Two years ago we highlighted worries that chronic pain sufferers may be exposed to a medication time-bomb in terms of the unknown long-term effects of taking prescription medication, particularly in multiple combinations.
Now, Public Health England (PHE) has published the first evidence-based review of dependence and withdrawal problems associated with some strong painkillers and other medications, namely:
- benzodiazepines – mainly prescribed for anxiety and insomnia;
- Z-drugs – for insomnia;
- gabapentinoids – for neuropathic pain;
- opioid pain medications – for chronic non-cancer pain such as low back pain and injury-related and degenerative joint disease;
- antidepressants.
Worrying findings
Their main findings were that the total number of prescriptions issued for these drugs continues to rise, although reductions were recorded in some categories. The overall rise is thought to be partly down to an aging population.
Worryingly, half of those who were using these categoroes of drugs in March 2018 had been taking them for over twelve months with a quarter of people having been on them for at least three years.
Trends
In terms of trends identified:
- The rate and duration of prescribing was higher in some of the most deprived areas of England, where the average number of medicines co-prescribed was also higher.
- The rate of prescribing was higher for women than men.
- The number of prescriptions for antidepressants and gabapentinoids is rising.
- The number of opioids, Z drugs and benzodiazepines prescribed continues to fall.
Uninformed
PHE say that “People who had experienced problems from prescription medicines also reported that they felt uninformed before they started them, and unsupported when they experienced problems.”
Whilst it is not possible from the data to identify the prevalence of dependence and withdrawal, they stress that “Long-term prescribing is likely to result in dependence or withdrawal problems”.
However, they stress that “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.”
Recommendations
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 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”
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