By: Aadil Jan Shah, Consultant Addiction Psychiatrist, CGL
Prescription drug addiction has been a topic of debate for a long time now but recently it came into significant limelight as this problem seems to be growing in England. The evidence from the NHS data suggest that one in every 11 patients in England is being prescribed medication that could be addictive, or difficult to come off. This includes sedatives, painkillers and antidepressants. This resulted in Public Health England (PHE) launching a review into this problem and the review will cover: a) sedatives and anti-anxiety drugs known as benzodiazepines and z-drugs (zolpidem and zopiclone) b) painkillers called opioids, pregabalin and gabapentin c) antidepressants
The most of this prescribing is happening in the primary care. The GP data for England suggests that prescribing of addictive medication has increased 3% over five years. The data on UK prescribing patterns of drugs associated with dependence shows that, antidepressant prescribing more than doubled over the last decade, and over 75 million prescriptions were dispensed in 2016 at a cost of over £340 million. There were 12 million benzodiazepine prescriptions in 2015, costing over £50 million and there were 28 million opioid prescriptions in 2016, costing over £340 million.
There are concerns that this problem could become quite significant as in the US if we don`t tackle it properly. There is therefore no room to be complacent.
Benzodiazepines and z-drugs are highly addictive and are mostly used for problems like anxiety, insomnia etc. These medications are recommended to be used only as a short-term measure because the long term use leads to issues like dependence, increased tolerance and a number of other side effects.
The opioid based pain killers are also highly addictive and are also recommended not to be used on long-term basis. There are number of opioid based pain killers like co-codamol, codeine phosphate, morphine preparations, tramadol etc which are very difficult to come off if used for a long time. The patients experience significant withdrawals and feel unwell when trying to come off.
The medications like pregabalin and gabapentin are mainly prescribed for nerve pain. These medications are being used quite a lot recently and overall there seems to be lack of education in both the doctors and the patients about their dependency potential.
While antidepressants are not addictive and can be used for long-term but some patients experience difficulties when they try to stop taking them. There was a systematic review and network meta-analysis published in The Lancet in February 2018 and all the antidepressants (about 21) included in the meta-analysis were more efficacious than placebo in adults with major depressive disorder. It is therefore very important that patients do not avoid taking antidepressants in light of PHE review.
It is recommended that patients should not come off their medication without speaking to their doctor. The British Medical Association, which represents doctors, is calling for more support, including a helpline for patients who develop drug dependency.
There needs to be more awareness and education around this issue. Doctors especially the GPs need to make people aware of the addictive nature of these drugs and fully explain the risks of becoming addicted to them. There is need to explore non-pharmacological treatments like psychological therapies but unfortunately there can be long waiting lists for these treatment and the resources for these are scanty. There also needs to be some guidance around ways to improve the prevention and management of prescribed drug dependence.
The addiction services have a role of supporting GPs, pain clinics etc to help addicted patients come off these medications in a safe manner. Overall there needs to be a joint and concerted effort from the above specialities in helping these patients and developing local pathways as per the needs of these patients and the local resources available.
Cite this article as-
Aadil Jan Shah (2018). Prescription Drug Addiction. The Beautiful Space-A Journal of Mind, Art and Poetry. February 2018: TBSB127
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