Asked by: Alex Norris (Labour (Co-op) - Nottingham North)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, with reference to the announcement, Millions at risk from antidepressant withdrawal, new review concludes, published by the All-Party Parliamentary Group for Prescribed Drug Dependence in October 2018, what steps his Department has taken to ensure the accuracy of prescribing guidance issued by the NHS.
Answered by Jo Churchill - Minister of State (Department for Work and Pensions)
The Government takes the issue of responsible prescribing seriously. The National Institute for Health and Care Excellence (NICE) is currently developing guidance for the National Health Service on the safe prescribing and withdrawal management of prescribed drugs associated with dependence and withdrawal. NICE’s guidance will be based on a thorough assessment of the available evidence and developed through extensive engagement with stakeholders. NICE expects to publish draft guidance in May 2021 with final guidance in November 2021.
On 10 September Public Health England will publish its evidence review on dependence and withdrawal associated with some prescribed medicines, including anti-depressants. This work is timely as it follows the Chief Medical Officer opioids roundtable held earlier this year and will further our understanding of dependency on prescribed medicines in England and Wales and how such issues should be addressed. We look forward to working with PHE to look at taking forward any recommendations made in the review.
Asked by: Ben Bradley (Conservative - Mansfield)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what programmes there are in prisons to provide support for prisoners with synthetic cannabis drug dependency.
Answered by Jackie Doyle-Price
In prison, patients presenting with problematic psychoactive substance use are assessed in the same way as other drug users and offered an appropriate range of psychosocial interventions.
In April 2018, NHS England and NHS Improvement published its updated service specification on ‘Integrated Substance Misuse Treatment Service in Prisons in England’. This is fully aligned to ‘Drug Misuse and Dependence: UK Guidelines on Clinical Management’, which sets out how clinicians should treat people with drug misuse and drug dependence problems.
The service specification describes a fully recovery orientated, integrated prison substance misuse treatment service, which covers traditional drugs of abuse, psychoactive substances (including synthetic cannabis), illicit abuse of prescribed and over the counter drugs and alcohol.
This improved substance misuse service offer is now being commissioned across all prisons and secures integration with mental health services so that growing numbers of people in prisons can access services to support their recovery and wellbeing.
Asked by: Daniel Zeichner (Labour - Cambridge)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what estimate he has made of the number of prescriptions dispensed in the community for nicotine replacement therapy in each year since 2010.
Answered by Steve Brine
The following table shows the number of nicotine dependence prescription items dispensed in the community, via an FP10 form, in England 2010-17. There are various other routes in which such medication can be supplied to a patient from the National Health Service including from community pharmacies via voucher schemes and a direct supply to patients from a Patient Group Direction, this data is not collected centrally.
| Bupropion Hydrochloride | Nicotine replacement therapy | Varenicline Tartrate | Total nicotine dependence |
2010 | 39,298 | 1,549,892 | 955,242 | 2,544,432 |
2011 | 32,290 | 1,580,051 | 994,775 | 2,607,116 |
2012 | 27,790 | 1,397,993 | 891,110 | 2,316,893 |
2013 | 23,719 | 1,138,522 | 741,506 | 1,903,747 |
2014 | 21,980 | 841,077 | 588,500 | 1,451,557 |
2015 | 21,831 | 667,877 | 517,228 | 1,206,936 |
2016 | 22,341 | 567,087 | 418,527 | 1,007,955 |
2017 | 23,338 | 494,614 | 395,808 | 913,760 |
Source: Prescription Cost Analysis (PCA) NHS Digital
Notes:
Prescriptions are written on a prescription form known as an FP10. Each single item written on the form is counted as a prescription item.
PCA Data
Prescription information is taken from the PCA system, supplied by NHS Prescription Services, a division of NHS Business Services Authority, and is based on a full analysis of all prescriptions dispensed in the community i.e. by community pharmacists and appliance contractors, dispensing doctors, and prescriptions submitted by prescribing doctors for items personally administered in England. Also included are prescriptions written in Wales, Scotland, Northern Ireland and the Isle of Man but dispensed in England. The data do not cover drugs dispensed in hospitals, including mental health trusts, or private prescriptions.
Prescribers are general practitioners, hospital doctors, dentists and non-medical prescribers such as nurses and pharmacists.
British National Formulary (BNF) Classifications
The PCA system uses the therapeutic classifications defined in the BNF using the classification system prior to edition 70. Information on why a drug is prescribed is not available in this dataset. Since drugs can be prescribed to treat more than one condition, it may not be possible to separate the different conditions for which a drug may have been prescribed.
The primary purpose of the BNF is to provide information for clinicians. The format of the BNF was changed with Edition 70 (September 2015 - March 2016) to make it more user friendly. However, the NHS Business Service Authority, who process dispensed prescription forms and collects dispensed prescribing data and produce the PCA data, continue to use the old BNF classification system to code medicines, which has become widely used in the United Kingdom as a classification to allow comparisons between drug groups. For example, it is used to report cost and trend in medicines use and supports several NHS Digital official publications. The data are used in many NHS IT systems.
Asked by: Lord Hunt of Kings Heath (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government whether they will establish a public inquiry into the harmful effects of prescribed benzodiazepine drug dependence over the last 50 years.
Answered by Lord O'Shaughnessy
The Parliamentary under Secretary of State (Steve Brine MP) commissioned Public Health England (PHE) to review the evidence for dependence on, and withdrawal from, prescribed medicines. The review was launched in January 2018 and is due to report in spring 2019 and we await its findings. It is the responsibility of local authorities to commission services, such as the provision of withdrawal centres for addiction to prescribed medicines, to meet assessed local need. The Government currently has no plans to increase the number of these centres.
The Government has no plans to introduce a separate national helpline to support people affected by prescribed drug dependence. Help and advice on prescribed drug dependence is already available from the 111 helpline or NHS Choices. People who feel that they might be dependent on either prescribed or over the counter medicines should seek help from a health professional in the first instance (such as a general practitioner or pharmacist).
PHE’s review includes prescribed benzodiazepine drug dependence but will not consider evidence further back than 10 years ago. There are no plans to establish a public inquiry into prescribed benzodiazepine drug dependence.
Asked by: Lord Hunt of Kings Heath (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government whether they will ensure that in establishing a 24 hour helpline for people affected by prescribed medicines addiction they will also ensure that adequate services are in place to refer patients to.
Answered by Lord O'Shaughnessy
The Parliamentary under Secretary of State (Steve Brine MP) commissioned Public Health England (PHE) to review the evidence for dependence on, and withdrawal from, prescribed medicines. The review was launched in January 2018 and is due to report in spring 2019 and we await its findings. It is the responsibility of local authorities to commission services, such as the provision of withdrawal centres for addiction to prescribed medicines, to meet assessed local need. The Government currently has no plans to increase the number of these centres.
The Government has no plans to introduce a separate national helpline to support people affected by prescribed drug dependence. Help and advice on prescribed drug dependence is already available from the 111 helpline or NHS Choices. People who feel that they might be dependent on either prescribed or over the counter medicines should seek help from a health professional in the first instance (such as a general practitioner or pharmacist).
PHE’s review includes prescribed benzodiazepine drug dependence but will not consider evidence further back than 10 years ago. There are no plans to establish a public inquiry into prescribed benzodiazepine drug dependence.
Asked by: Lord Hunt of Kings Heath (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what plans they have, if any, to increase the number of prescribed medicines withdrawal centres to cover the whole of England.
Answered by Lord O'Shaughnessy
The Parliamentary under Secretary of State (Steve Brine MP) commissioned Public Health England (PHE) to review the evidence for dependence on, and withdrawal from, prescribed medicines. The review was launched in January 2018 and is due to report in spring 2019 and we await its findings. It is the responsibility of local authorities to commission services, such as the provision of withdrawal centres for addiction to prescribed medicines, to meet assessed local need. The Government currently has no plans to increase the number of these centres.
The Government has no plans to introduce a separate national helpline to support people affected by prescribed drug dependence. Help and advice on prescribed drug dependence is already available from the 111 helpline or NHS Choices. People who feel that they might be dependent on either prescribed or over the counter medicines should seek help from a health professional in the first instance (such as a general practitioner or pharmacist).
PHE’s review includes prescribed benzodiazepine drug dependence but will not consider evidence further back than 10 years ago. There are no plans to establish a public inquiry into prescribed benzodiazepine drug dependence.
Asked by: Lord Hunt of Kings Heath (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what plans they have to secure funding for existing prescribed medicines withdrawal centres.
Answered by Lord O'Shaughnessy
The Parliamentary under Secretary of State (Steve Brine MP) commissioned Public Health England (PHE) to review the evidence for dependence on, and withdrawal from, prescribed medicines. The review was launched in January 2018 and is due to report in spring 2019 and we await its findings. It is the responsibility of local authorities to commission services, such as the provision of withdrawal centres for addiction to prescribed medicines, to meet assessed local need. The Government currently has no plans to increase the number of these centres.
The Government has no plans to introduce a separate national helpline to support people affected by prescribed drug dependence. Help and advice on prescribed drug dependence is already available from the 111 helpline or NHS Choices. People who feel that they might be dependent on either prescribed or over the counter medicines should seek help from a health professional in the first instance (such as a general practitioner or pharmacist).
PHE’s review includes prescribed benzodiazepine drug dependence but will not consider evidence further back than 10 years ago. There are no plans to establish a public inquiry into prescribed benzodiazepine drug dependence.
Asked by: Lord Hunt of Kings Heath (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government whether they will ensure that members of Parliament and members of the House of Lords will have an opportunity to meet with Public Health England to discuss the review of prescribed medicines addiction before it reports.
Answered by Lord O'Shaughnessy
Public Health England (PHE) is open to engagement with hon. Members and noble Lords on this issue.
PHE is also in regular contact with the All-Party Parliamentary Group on Prescribed Drug Dependence, including presenting at the group’s meetings in Parliament. We expect that this contact will continue.
Asked by: Lord Hunt of Kings Heath (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what assessment they have made of the effectiveness of substance misuse services and, in particular, whether they may bring patients off the use of prescribed medicines too quickly leaving many in a damaged state.
Answered by Lord O'Shaughnessy
Public Health England (PHE) carried out an extensive review of the effectiveness of drug treatment in England. The review gives policy makers and local areas an objective assessment of what drug treatment outcomes are achievable, and compares outcomes in England to the evidence and to other drug treatment systems. An evidence review of outcomes that can be expected of drug misuse treatment in England is attached.
Local authorities are responsible for assessing local need for substance misuse treatment and commissioning services to meet these needs. This includes making sure the services follow clinical guidelines in treating people who have dependence problems. The United Kingdom drug treatment clinical guidelines set out guidance for clinicians in managing withdrawal for patients from prescribed medicines.
PHE is undertaking a review of the evidence for dependence on, and withdrawal from, prescribed medicines. The review will bring together the best available evidence on effective prevention and treatment of dependence, withdrawal and discontinuation syndrome for each drug category. The review is due to be published in spring 2019.
Asked by: Lord Hunt of Kings Heath (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government whether the Public Health England Expert Group on Prescribed Drug Dependence will accept as evidence the individual testimonies of patients.
Answered by Lord O'Shaughnessy
Public Health England (PHE) has been commissioned to undertake a public health evidence review of available data and published evidence on the problems associated with dependence, and the short term discontinuation or longer term withdrawal symptoms, associated with prescribed medicines.
PHE is aware of the importance and relevance of the experience of patients in understanding the issues. The review will include a call for papers which specifically identifies published accounts of the patients’ experiences, and this material will be specifically and deliberately focused on in the review. This process is distinct from a public inquiry, which would include individual testimony.
PHE is committed to publishing the agenda, papers and minutes of meetings of the expert reference group and the first set of these documents will be available during July 2018.