An Inquiry into Physical Dependence and Addiction to Prescription and Over-the-Counter Medication (January 2009)
Recommendations of the All Party Parliamentary Drug Misuse Group
1. Training for Medical Professionals
1.1 That the British Medical Association (BMA), the GMC and the Royal College of Nursing (RCN) should ensure that all medical students and nurses are trained to recognise the symptoms of physical dependence and addiction to drugs including over-the-counter and prescription medications.
1.2 That the BMA, GMC and RCN should make training in substance misuse part of the continuing professional development of GPs and nurses, as information on this topic is being uncovered all the time.
1.3 That the BMA and GMC should ensure that medical students receive comprehensive training in good prescribing practice and are taught the skills to help them to deal with anxious or depressed patients to allow them to move away from the “pill for every ill” prescribing attitude.
2.1 That the MHRA, working with the professional associations, must promote better awareness amongst doctors and other health professionals about the guidelines on prescribing and encourage them to work together to try to reduce the number of people taking these potentially problematic drugs.
2.2 That, when GPs prescribe drugs which are known to have the potential to cause physical dependence or addiction, they must explain these potential risks to the patient.
2.3 That the MHRA and the pharmaceutical industry must put warnings about potential dependence on the boxes of products containing over-the-counter codeine as well as prominently in the PIL.
2.4 That the MHRA and the DH should seek to raise awareness about the risk of developing dependence problems with codeine-containing painkillers, either over-the-counter or on prescription.
2.5 That the advertising and promotion of codeine-containing products must end.
2.6 That the DH must undertake a campaign to encourage patients to take more responsibility for their own health and prescription choices. This campaign must also extend to the use of online pharmacies and the potential risks people expose themselves to when they buy from fraudulent online pharmacies.
2.7 That the MHRA, DH, RPSGB and other interested parties must work together to tackle fraudulent online pharmacies. An assessment of online pharmacy usage and the impact of the RPSGB logo for legitimate sites needs to be undertaken.
2.8 A joined-up approach between Customs, Police and Internet Service Providers must be taken to tackle the problem of fraudulent drug sales globally.
3. Prescribing and Monitoring
3.1 That the MHRA must be rigorous in ensuring that all pharmaceutical companies monitor their products through clinical trials and after their introduction into general practice, and report to the MHRA problems of physical dependence and addiction. Full information about clinical trials, including those abandoned, should be publicly available.
3.2 That the DH sets up procedures to monitor the prescribing habits of doctors, particularly with a view to preventing prescribing outside the BNF and DH guidelines. GPs who prescribe outside the guidelines must be required to justify their decision to the PCT. Pharmacists should be encouraged to flag up to PCTs doctors who are regularly prescribing to their patients outside these guidelines.
3.3 That, when GPs prescribe drugs that are known to have the potential to cause physical dependence or addiction, such as opiate-containing products and benzodiazepines and related classes of drugs, they should set up procedures to monitor the patient. Monitoring could, for example, be carried out by a practice nurse or a pharmacist working within or alongside the practice. The practice of repeat prescription without review for these drugs must end.
3.4 That the MHRA should restrict access to codeine-containing painkillers, such as Nurofen Plus, by reducing pack sizes (to 18) and making them only available after consultation about the problem with a pharmacist.
3.5 That PCTs should play a greater role in ensuring doctors, healthcare professionals and patients are all aware of the ways to report adverse drug reactions. For example, the BMA publication “Reporting adverse drug reactions: a guide for healthcare professionals” should be made available to every healthcare professional.
4. Recognition and Research
4.1 That more research must be undertaken in the field of dependence to prescription and over-the-counter medication to determine the scale and related implications of the problem.
4.2 That more research must be undertaken into anxiety, depression and pain control to ensure that appropriate treatments are being offered to patients.
4.3 That more research is undertaken in the field of dependence and addiction to both licit and illicit drugs to ensure that lessons are being learned and that appropriate help and support can be provided.
4.4 That better records, particularly with regard to suicides and drugs being taken, are kept to allow research and monitoring to be undertaken in this area.
5.1 That, for patients who are already physically dependent or addicted to a prescription or over-the-counter medicine, GPs should be required to assess the situation and help the patient whenever possible to withdraw from the drug using the available guidance, or should refer them on to a support organisation or a treatment centre.
5.2 That the DH should require PCTs to provide appropriate treatment for those addicted to these drugs. We believe that it would be inappropriate to refer patients for treatment to DAATs for the reasons given in this report. We recommend that a centre be established in each region and that these should work on a „hub and spoke‟ model so that patients in each PCT area can be referred to clinics where specialist advice is available.
5.3 That PCTs should ensure that pathways for treatment of patients presenting with a dependency should be as flexible as possible and accessible. Patients should be able to refer themselves to these treatment centres. The APPDMG encourages PCTs to undertake preventative action in reducing the number of addicts in their area, as well as working with those who become dependent.
5.4 That the value of local support groups for those who have become physically dependent or addicted to prescription or over-the-counter medication should be recognised by Government and its agencies. Online support groups and those providing 24-hour services are particularly valuable in our opinion and should receive appropriate funding.