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David J Rowlands AC/AM
Chair – Petitions Committee
National Assembly for Wales
Cardiff Bay
Cardiff,
CF99 1NA
09th of March 2018
Dear Mr Rowlands
RE: Prescription drug dependence and withdrawal – recognition and support
The Royal Pharmaceutical Society (RPS) Wales welcomes the opportunity to share its view on this petition.
RPS Wales is supportive of the asks in this petition and agrees that individuals in Wales who become addicted to prescription medicines must be provided with timely and appropriate support without any fear of judgement.
Background information on Benzodiazepines;
Benzodiazepines can be grouped into hypnotics and anxiolytics (sedatives and tranquillisers) and have been available to prescribe for anxiety and insomnia since the 1960’s when they replaced older drugs such as barbiturates. They were much safer in overdose and were initially thought to have little or no addiction potential. Unfortunately as prescribing increased and more data was available it became obvious that there was both a serious addiction potential, both physical and psychological, and that withdrawing the medicines could precipitate severe withdrawal symptoms which were very similar to the original anxiety disorder.
Tolerance to the drug effects occurs within a few days or weeks of use leading to the requirement for larger doses for the effect and subsequently withdrawal is more difficult.
There is little evidence of effectiveness after prolonged use and the problems of withdrawal have led to numerous warnings and clinical guidelines.
BNF states[1];
1. Benzodiazepines are indicated for the short-term relief (two to four weeks only) of anxiety that is severe, disabling, or causing the patient unacceptable distress, occurring alone or in association with insomnia or short-term psychosomatic, organic, or psychotic illness.
2. The use of benzodiazepines to treat short-term ‘mild’ anxiety is inappropriate.
3. Benzodiazepines should be used to treat insomnia only when it is severe, disabling, or causing the patient extreme distress.
The effects of benzodiazepines are both physical and psychological and so withdrawal can be very difficult. The short acting drugs tend to precipitate more severe withdrawal symptoms and some patients with other health or addiction problems may be more likely to both become addicted and have problems withdrawing.
NICE guidance states;
· Withdrawal should be gradual (dose tapering, such as 5–10% reduction every 1–2 weeks, or an eighth of the dose fortnightly, with a slower reduction at lower doses), and titrated according to the severity of withdrawal symptoms.
o This may take 3–4 months to a year or longer. Some people may be able to withdraw in less time.
Background information on Antidepressants
Antidepressants can be very effective for moderate to severe depression when used correctly and appropriately, however there is a need to prescribe within guidelines. The BNF states;
Antidepressant drugs should not be used routinely in mild depression, and psychological therapy should be considered initially; however, a trial of antidepressant therapy may be considered in cases refractory to psychological treatments or in those associated with psychosocial or medical problems. Drug treatment of mild depression may also be considered in patients with a history of moderate or severe depression1.
It is important that individuals who are prescribed antidepressants are supported and
Fully informed about how antidepressants work, particularly as many can take several weeks for the antidepressant action to start. During the first few weeks of treatment, patients may feel anxiety, and even suicidal ideation. It is crucial that these patients feel that they have a point of contact to discuss any problems.
Addiction to prescribed drugs and to some over the counter medication can be challenging for patients and for health professionals to address. A multidisciplinary approach should be taken to ensure patients receive the right support when withdrawing from medication that they, often inadvertently, have become reliant upon. RPS believes that the expertise and clinical knowledge of pharmacists must be better utilised to support people needing these medicines and help them to achieve the desired outcomes from their treatment.
RPS Wales is therefore supportive of this petition and agrees that individuals in Wales who become addicted to prescription medicines must be provided with timely and appropriate support without any fear of judgement
Yours faithfully
Mair Davies, FFRPS, FRPharmS, FHEA, Director, RPS Wales