Health Secretary Declares 'Over-medication Crisis'

Peter Russell

September 10, 2019

More than 1 in 4 adults are prescribed drugs that are potentially addictive or pose withdrawal problems, a report said.

The evidence review by Public Health England (PHE) found that in the year to March 2018, half of those receiving a prescription for a drug from five classes of medicines had been continuously prescribed them for at least a year.

Matt Hancock, Secretary of State for Health and Social Care, said evidence from the report made it clear to him that we were "in the grip of an opioid crisis".

The analysis showed that in 2017 to 2018, 11.5 million adults in England (26% of the adult population) received, and had dispensed, one or more prescriptions for any of these medicines.

The medicines included in the review were:

  • Benzodiazepines (1.4 million people)

  • Z-drugs (1.0 million)

  • Gabapentinoids (1.5 million)

  • Opioids for chronic non-cancer pain (5.6 million)

  • Antidepressants (7.3 million)

Prof Paul Cosford, PHE's medical director, said: "This report shows that while the vast majority of new prescriptions for these medicines are for short-term use, within clinical guidelines, it also highlights significant numbers have been taking these medicines for a long time.

"It is vital that clinical guidelines for prescribing are followed and regular reviews with patients take place to address this."

Prescription Rates

Between 2015 to 2016 and 2017 to 2018, there was a small decrease in prescribing rates for opioids, benzodiazepines, and z-drugs. However, prescriptions for antidepressants increased from 15.8% of the adult population to 16.6% and for gabapentinoids from 2.9% to 3.3%.

Rates of prescribing were 1.5 times higher for women than men, and rates generally increased with age.

Long-term Use

A snapshot of people receiving prescriptions in March 2018 found that around half of patients in each medicine class had received a prescription continuously for at least a year.

Between 22% and 32% had received a prescription for at least the previous 3 years, depending on the class of medicine.

The number of patients known to have received a prescription continuously between April 2015 and March 2018 ranged from 100,000 people receiving z-drugs to 930,000 people receiving antidepressants.

The review concluded that longer-term prescribing was widespread. It said that apart from antidepressants, which some people needed to take to maintain benefit and prevent relapse, the medications reviewed were all licensed and usually indicated for short-term treatment of acute conditions.

Benzodiazepines, for instance, should not usually be prescribed for longer than 2 to 4 weeks, while long-term prescribing of opioids for chronic, non-cancer pain was not effective for most patients, it said.

Mr Hancock said he was "incredibly concerned" about the findings which he said showed the impact of over-medicalisation. On opioid prescriptions, he said: "The figures show that usage has been more or less flat for the last couple of years, but the level is far, far too high."

Links to Deprivation

The review found large variations in the standardised rates of prescribing across clinical commissioning groups.

Prescriptions for opioid pain medicines and gabapentinoids were more common in areas of greater deprivation, while the other three classes of medicine had a weaker association with deprivation.

For all five classes of medicine the proportion of people receiving prescriptions for a year or more was higher in more deprived areas, the analysis found.

Prof Helen Stokes-Lampard, chair of the Royal College of GPs, said problems identified in the report indicated "the severe lack of alternatives to drug therapies for many conditions – and where effective alternatives are known and exist, inadequate and unequal access to them across the country".

She added that GPs needed "better access for our patients to alternative therapies in the community" as well as "more high-quality research into alternatives to drug therapies in general".

The PHE review also made a number of recommendations. These fell into five broad categories, which were:

  • Increasing the availability and use of data on the prescribing of medicines that can cause dependence or withdrawal

  • Enhancing clinical guidance and the likelihood it will be followed

  • Improving information for patients and carers on prescribed medicines and other treatments

  • Improving the support available from the healthcare system for patients experiencing dependence on, or withdrawal from, prescribed medicines

  • Further research on the prevention and treatment of dependence on, and withdrawal from, prescribed medicines

Karen Tyrell, spokesperson for the drug and alcohol charity Addaction, commented: "This review has found that a quarter of us have been prescribed one of these medicines in the last year.

"The scale of what we are seeing here should sound alarm bells. There needs to be clearer national guidance on the use of all prescription pain medication."

Dr Paul Chrisp, director of the Centre for Guidelines at the National Institute for Health and Care Excellence (NICE), said: "NICE is developing a guideline on the safe prescribing and withdrawal of prescribed drugs.

"The proposed scope of this guideline should complement the evidence review. We are consulting on the proposed scope until the end of the month."

NICE was also updating its guideline on the diagnosis and management of depression in adults, he said.

The Medicines and Healthcare products Regulatory Agency said it took the experience in the US of dependence and addiction to opioids very seriously and promised action "to minimise the risks of dependence and addiction in the UK and prevent a US-style opioid epidemic from taking hold".

It said an expert working group had been established by the MHRA to review the benefits and risks of opioid medicines, including dependence and addiction.

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