Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what steps he is taking to raise awareness of the long term impact of prescription painkillers.

The Medicines and Healthcare products Regulatory Agency (MHRA) is an executive agency of the Department, with responsibility for ensuring medicines meet appropriate standards of quality, efficacy, and safety.

Medicines authorised to treat pain fall with several different classes of medicine. Prescription medicines include opioids, gabapentinoids, namely pregabalin and gabapentin, and non-steroidal anti-inflammatories (NSAIDs). Other classes of medicine such as anti-epileptics or antidepressants may also be used for the treatment of neuropathic pain, a type of pain evolving from nerve damage, as recommended by the National Institute for Health and Care Excellence (NICE), with further information available at the following link:

https://www.nice.org.uk/guidance/cg173

New medicines are also available for the treatment of migraine. The MHRA monitors the safety of all these medicines and has issued warnings and updated product and patient information on the risk of addiction to opioids, with further information available at the following link:

https://www.gov.uk/drug-safety-update/opioids-risk-of-dependence-and-addiction

The MHRA is currently undertaking a review to improve the information supplied with dependency-forming medicines including gabapentinoids. If additional signals of risk arise, action will be taken to protect public health.

All medicines have side effects, although not everyone will experience them. The MHRA encourages anyone who suspects or experiences a side effect of their medicine to report it to the MHRA through the Yellow Card scheme.

NICE also provides clinical guidance called Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults, code NG 215. This guidance is available at the following link:

https://www.nice.org.uk/guidance/NG215

Additionally, NHS England has an initiative to reduce long-term opioid use, with further information available at the following link:

https://www.england.nhs.uk/long-read/reducing-long-term-opioid-use/

In March 2023, NHS England published Optimising personalised care for adults prescribed medicines associated with dependence or withdrawal symptoms: Framework for action for integrated care boards (ICBs) and primary care, which is available at the following link:

https://www.england.nhs.uk/long-read/optimising-personalised-care-for-adults-prescribed-medicines-associated-with-dependence-or-withdrawal-symptoms/

The framework includes five actions, resources and case studies to help systems develop plans that can support people who are taking medicines associated with dependence and withdrawal symptoms by:

- optimising personalised care for adults prescribed medicines associated with dependence or withdrawal symptoms;

- informing ICB improvement and delivery plans, when commissioning services and developing local policies that offer alternatives to medicines in the first place and/or support patients experiencing prescribed drugs dependence or withdrawal; and

- ensuring a whole system approach and pathways involving multiple interventions, to improve care for people prescribed medicines associated with dependence and withdrawal symptoms.

The commissioning of services to support people to safely withdraw from prescribed medicines that may cause dependence and withdrawal lies with ICBs. NHS England expects ICBs to commission appropriate services to meet the needs of the population that the ICB geographically covers. This includes taking due regard to any national commissioning and clinical guidance.

The National Health Service Business Services Authority provides data dashboards relating to painkiller prescribing, to help systems develop plans and to monitor improvement in line with the published Optimising personalised care for adults prescribed medicines associated with dependence or withdrawal symptoms: Framework for action for integrated care boards (ICBs) and primary care guidance.