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

They found that one in four adults had been prescribed at least one of these classes of medicines in the year ending March 2018 and 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.

The five drugs included in the review were 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) and antidepressants (depression)

The study found that the number of prescriptions for antidepressants and gabapentinoids are rising and women and older adults (particularly over-75s) are prescribed to at the highest rates

Prescribing  rates and duration of prescription are higher in some of the most deprived areas of England while 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

Opioids for chronic non-cancer pain are known to be ineffective for most people when used long-term (over 3 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.

Rosanna O’Connor, Director of Alcohol, Drugs, Tobacco and Justice at PHE said:

We know that GPs in some of the more deprived areas are under great pressure but, as this review highlights, more needs to be done to educate and support patients, as well as looking closely at prescribing practice, and what alternative treatments are available locally.

While the scale and nature of opioid prescribing does not reflect the so-called crisis in North America, the NHS needs to take action now to protect patients.

Our recommendations have been developed with expert medical royal colleges, the NHS and patients that have experienced long-term problems. The practical package of measures will make a difference to help prevent problems arising and support those that are struggling on these medications.


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