Healthcare: Controlled Drugs

Earl of Sandwich Excerpts

Thursday 14th September 2023 Grand Committee

[The Earl of Sandwich (CB)]

My Lords, I too support my noble friend, and I am grateful to him for this chance to address a related subject of great concern: the highly damaging effects of the use of certain drugs prescribed in good faith. Older colleagues may recall that some years ago a member of my family had a bitter experience with benzodiazepine and sudden withdrawal from it at her doctor’s request. I introduced various debates and asked various questions at that time. I therefore declare my interest as a founder member of the Prescribed Drug Dependence—PDD—All-Party Parliamentary Group, which is soon to be renamed the “Beyond Pills” APPG. Most of the intellectual backup for the all-party group comes from the Council for Evidence-based Psychiatry, or CEP UK, which has found that the prescription of antidepressants and other drugs is still increasing rapidly year by year.

The Pharmaceutical Journal reported in July that the number of antidepressants prescribed in England rose by 5.1% in 2021-22, compared with the previous year, which was the sixth annual increase in a row. Over the same period, the number of antidepressant items prescribed increased by 34.8%, rising to 83.4 million items in 2021-22. According to Public Health England, as many as one in four adults in England over 18 are being prescribed benzos, Z-drugs, opioids or some form of antidepressant.

In 2019, following a lot of pressure from the APPG, Public Health England published a comprehensive evidence review of dependence-forming drugs. This showed that 26% of the adult population in England was prescribed a dependence-forming drug in the previous year. In its earlier review of data, PHE found that more people were being prescribed medicines inappropriately, and often for longer than good practice guidance recommended.

A recent BBC “Panorama” programme, I think in June, showed that there are still almost no NHS services to support patients who have been harmed by taking drugs as prescribed by their doctor. The programme detailed how patients experiencing severe and prolonged withdrawal symptoms have resorted to online peer groups for validation, support and safe drug tapering advice. My noble friend knows the inner processes of government from over many years, and he will have a lot more patience than me with the inability of officials to act on agreed principles. We have heard his frustration, and we can all easily sympathise with it. When it comes to helping those suffering from withdrawal, at least two promised policies involving a helpline and the support of the voluntary sector have been, if not shelved, then placed firmly on the shelf.

In response to the 2019 PHE review, NHS England published its framework for action, Optimising personalised care for adults prescribed medicines associated with dependence or withdrawal symptoms. This was published in March and was intended to encourage integrated care boards to develop services. While that has been widely welcomed as a further positive step by government, a recent FOI revealed that only 6% of the ICBs are considering taking any action on the framework. The same PHE review also recommended that a national helpline to support people going through intense withdrawal from prescribed drugs should be set up in partnership with those with relevant experience—in other words, something very practical. At a time when issues of patient safety are very much in the public mind, it is disappointing that the DHSC has recently confirmed that it cannot find the £2 million necessary to set up this lifeline, which is urgently needed until local services start to become available.

There are a number of small voluntary organisations scattered across the country—in Camden, north Wales, Bristol, for instance—providing a vital service to patients. But their relations with the NHS are tenuous. As the BBC reported again this morning, many are so frail that without funding, some, such as the Bristol Tranquilliser Project, have ceased or are ceasing to operate. In another survey of 500 patients, 92% said that they were not told about withdrawal effects when they were first prescribed antidepressants. This seems unimaginable. Surely, this is a service much too valuable to public health to be allowed to collapse. I have seen the rather negative letter from the DHSC, dated 3 August. This was a key recommendation of the review. When will it be reconsidered?

On the specific Question and paramedics, I draw attention to the NICE guidelines concerning safe prescribing and withdrawal management for medicines associated with dependence. Will paramedics who are able to prescribe be required to comply with guideline NG215, entitled Medicines Associated with Dependence or Withdrawal Symptoms: Safe Prescribing and Withdrawal Management for Adults? The practicalities associated with following such guidelines in an emergency situation, such as my noble friend described, need to be assessed and specific provision made for informed consent and follow-up by a GP to put in place NICE’s recommended management plan for such drugs.

Secondly, patients who have had difficulty withdrawing from dependence-forming medications frequently choose not to take such drugs in future. Would the Minister agree that paramedics need to take account of that? They must be able to check records for any history of discontinuation or protracted withdrawal syndrome, or advanced decisions made about the future administration of those medicines.

Following the PHE review, the all-party group is aware of efforts by NHSE to create an internal information hub on drugs associated with dependence, agreed in principle to be held on the NHS Specialist Pharmacy Service website. Can the Minister also confirm that paramedics will be signposted to this information in the event of any questions?

As I said, I warmly congratulate my noble friend. He has made a point and created a scene of what might happen to any of us. I hope the Minister will give him a really solid reply.