Government launches review of prescription drug misuse in England

The government has launched a “landmark review” to address prescription drug addiction and dependency in England.

Pharmacy minister, Steve Brine, has commissioned Public Health England (PHE) to carry out an evidence review to assess the scale of prescription drug addiction in the country and devise recommendations on how best to address it.

The review will consider the reasons why: one in 11 patients is prescribed an addictive medicine; prescribing of these drugs has increased by 3% over the past five years; antidepressant prescriptions in England have more than doubled in the past ten years; a recent survey found that 7.6% of adults had taken a prescription-only painkiller not prescribed to them.

It will cover benzodiazepines, z-drugs, pregabalin and gabapentin, opioids and antidepressants.

“We know this is a huge problem in other countries like the United States—and we must absolutely make sure it doesn’t become one here,” said Brine.

“While we are world-leading in offering free treatment for addiction, we cannot be complacent — that is why I have asked PHE to conduct this review.

“This will help us understand the scale of this issue here and how we can address it,” he added.

Director of drugs, alcohol and tobacco at PHE, Rosanna O’Connor, said she welcomed the opportunity to develop a better understanding of how widespread the problem of prescription drug addiction is and the most effective ways to help those in need.

“It is of real concern that so many people find themselves dependent on or suffering withdrawal symptoms from prescribed medicines. Many will have sought help for a health problem only to find later on they have a further obstacle to overcome,” she said.

Evidence-based strategies needed

Roger Knaggs, an advanced pharmacy practitioner specialising in pain management, and a spokesperson for the Royal Pharmaceutical Society, said that although opioid prescribing has increased in the UK it does not appear to be having the same influence on mortality in the UK as in the US.

He went on to explain that while opioids can be effective for pain after trauma or surgery and at the end of life, current evidence suggests they are of benefit for a much smaller proportion of patients with long-term pain.

“Analgesic medicines are only helpful for a minority of patients with long-term pain,” he said.

”Best prescribing practices would suggest that they are started for a short trial period and reviewed around one month after initiation — if there is no benefit then, they should be tapered and other treatment approaches considered.”

Knaggs emphasised that there needs to be improved understanding by healthcare professionals, policymakers and the public alike, about long-term pain, its influences, meaning and treatment.

“Evidence-based strategies to support patients with ongoing pain and continuing to take analgesic medicines but not obtaining any benefit need to be highlighted and funded appropriately,” he said.

“There needs to be better liaison between primary care and specialist pain and misuse services for this group of patients who are ineligible or do not wish to attend addiction/misuse services currently commissioned for people with misuse problems with illicit substances.”

Helen Stokes-Lampard, chair of the Royal College of GPs, welcomed the review but said it was important not to jump to the conclusion that more drugs being prescribed was always a bad thing.

“GPs will always prescribe in the best interests of the individual patient in front of us, taking into account the physical, psychological and social factors that might be impacting their health,” she said.

“We will only prescribe medication after a frank conversation with the patient about the potential risks and benefits, and we will also conduct regular medication reviews in partnership with the patient.”

The findings of the PHE review will be published in early 2019.