Review of medicines finds one in four adults taking ‘potentially addictive drugs’

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Almost 12 million adults in England were prescribed potentially addictive drugs such as sleeping pills and painkillers last year, with half taking them long term, a new report says.

A review of five classes of medicines – including anti-anxiety drugs, anti-depressants and opioid painkillers – found some patients struggle to come off them, suffering suicidal thoughts and anxiety as a result.

Public Health England (PHE), which led the Government-ordered review, said a helpline must be set up for the millions of people who may be dependent on the drugs.

Health Secretary Matt Hancock said the country was in the “grip of an over-medication crisis”.

The PHE study found that, since at least a decade ago, more people are being prescribed potentially addictive medicines and for longer periods of time.

It looked in detail at benzodiazepines (such as diazepam) which are commonly prescribed for anxiety and insomnia; Z drugs (such as zopiclone for insomnia); gabapentinoids (such as pregabalin for nerve pain, epilepsy and anxiety); opioid pain medications for non-cancer pain; and anti-depressants.

PHE experts found one in four adults in England had been prescribed one of these drugs in the year up to the end of March 2018, with half of these having had a continuous prescription for at least the previous 12 months.

In one year, 17% of the adult population were given anti-depressants (7.3 million people), 13% were given opioids (5.6 million), 3% gabapentinoids (1.5 million), 3% benzodiazepines (1.4 million) and 2% were given Z drugs (one million).

Up to a third of people had been on the drugs for at least three years, including 930,000 people on anti-depressants and 540,000 on opioids.

Experts said opioids are known to be ineffective for most people over the long term (over three months), while benzodiazepines are not recommended for use for longer than 28 days.

PHE was unable to put an exact figure on how many people are addicted to the drugs long term or who suffer problems when trying to come off them.

But it said patients must be warned via a national helpline and website about common side-effects of the drugs, receive advice on withdrawing from the medicines and what to expect, and be offered coping strategies.

It urged the public not to stop taking their drugs in light of the review but to speak to their GP if they had concerns.

The report made a series of other recommendations, including more training for doctors, giving medics better access to data, including on prescribing rates in their area, and updating guidance on dependency and withdrawal problems.

It said doctors must also look to other therapies for their patients, such as cognitive behavioural therapy, or “social prescribing” of activities that might help, such as joining clubs or choirs.

Professor Paul Cosford, emeritus medical director at PHE, said some of the drugs, such as anti-depressants, do need to be taken in the long term to realise their full effect but admitted he was “surprised” by the number of people on the drugs.

He said the review found that while most prescriptions were short term, “significant numbers (of people) have been taking these medicines for a long time”.

He added: “We are not trying to stigmatise either these drugs or the people who take these drugs.

“When people are started on the drugs, it’s in line with clinical guidance.

“What you see is that a proportion of those people then find it very difficult to withdraw from the drugs and end up on a long-term prescription.

“That proportion gradually builds because it accumulates over the years and that’s the group we are particularly concerned about.”

The review found prescriptions for anti-depressants rose 10% between 2016 and 2018, while prescriptions for gabapentinoids increased by 20%.

However, prescriptions for opioids fell 3% across the same period, Z drugs by 6% and benzodiazepines by 8%.

The review found that women are 1.5 times more likely to be prescribed the drugs than men, while those living in deprived parts of England, particularly in the North East, are more likely to be given them, particularly opioids.

In March 2018, 513,000 people were taking both anti-depressants and opioids. Thousands more were taking a combination of three or more drugs.

Benzodiazepines and Z drugs can create long-term dependency and a risk of “rebound symptoms” when they are stopped, such as increased anxiety and sleep problems.

People coming off anti-depressants can also experience varying symptoms over the short term including insomnia, nausea and flu-like symptoms.

Meanwhile, opioids are addictive while offering little long-term benefit, the review said.

Mr Hancock said he would end “over-medicalisation”.

He said: “I’m incredibly concerned by this new evidence about the impact over-medicalisation is having on people across our country.

“The disturbing findings of the report – especially that one in eight adults in England are taking super strength, addictive opioid painkillers, many for extended periods of time – proves to me that we are in the grip of an over-medication crisis.

“What is equally alarming is that in many cases, these medicines are unlikely to be working effectively due to over-use.

“I refuse to let this escalate to the level seen in the United States. This review is a wake-up call, and we have already taken steps to address this issue.

“To be clear: the entire healthcare system will now be involved in making sure that we put an end to this once and for all.”

Professor Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said the study showed that the “vast majority of prescriptions issued are short term, and that we are seeing a decline in opioid prescriptions for chronic pain, both of which are encouraging trends”.

She added: “What it also indicates is the severe lack of alternatives to drug therapies for many conditions – and where effective alternatives are known and exist, inadequate and unequal access to them across the country.

“There are wide-ranging and complex issues surrounding the prescribing of opioids and anti-depressants.

“GPs don’t want to prescribe medication long term unless it is essential and most patients don’t want to be taking medication long term, but there will always be some patients for whom medication is the only thing that helps with distressing conditions such as chronic pain, or depression and anxiety.”

Dr Andrew Green, from the British Medical Association (BMA), said: “We have seen the devastation that addiction to prescription drugs has had in the United States, and while the problem here is on a lesser scale, doctors in the UK are of course concerned at the number of patients being prescribed these medicines, and the length of time they are taking them for.

“The BMA has been working for some years with patients and health organisations to understand and address the causes behind high prescription rates, and we were pleased to engage with this review and welcome its recommendations.

“Indeed, today’s report shows that prescription rates for some drugs – including opioid painkillers – are beginning to fall thanks to doctors actively working with their patients to avoid inappropriate prescribing.

“While there isn’t a single cause for high prescription rates, social deprivation, an increased prevalence of mental health problems and poor access to mental health care, a rise in the demand for GP services and a growing, ageing population are likely to be significant contributing factors.”

He said the country needed “many more alternatives to medication, such as pain clinics, improved access to mental health services, and physiotherapy – the universal provision of which are all lacking”.

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