Dependence on prescription medicines uncovered in Public Health England review

Dependence on prescription medicines uncovered in Public Health England review

A Public Health England review of prescribed medicines has linked dependence on prescription medicines to deprivation.

Public Health England has published the first-ever evidence review of dependence and withdrawal problems associated with five commonly prescribed classes of medicines in England.

The review assesses the scale and distribution of prescribed medicines – and makes recommendations for better monitoring, treatment and support for patients. It uses available prescriptions data, a literature review and reports of patients’ experiences.

A total of five classes of medicines were included in the review:

  • benzodiazepines (mainly prescribed for anxiety and insomnia),
  • Z-drugs (insomnia),
  • gabapentinoids (neuropathic pain),
  • opioid pain medications (for chronic non-cancer pain such as low back pain and injury-related and degenerative joint disease),
  • antidepressants (depression).

The main findings include:

  • one in four adults had been prescribed at least one of these classes of medicines in the year ending March 2018,
  • in March 2018, half of those receiving a prescription (of these classes of medicine) had been continuously prescribed for at least the previous 12 months. Between 22% and 32% (depending on the medicine class) had received a prescription for at least the previous three years,
  • long-term prescribing of opioid pain medicines and benzodiazepines is falling but still occurs frequently – which is not in line with the guidelines or evidence on effectiveness.

Trends in prescribing include:

  • the number of prescriptions for antidepressants and gabapentinoids are rising,
  • following years of increase prior to 2016, prescriptions for opioid pain medicines and z-drugs are now falling,
  • prescriptions for benzodiazepines continue to fall, as they were prior to 2016,
  • women and older adults (particularly over-75s) are prescribed to at the highest rates.

Links to deprivation include:

  • prescribing rates and duration of prescription are higher in some of the most deprived areas of England,
  • a similar pattern is also seen for the number of medicines co-prescribed (for example, at least two of the drugs),
  • for opioids and gabapentinoids, the prescribing rate in the most deprived quintile was 1.6 times the rate in the least deprived quintile,
  • the co-prescribing rate in the most deprived quintile was 1.4 times higher than in the least deprived quintile (30% compared to 21%).

Opioids for chronic non-cancer pain are known to be ineffective for most people when used long-term (over three months), while benzodiazepines are not recommended to be used for longer than 28 days. The review identified that when first used these medicines are prescribed for short term use. However, some patients do still end up being prescribed these medicines for longer periods.

Long-term prescribing is likely to result in dependence or withdrawal problems, but it is not possible to put an exact figure on the prevalence of dependence and withdrawal from current data.

People who have been on these drugs for longer time periods should not stop taking their medication suddenly. If they are concerned, they should seek the support of their GP.

People who had experienced problems from prescription medicines also reported that they felt uninformed before they started them, and unsupported when they experienced problems.

The drugs in this review are vitally important (when prescribed properly) for the health and wellbeing of many patients. It is important that doctors follow the clinical guidelines and do not put inappropriate limits on prescribing that could cause patients’ harm or drive them to seek drugs from illicit sources.

The review makes a number of recommendations focusing on education and treatment, including:

  • giving NHS commissioners and doctors better access to data, improving insight of prescribing behaviour in their local area and enabling GPs to follow best practice,
  • updating clinical guidance for medicines which can cause problems with dependence and withdrawal, and improving training for clinicians to ensure their prescribing adheres to best practice,
  • to develop new clinical guidance on the safe management of dependence and withdrawal problems,
  • giving better information to patients about the benefits and risks with these medicines
  • doctors should have clear discussions with patients – and where appropriate offer alternatives, such as social prescribing,
  • commissioners should ensure appropriate support is available locally for patients experiencing problems,
  • a national helpline for patients to be set up,
  • ensuring high-quality research around dependence and withdrawal is undertaken.

Public Health England has also published a detailed geographical breakdown by clinical commissioning groups of prescribing rates for 2017 to 2018 and the proportion of people that had been receiving a prescription for at least 12 months prior to March 2018.