Prescribed drugs associated with dependence and withdrawal

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.

Location: UK
Audience: All doctors
Updated: Monday 7 September 2020
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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.

For a number of years, we have worked collaboratively with medical bodies and patients to identify what positive action can be taken to support patients.

This has had a particular focus on the prescribed use of benzodiazepines, z-drugs, opioids and antidepressants.

While there is a wide range of actions needed to address this issue comprehensively, the following recommendations set out key policy calls identified through our ongoing programme of work.

 

A national, 24 hour helpline

The UK government, working with the devolved nations, should introduce a national, 24 hour helpline for prescribed drug dependence.

There is a strong view among stakeholders that this should be the top priority action for providing better support to individuals affected by prescribed drug dependence. Evidence submitted to the BMA sets out a compelling case for a helpline which would provide vital, real time support, and could be implemented in a relatively short time frame.

While there are a limited number of existing helplines run by small charities and support groups, these only cover a small proportion of the UK, and report significant demand. Too many patients do not therefore have access to this critical support.

A national helpline would sit alongside a website and act as a single trusted resource for patients on managing prescribed drugs dependence, coping strategies and support for carers and family members. It would also provide a service that doctors could signpost patients to when they need support.

This would follow a similar model to the FRANK service that provides advice on illicit drugs.

 

Specialist support services

Each of the UK governments, relevant health departments and local authorities should establish, adequately resourced specialist support services for prescribed drug dependence.

Our analysis highlighted a gap in the provision of appropriate and specialised services for those suffering with dependence to prescribed drugs. There are limited examples of support services in some local areas where a concerted lobbying effort has resulted in an effective local response; for example the Bridge Project based in Bradford and Oldham Tranx. However, these services are isolated examples of good practice and provision is inconsistent across the country.

In the absence of specialist services, patients are often referred to general drugs services, which do not have the resource, training or skills to manage prescription dependence. Patients may also not access these services because of the stigma around illicit drug use. To overcome the inconsistent provision of support across the UK, a national approach should be adopted in order to allow doctors to refer patients who require support in their local area.

 

Guidance on tapering and withdrawal management

Clear guidance on tapering and withdrawal management should be developed collaboratively with input from professional groups and patients.

Prescribing of psychoactive medications should be informed by good quality guidance. Our analysis found that doctors do not feel there is adequate guidance on tapering and withdrawal management, particularly in relation to benzodiazepines. In contrast, charity and support groups are broadly of the view that these exist and should already be in use. This difference can be attributed to the existing guidelines on benzodiazepines being expert-based rather than having a strong scientific evidence base, and medical professionals therefore not feeling confident in using them. Our analysis also found that there is an inconsistent approach to managing withdrawal from antidepressants, and that existing guidance was in urgent need of revision.

The adverse consequence of these issues is patients suffering significant harm as a result of rapid and poorly managed tapering protocols. Action is therefore needed to develop robust guidance on tapering and withdrawal management for psychoactive medications. NICE (National Institute for Health and Care Excellence) have recognised that this is an issue and is considering the development of guidance on managing prescription medicines associated with dependence and withdrawal. As is their standard approach, such a review would include actively seeking input from a wide range of stakeholders including practitioners and those who use services and family members or carers.

To complement these measures, it is important to promote best practice through the development of a readily accessible, practical and compact resource for prescribers and other clinicians.

The Royal Pharmaceutical Society publish a competency framework for all prescribers in collaboration with patients and other prescribing professions. The framework published in July 2016 is endorsed by a number of professional bodies and is next due to be updated in July 2020.