PHE report examines extent of prescription drug dependence

PHE has published a prescribed medicines review that reports for the first time on the extent of dependence and withdrawal problems associated with commonly prescribed medicines in England and what can be done to address this.

 The review was commissioned in 2017 by the Minister for Public Health and Primary Care, and covers medicines prescribed for adults from five drug classes associated with dependence and withdrawal: benzodiazepines; ‘z-drugs’ (ie insomnia medicines such as zolpidem, zopiclone); gabapentinoids (gapapentin and pregabalin); opioids for chronic non-cancer pain; and antidepressants.

 The report showed that in the year 2017 to 2018, 11.5 million adults in England (ie over a quarter of the adult population) received one or more prescription for at least one of the medicines covered by the review. The most commonly prescribed medicines were antidepressants and opioids (prescribed to 17% and 13% of adults respectively). Rates of prescribing increased between 2015–2016 and 2017–2018 for antidepressants and gabapentinoids, but decreased slightly for the other three classes under review during this period, including opioids (after a long-increasing trend). Rates of prescribing were higher for women (1.5 times that of men) and increased with age. There were large variations in prescribing rates across CCGs and prescribing rates for opioid pain medicines and gabapentinoids were higher in areas of greater deprivation.

Of all those patients receiving a prescription in March 2018, about half in each medicine class were estimated to have been receiving a prescription continuously for at least 12 months, despite the fact that all the medicines reviewed (with the exception of antidepressants) are licensed for short-term treatment of acute conditions. The proportion of patients on these long-term prescriptions increased with higher deprivation. PHE estimated that the total number of patients who continuously received a prescription for an opioid pain medicine between April 2015 (or earlier) and March 2018 in England was 540,000, despite the lack of evidence for their long-term efficacy.

An assessment of the evidence on the harms associated with the medicines under review indicated that they are all associated with risks of dependence and/or withdrawal. Some patients reported harmful effects and withdrawal symptoms on stopping benzodiazepines, z-drugs, opioids and antidepressants. Higher initial opioid doses were associated with increased risk of long-term opioid use and prior mental health problems were associated with dependence.

 In light of these findings, PHE has made several recommendations, including improving clinical guidance for prescribers, more informed choice for patients on the use of prescription medicines that can cause dependence, improving support for patients experiencing dependence or withdrawal, and more high-quality research on the prevention and treatment of prescription medicine dependence and withdrawal.

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