New report highlights scale and causes of prescription drug dependence in UK
A new report has highlighted the scale and causes of prescription drug dependence in the UK. In 2017, the minister for public health and primary care commissioned Public Health England (PHE) to identify the scale, distribution and causes of prescription drug dependence, and what might be done to address it.
The review covered adults (aged 18 and over) and 5 classes of medicines:
- benzodiazepines (mostly prescribed for anxiety)
- z-drugs (sleeping tablets with effects similar to benzodiazepines)
- gabapentin and pregabalin (together called gabapentinoids and used to treat epilepsy, neuropathic pain and, in the case of pregabalin, anxiety)
- opioids for chronic non-cancer pain
PHE’s analysis shows 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 the medicines within the scope of the review. The totals for each medicine were:
- z-drugs – 1.0 million (2%)
- benzodiazepines – 4 million (3%)
- gabapentinoids – 5 million (3%)
- antidepressants – 3 million people (17% of the adult population)
- opioid pain medicines – 6 million (13%)
Between 2015 to 2016 and 2017 to 2018 the rate of prescribing for antidepressants increased from 15.8% of the adult population to 16.6% and for gabapentinoids from 2.9% to 3.3%. There was a small decrease in prescribing rates for the other 3 medicine classes. Rates of prescribing were higher for women (1.5 times those of men), and the rates generally increased with age. After a long increasing trend, the annual number of prescriptions for opioid pain medicines has slightly decreased since 2016. There is a continuing longer-term fall in prescription numbers for benzodiazepines. A longer-term increase in annual prescription numbers for z-drugs started to reverse in 2014.
Officials said long-term use on such a scale could not be justified and was a sign of patients dependence.
PHE medical director Prof Paul Cosford said he was worried.
“These medicines have many vital clinical uses and can make a big difference to people’s quality of life.”
But he added there were too many cases where patients were using them for longer than “clinically” appropriate – where the drugs would have simply stopped working effectively or where the risks could outweigh the benefits.
One in 4 adults in England were prescribed benzodiazepines, z-drugs, gabapentinoids, opioids for chronic non-cancer pain, or antidepressants. Prescriptions for antidepressants and gabapentinoids are increasing, but prescriptions for opioid pain medicines are decreasing. Prescriptions for benzodiazepines continue to fall, and those for z-drugs have more recently started to fall.
Peter Burkinshaw at PHE, one of the authors said: “The long-term prescribing of opioid pain medicines and benzodiazepines is not supported by guidelines and is not effective.”
Fellow author Rosanna O’Connor, 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.
Dependence and withdrawal associated with some prescribed medicines (PHE)
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