to and interest in this issue and the depth of his research and investigations. My earliest involvement in this subject was in the early 1970s when I worked in child guidance clinics in Brixton and Peckham. I was all too aware of the number of mothers whom I met who had been prescribed Valium or Librium for their problems, which did not seem to help them one little bit. In some cases, it seemed to remove the inhibitions that they might otherwise have had and their family situation deteriorated faster.

I can understand what it is like to be a general practitioner in an impoverished area where a great number of people come into the practice with insoluble social, psychological and economic problems. The requirement of a patient for a pill for every ill must have been irresistible. One of the great strengths of GP fundholding was forcing and enabling general practitioners to look at the opportunity cost of pharmaceutical routes. Some of them could prescribe more cautiously and employ a counsellor or a more appropriate resource to help these patients, the problems of many of whom were highly complex and difficult—even intractable. For some of them, with the best will in the world, the general practitioner was very poorly equipped. However, once a benzodiazepine is prescribed, addiction can easily develop.

I am aware that all medication has side effects. For every physician and clinician who prescribes any product, there is a risk-benefit analysis. Many of those who visit a physician in these circumstances are in a deeply troubled and disturbed state. I also accept that when you look at the detail, for example, of the Royal College of Psychiatrists’ 1997 report, or at the NHS South Essex Partnership’s All About Benzodiazepines: Treatment for Anxiety and Psychosis, you see that best practice now advocates that,

“this should be no longer than about one month to help you get over your problems”,

and that there should be short-term prescribing and much lower doses.

In days gone by, particularly when benzos were still within patent, it may have been that pharmaceutical companies oversold their benefits and the drugs were overpushed as a solution to too many problems. That is no longer the case, because the drugs are now into the generic space and there is not the same advantage to the pharmaceutical companies of overpushing these products. Neither are we a nation of great pill pushers.

However, a great number of people suffer from anxiety and mental health conditions and we have been all too slow at making talking therapies as available as a pharmaceutical outcome. We need to consider all those contributing elements as we look at our problems today. I very much hope that, with the review that the Government have in hand, they will look again at the pathway of care for many of those who have ended up addicted. It of course starts with the general practitioner and with looking to all community resources, as well as with perhaps looking at the acute sector. I hope that they will reissue guidance and that, given this new start with general practitioners in a much more powerful position in commissioning care and planning care pathways, they will be absolutely certain that the real facts, and the issues and concerns over benzodiazepines, are properly understood.

The noble Earl referred to Professor Heather Ashton at Newcastle University. She and others have taken care, time and trouble to look at ways in which addiction can be tackled. But, once addicted, all will be aware that the withdrawal of the product is extraordinarily difficult. Debate has been mentioned about the National Treatment Agency possibly taking over this field. This is not a preference for the All-Party Parliamentary Group on Involuntary Tranquiliser Addiction. There is real anxiety that, instead of getting better, things will somehow get worse and fall between the cracks. The Government will make their decisions, but I think that all of us would ask that if this is a step forward it must be taken from first principles. The arguments, issues, dangers and risks must be properly addressed if the agency takes on that additional responsibility.

I, too, ask the Government for the timetable of the review. I would like to know more about the review. Who is chairing it? Who is being consulted and what are the real objectives? I ask the Minister to assure us that the result will be not only a review but guidelines for best practice. As the noble Earl said, all too many people at this moment are involuntary addicts of benzodiazepines. The danger, the damage, the hurt and the pain, not only for those individuals but for their families, are almost without cost. I very much support the noble Earl.