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e-Petition number: P-05-784 Petition title: Prescription drug dependence and withdrawal - recognition and support Text of petition: We call on the National Assembly for Wales to urge the Welsh Government to take action to appropriately recognise and effectively support individuals affected and harmed by prescribed drug dependence and withdrawal. This petition has been set up to raise awareness of the plight of individuals in Wales who are affected by dependence on and withdrawal from prescribed antidepressants and benzodiazepines – and specifically to ask the Welsh Government to support the BMA's UK-wide call for action to provide timely and appropriate support for individuals affected. The term "prescription drug dependence" refers specifically to the situation where, having taken their antidepressant or benzodiazepine medication exactly as prescribed by their doctor, patients find they are unable to stop because of the debilitating withdrawal effects. It is important to note here that addiction and dependence are related but different issues. Use of the term addiction implies pleasure seeking behaviour. Reporting of prescription drug dependence in the media continues to allude to "misuse" and "addiction" as if the patient is responsible in some way for their own harm. This is far from the truth. There is no pleasure whatsoever in finding that if you try to reduce or stop your antidepressant, you suffer a wide range of physical and emotional disturbances, that for some people can be life limiting and, tragically, even life ending. Patients need formal acknowledgement, support and guidance to help them through their withdrawal journey and this currently does not exist. The British Medical Association has recently highlighted the issue of prescribed drug dependence. In May 2017, they wrote: "Prescribing of psychoactive drugs is a major clinical activity and a key therapeutic tool for influencing the health of patients. But often their use can lead to a patient becoming dependent or suffering withdrawal symptoms. In the absence of robust data, we do not know the true scale and extent of the problem across the UK. However, the evidence and insight presented to us by many charity and support groups shows that it is substantial. It shows us that the 'lived experience' of patients using these medications is too often associated with devastating health and social harms. This represents a significant public health issue, one that is central to doctors' clinical role, and one that the medical profession has a clear responsibility to help address." Because the side effects, tolerance effects and withdrawal effects of these medicines are not medically recognised for what they are, when patients develop these related effects/symptoms they are often prescribed other medicines and then polypharmacy complicates the problems further. Affected patients are finding themselves with vague diagnoses eg: 'medically unexplained symptoms' or 'functional/somatic system disorders'. These are essentially psychiatric diagnoses attributing various debilitating and disabling physical symptoms to patients' own anxiety, beliefs, etc. This has the effect of discounting, disempowering and demoralising these patients still further. If it cannot be acknowledged that patients can have sustained functional nervous system dysfunction and damage as a consequence of taking medicines 'as prescribed' (sometimes over many years), systemic medical learning and improvement is stifled and patients continue to be further harmed. Meanwhile the initial prescribing risks remain severely underestimated and misleading prescribing guidelines and 'best practice' advice is unchanged. |
Background
The use of prescribed psychoactive drugs (such as antidepressant or benzodiazepine medication) can often lead to a patient becoming dependent or suffering withdrawal symptoms. The British Medical Association (BMA) highlights on its website that due to the absence of robust data, they do not know the true scale and extent of the problem across the UK. However the evidence and insight presented to them by many charity and support groups shows that it is substantial. Data on UK prescribing patterns is provided on their website.
The BMA has undertaken a project working collaboratively with key stakeholders to start to identify what positive action can be taken for the future benefit of patients. This has had a particular focus on the prescribed use of benzodiazepines, z-drugs, opioids and antidepressants.
In March 2014, the BMA board of science sent out a call for evidence to gather the views of stakeholders on ways to improve the prevention and management of prescribed drug dependence. This evidence was set out in an analysis report published in October 2015, entitled ‘Prescribed drugs associated with dependence and withdrawal – building a consensus for action’.
Further to their work with a range of professional and governing bodies, charities and support organisations, the BMA is of the view that it is clear that there is an urgent need for better support systems for patients suffering because of dependence or withdrawal. The BMA also notes that patients often feel there is no support, and no one to talk to, when they encounter problems with these psychoactive drugs.
In October 2016, the BMA published recommendations based on its analysis report:
§ The UK Government, supported by the devolved nations, should introduce a national, 24 hour helpline for prescribed drug dependence.
§ Each of the UK governments, relevant health departments and local authorities should establish, adequately resourced specialist support services for prescribed drug dependence.
§ Clear guidance on tapering and withdrawal management should be developed collaboratively with input from professional groups and patients.
Welsh Government action
The response to the petition by the Minister for Social Services and Public Health (dated 18 October 2017) refers to 'Working Together to Reduce Harm', the Welsh Government’s 10-year strategy to tackle the associated harms of substance misuse which sets out the approach to tackling the full range of substances that are misused in Wales. This includes prescription only medicines and over the counter medicines, such as preparations containing codeine.
The Welsh Government has also published a Substance Misuse Delivery Plan for 2016-18 and a Substance Misuse Annual Report and Forward Look 2017. The Minister’s response to the petition notes that there are a number of specific actions in the Substance Misuse Delivery Plan 2016-18 relating to tackling dependence on prescription only medicines and over the counter medicines. These actions include targeted prevention and awareness raising campaigns and the development of a specific Substance Misuse Treatment Framework (SMTF) focusing specifically on prescription only medicines and over the counter medicines. The Minister goes on to say that this guidance, expected to be published in March 2018, will assist Area Planning Boards and treatment services in responding to the needs of those with a dependence on these medicines.
The Minister’s response highlights that guidance has been published by the National Institute for Health and Care Excellence (NICE), the All Wales Medicines Strategy Group and the Welsh Government which should be followed when prescribing treatment to patients.
The Welsh Government invests almost £50m in the substance misuse agenda annually, with £22.6m provided to the seven Area Planning Boards which are responsible for commissioning all local substance misuse services in order to support those who are dependent on a range of drugs, including prescription only medicines and over the counter medicines.
Further information
The Assembly’s Health and Social Care Committee carried out an inquiry into alcohol and substance misuse and published its report in August 2015.
The Research Service produced a briefing in June 2016 on the Misuse of prescription and over-the-counter medications. This briefing describes the extent of the problem of the misuse of prescription and over-the-counter medicines in Wales and summarises the action being taken to tackle it.