Health: Addiction to Prescribed Drugs

Baroness Masham of Ilton Excerpts

Wednesday 6th October 2010 Lords Chamber

[Baroness Masham of Ilton]

My Lords, I thank my noble friend the Lord Sandwich for this short but important debate. His close association with this difficult problem makes this debate more pertinent. The All-Party Parliamentary Drug Misuse Group undertook an inquiry into physical dependence and addiction to prescription and over-the-counter medication in the parliamentary Session 2007-08. I found the inquiry most interesting but of great concern. I hope that the inquiry will be helpful to the people taking part in the Government’s review and that some of our recommendations will be adhered to.

An estimated 1.5 million people are addicted to benzodiazepine drugs in the UK. Many of these people will have been addicted for long periods. There is a common pattern to their submissions. First, there is a visit to their GP and a prescription for a particular benzodiazepine, followed by years of repeat prescriptions, often without review. For many patients, the drug initially alleviates their symptoms, but for others the symptoms continue and their general health deteriorates.

The British National Formulary states that benzodiazepines are indicted for short-term relief—two to four weeks only—of anxiety that is severe and disabling or which subjects the individual to unacceptable distress. It states that the use of benzodiazepines for short-term “mild” anxiety is inappropriate and unsuitable and advocates that withdrawal from benzodiazepines should be gradual, as abrupt withdrawal may produce confusion, toxic psychosis, convulsions or a condition resembling delirium tremens.

Your Lordships might be interested to hear a case study from the inquiry:

“Ms R was prescribed benzodiazepines following treatment for alcohol addiction. For the next 28 years her doctor allowed her repeat prescriptions of the drug despite the fact that she continued to experience feelings of anxiety and ill health. More recently she has attempted withdrawal but failed on a number of occasions. Her GP told her his medical training did not equip him with the skills to help her withdraw, so she approached her local Drug and Alcohol Action Team (DAAT) who refused to help her as she was ‘only a prescription drugs addict.’ She was told that, as her GP had created the problem, it was up to him to solve it. Her DAAT told her that, if she had become addicted to benzodiazepines through illicit use, they would have been able to help her”.

Clearly, there must be a more joined-up approach to educating all health professionals, from pharmacists to nurses and doctors, to ensure that they are able to help vulnerable patients. Despite the fact that the guidelines have been made quite clear about prescribing benzodiazepines, repeat prescriptions for longer than two-week to four-week periods continue to be allowed. Conversely, some GPs continue to try to reduce the benzodiazepine usage of their patients too fast, which is most dangerous. What can be done about this?

The drugs, which contain codeine and include brand names such as Nurofen Plus and Solpadeine Plus, are sold over the counter and are routinely used to ease headaches, back pain and period pains. Official figures show that tens of thousands of people have become dependent on them, many accidentally, with women at the most risk of developing an addiction. Warning that addiction can begin after just three days, the Medicines and Healthcare Products Regulatory Agency has said that, from this year, all packets of painkillers will carry a prominent warning label that will read, “Can cause addiction after only three days’ use”. Also, the pills will be available at a maximum of 32 per packet instead of 100. That is good news, but has this already happened?

With so many problems in the training of junior doctors and student nurses, it is important that the British Medical Association, the General Medical Council and the Royal College of Nursing should ensure that all medical students and nurses are trained to recognise the symptoms of physical dependence and addiction to drugs, including over-the-counter and prescription medications, and that voluntary groups working in this field should be supported. There is the added problem of people ordering drugs such as anabolic steroids over the internet, despite the potential health risks. Does not the Minister agree that the safety of all drugs should be made a priority?