Prescription drug addiction: government launches investigation

Public Health England will review prescription of medicines including opioid painkillers

The government has ordered an investigation into the growing problem of addiction to prescription drugs such as painkillers and medicines to treat anxiety and insomnia.

Steve Brine, the public health minister, has acted after it emerged that one in 11 (8.9%) patients treated by the NHS in England last year was given a drug that can induce dependency.

Fears about excessive prescription has also been boosted by the more than 100% rise in the number of antidepressants prescribed in England over the last decade and the fact that prescription of addictive medicines has increased by 3% over the last five years.

Britain needed to heed warnings from America, where an estimated 64,000 people a year are dying from drug overdoses, partly as a result of a huge recent increase in addiction to painkillers, Brine said.

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

Brine has asked Public Health England to undertake an independent inquiry into the scale of the problem, including the harms caused by dependence on and withdrawal from a range of commonly prescribed drugs.

PHE will assess the evidence relating to the prescription of, and problems resulting from, the use of:

  • Benzodiazepines (anti-anxiety medications) such as Valium, Ativan and Xanax.
  • Z-drugs, a similar class of drugs often used to treat insomnia.
  • Antidepressants.
  • Opioid pain-relieving drugs.
  • Pregabalin, which is used for anxiety, insomnia and nerve pain.
  • Gabapentin, an anticonvulsant used to treat epilepsy

“It’s 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,” said Rosanna O’Connor, PHE’s director of drugs, alcohol and tobacco.

PHE said it will be conducting a “broad, public-health focused review of commonly prescribed medicines for adults who have pain [excluding pain from cancer], anxiety, insomnia or depression”. It is due to report its findings in early 2019.

Brine has asked PHE to make recommendations outlining what it thinks the government and NHS should do to limit problems of addiction.

The British Medical Association, which represents most of Britain’s doctors, said ministers should establish a helpline to give addicts help and advice as a matter of urgency.

“A national helpline, similar to the Frank service [for users of illicit drugs such as heroin and cocaine], could be set up relatively quickly. This would give individuals suffering with dependence to drugs like benzodiazepines vital, timely support,” said Dr Andrew Green, the clinical and prescribing lead on the BMA’s GPs committee.

Almost 100 people are dying every day across America from opioid overdoses – more than car crashes and shootings combined. The majority of these fatalities reveal widespread addiction to powerful prescription painkillers. The crisis unfolded in the mid-90s when the US pharmaceutical industry began marketing legal narcotics, particularly OxyContin, to treat everyday pain. This slow-release opioid was vigorously promoted to doctors and, amid lax regulation and slick sales tactics, people were assured it was safe. But the drug was akin to luxury morphine, doled out like super aspirin, and highly addictive. What resulted was a commercial triumph and a public health tragedy. Belated efforts to rein in distribution fueled a resurgence of heroin and the emergence of a deadly, black market version of the synthetic opioid fentanyl. The crisis is so deep because it affects all races, regions and incomes

The Royal College of GPs however sounded a note of caution and said family doctors were not routinely overprescribing drugs that can lead to patients becoming addicted.

“Many addictive medications, when prescribed and monitored correctly, and in line with clinical guidelines, can be very effective in treating a wide range of health conditions. But all drugs will have risks and potential side-effects,” said Prof Helen Stokes-Lampard, the college’s chair.

“It is important not to automatically jump to the conclusion that more drugs being prescribed is always a bad thing. Advances in medical research mean that more medications are constantly becoming more available for patients, and they can increasingly be used to improve their health, and the nature of our NHS is that these medications are available to anyone who could benefit from them,” she added.

Limited availability of NHS alternatives to certain drugs, such as talking therapies instead of antidepressants, means GPs can end up prescribing potentially addictive medications.

“We know most patients would rather not be on long-term medication and where appropriate we will explore non-pharmacological treatments, but these – and this is particularly so for psychological therapies – are often scarce at community level,” said Stokes-Lampard.


Denis Campbell Health policy editor

The GuardianTramp

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