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With addiction to prescription and over-the-counter drugs at epidemic proportions in
the US, GPs here are being warned to take care when prescribing any drugs that
could lead to dependence
News focus |
Analysis
PRESCRIPTION FOR CHANGE?
6 |
drinkanddrugsnews
| February 2013
www.drinkanddrugsnews.com
‘Prescription drug abuse’ is classified
as an epidemic by America’s Centers
for Disease Control and Prevention
,
prompting the Obama administration to issue a
specific prevention plan to expand on its 2010
National Drug Control Strategy (
DDN
, May 2010,
page 5). As former White House drugs advisor Keith
Humphreys told
DDN
last year, legal pharmaceutical
drugs are the leading cause of overdose in the US,
and one in eight American teenagers have taken
potentially addictive legal drugs like Vicodin and
OxyContin (June, page 16).
Now UK doctors and psychiatrists are warning
that care must be taken ‘in the initiation of any drugs
that can lead to dependence’. A consensus statement
issued by the Royal College of General Practitioners
(RCGP) and Royal College of Psychiatrists (RCPsych),
and supported by 17 other organisations, says that
medicines such as tranquilisers and painkillers should
not be prescribed for long periods ‘except in
exceptional circumstances’ (see news story, page 5),
and that patients need to understand the risks
involved in order to make informed choices.
‘Addiction psychiatrists are increasingly working
with people who have developed dependence
problems with prescribed or over-the-counter
medication,’ said RCPsych consultant psychiatrist, Dr
Emma Whicher. ‘Although these medications are
beneficial to many people, awareness of the
alternatives and risks is also important.’ Prescribing
must be informed by the very latest guidance – such
as that from NICE – says the statement, and patients
should also be offered appropriate non-
pharmacological options as adjuncts, or alternatives,
to their prescription.
‘We talk about addiction to prescription-only
medicines, but we’re not talking about one group –
we’re talking about a range of medications, from
laxative abuse right through to serious opioid misuse,’
RCGP substance misuse lead Dr Linda Harris tells
DDN
. ‘That means that the complexity of these
presentations can vary enormously.’
While the statement was welcomed by the NTA,
the agency stated that much of what it called for
was already being done. ‘I think that’s a fair
assessment,’ says Harris. ‘This is an area where I
don’t think one agency or college is going to be in a
position to take all the responsibility – there’s a firm
platform of activity that we’re developing and
building on. Where I might disagree is that there are
some gaps around options in primary care. I get
doctors saying to me, “yes, we’d clearly like to do
less prescribing but we need more options”. That
means more access to counselling, psychotherapy,
psychosocial and the like.’
Isn’t it the case that there can sometimes be
long waiting times for NHS mental health services,
though? ‘I don’t know the full national picture but for
me locally I can draw on my IAPT [Improving Access
to Psychological Therapies] services – our substance
services are well joined up to IAPT, and our waiting
times are within national targets. But I suspect that it
might be patchy. It’s down to localities now to
identify if there are gaps, and there are things that
GPs can take more control over if they think that
locally they haven’t got those resources.’
According to the statement, the issue is best
addressed through collaborative action – is there
enough joined-up working going on around this? ‘I
think we’re poised – we should be able to do it,’ she
says. ‘And the clinical commissioning groups are
commissioning more assertively to meet local need.’
Does she feel that drug treatment services
generally give enough consideration or priority to
prescription and over-the-counter drugs? ‘I think
they’re beginning to. The 2010 drug strategy firmly
identifies this as an area that substance misuse
services should be responding to, and they certainly
have the skills, but many services have been
commissioned with a focus and emphasis on illicit
drug misuse – they might not be seen by the general
population, or even GPs, as the place where you’d
refer. So we want to do a lot of work to raise
awareness, that absolutely there are skills, and
particularly with shared care.’
What about people who say that there are some
GPs who are quite happy to just sign prescriptions,
as it’s the easiest thing to do? ‘I would challenge
that position,’ she states. ‘We have to understand
that the GP cohort is mixed – there’s a mixture of
ages, and people at different stages of their careers,
where experience of education and training may be
different. With our younger GPs, the modern
curriculum equips them with the full competencies
around safe and effective prescribing, and obviously
if GP training were to be extended – as the Royal
College would love to see – that would give us more
opportunities for young GPs in training to be
exposed to services and wraparound care.
“They’d be even better placed – when faced with
those decisions, when they’ve got the pressure of
day-in, day-out consultation in primary care – to really
do the right thing. My feeling is that we’re really
getting on top of this.’
DDN
Consensus statement at www.rcgp.org.uk
‘We talk about
addiction to
prescription-only
medicines, but we’re
not talking about one
group – we’re talking
about a range of
medications, from
laxative abuse right
through to serious
opioid misuse.’
DR LINDA HARRIS, RCGP