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This week, the BMA published recommendations based on its report Prescribed drugs associated with dependence and withdrawal – building a consensus for action. We have three main calls to action.
The publicity was huge, with headlines on the national news throughout the day and BBC Radio 5 Live devoting the whole of its Sunday morning investigative programme to benzodiazepine dependence, pushing aside another planned story, and I found myself doing a round of TV, radio, and press interviews over a weekend originally set aside for more domestic duties.
Although the BMA’s work, and the recommendations, have been widely welcomed by patient groups and other bodies, a subject as emotive as this was bound to raise strong reactions and two themes kept returning - what took you so long, and why is long-term prescribing continuing?
While it is true that the problems of benzodiazepine dependence have been known for many years, the scale of the problem, and the depth of feeling of those patients involved, has perhaps not been acknowledged.
Although the total number of benzodiazepine prescriptions has been reducing, it is unclear how many of these relate to long-term use, and The University of Roehampton has attempted to calculate this, with a suggested total of over a quarter of a million patients receiving prescriptions for more than six months.
Every patient’s story is different, but many contain similar themes. They describe the bitterness they feel at having been harmed by a medication they thought would help them, and then having this compounded by finding, when they turned to the NHS for help, that the services for them were not there. Indeed, some reported feeling that they were being blamed for their dependence, when actually they had taken the medication as instructed by their doctors.
This situation of blame and mutual distrust benefits nobody, and it was to break this logjam that the BMA begun their work, by looking for areas of agreement, and looking forward to how the current situation might be improved.
So, was I left defending the indefensible, defending the irresponsible and continuing over-prescribing of these drugs in contravention to established guidelines? I don’t think so, no; primarily because defending was never the intention, explaining was.
The number of patients involved is too high, without a doubt, but it represents about half a dozen people per GP, so an individual doctor will sign a couple of repeat prescriptions per week. When mental health issues are the largest single reason for a GP visit, this demonstrates that the clear majority of distressed patients and managed within the current guidance.
Continued prescribing is also in many cases appropriate. It is indefensible to stop these medications abruptly, and reductions done without full agreement and commitment from the patient are doomed to failure, adding to the patient’s misery and feelings of failure and anxiety. Repeat prescriptions is these circumstances are best looked on as harm-reduction maintenance until the patient is ready for change.
We are in some danger of concentrating too much on the final act of prescribing, the pressing of the ‘enter’ key and the spitting out from the printer of the green piece of paper. The prescribing decision is simply the end of a complex interaction between the doctor, the patient, the illness, and society, and while we continue to live in a fragmented unequal world, with poor access to acute mental health services, and with GPs who have less time to spend with their patients than those in other comparable countries, prescribing will continue to be higher than it might.
My hope is that this work will enable doctors and patients to speak together, with one voice, looking to reduce prescribing through the provision of services to help those trapped in this situation, as well as by preventing others beginning what we have heard can be a terrible journey.
Andrew Green is the BMA GPs committee clinical policy lead
For more information visit the BMA website
Hallelujah! I wish this could happen on my side of the pond in the U.S. I can only imagine prescription drug dependency is an equal or even bigger problem here! I hope your experts will be accessed by U.S. stakeholders to help provide adequate support for people here! This is a tragedy that the medical establishment, government and drug companies must stop sweeping under the rug! Donna Kolojeskie - USA
Thank you for this helpful article on an issue which produces conflict in my experience between GPs in practices depending on the involvement they have in seeking to continue to support and treat patients in a holistic way and not just look at prescribing targets. You are right that it relates to time available to spend with patients, listening to their perspective and helping them to build confidence and find better ways to reduce anxiety. An ongoing challenge especially for those in deprived areas.
I am so pleased to see this position coming from the BMA, coming from NI with the highest rate of prescription drug use in the UK, and we have recently found, higher inclusion of prescription drug than illicit drug rates in coroner reports. I am writing up research with prisoners and one of the biggest narratives of participants was being withdrawn off prescribed prescription medication on entry with no supports put in place, whilst being demonised as 'drug seeking'.
Please take a look at the RxISK blog. There is no need to repeating the same data gathering gathering over and over again...there is no mention of looking for a cure for the arms caused to so many people ..Why not? it adds to the cynicism of 'suffers.