My Lords, treatment should be based on individual need, not the legal status of a drug. The Health and Social Care Act places responsibility for commissioning services to treat dependence at the local level. My honourable friend Anne Milton is leading work to improve the prevention and treatment of addiction to medicines, and has visited local areas where support for dependence on prescription drugs is an integral part of the local treatment system.
My Lords, I thank the Minister and I know that he and his fellow Minister are fully aware of the problem. However, there are only a handful of voluntary organisations and one or two primary care trusts dealing with this. The basic question is surely the control of prescription drugs. Does the Minister recognise that the British National Formulary guidelines are being routinely breached? Is there nothing that the Government can do effectively to control and monitor these prescription drugs, separately from illegal drugs?
My Lords, the report commissioned by the Department of Health from the National Addiction Centre brought together published evidence on the scale of the problem. That report suggested that while some GPs prescribed for longer than the recommended period, most prescribing in fact falls within current guidelines. I say to the noble Earl that what matters most in these circumstances is that patients should be treated according to the level of their need, regardless of what the dependence is and where it has come from.
My Lords, while there certainly is a focus on recovery for illegal drug users, does the Minister agree that the journey from being a drug user to becoming “recovered”—that is, to abstinence—is very complicated? It may require that person to have treatments, including methadone, Subutex and other drugs. It is not simply a matter of someone becoming abstinent, especially in the current economic climate. Does he agree that that is still the direction of travel?
Will the Minister ensure that whatever else is done, nothing shall prejudice the treatment of illegal drugs and of alcoholism, which is the greatest problem? Will he also take note that in the distant past, when I was a Home Office Minister and Roy Jenkins was Secretary of State for the first time, the use and possession of drugs such as heroin was not a crime and that this greatly facilitated the possibility of access to treatment?
There are no plans to revert to the former situation as regards heroin, but my noble friend makes the point that alcohol addiction is an extremely important issue. The commissioning of services to treat addiction will in the future architecture of the system be devolved to local areas. The all-party group on benzodiazepines on which the noble Earl sits has done some important work in exposing those areas where services are not as good as they should be.
I applaud the Minister’s comment that treatment must be based on need rather than on whether a substance is legal or illegal. Is he aware of the excellent work being done to treat heroin addicts in Switzerland, where a third of people are in employment and two-thirds of people are living legally within 18 months? Will he consider introducing to this country these highly cost-effective approaches?
My Lords, does the noble Earl think, as I do, that if the Department of Health were to be the lead department for the Government’s policy on drugs we would get better results than we have been getting with the Home Office as the lead department?
My Lords, the Home Office has a particular responsibility for drugs which is distinct from my department’s responsibility, which is to do with ensuring that those who are addicted to drugs get the proper treatment. The two are distinct and it would not necessarily be helpful to blend them together.
Will the Government ensure that the recommendations from the Royal College of General Practitioners for increased training in psychiatry is implemented in workforce planning after the new Act is in place? The inappropriate initiation of prescriptions is a major problem for those becoming dependent when alternative therapies, such as cognitive behavioural therapy, or simply better social support, would have avoided the inappropriate prescription of a drug on which physical dependence then develops.
The noble Baroness is absolutely right, and I am very pleased that both the Royal College of General Practitioners and the Royal College of Psychiatrists have been keen participants in the round table group on addiction to medicines convened by my colleague Anne Milton. The actions agreed by the group have included greater recognition of the risk and the treatment of dependence on prescription drugs within the core competencies of psychiatrists and the further development of training and guidance on this issue for GPs and other healthcare practitioners.
My Lords, does the Minister agree that one of the biggest obstacles to recovery for people with addictions to alcohol and drugs is stigma? Will he confirm that there is no thought in mind of moving down the avenue suggested in the Question because that would lead to greater stigma?
I am well aware of the point that the noble Lord appropriately raises. Stigma is an issue and we need to take account of the risk of it. That means that quite often when treatment services are provided to those who are addicted to medicines, they take place in a different setting from those administered to addicts of illegal substances.
Will the Minister recommend that, given that withdrawal from legally prescribed drugs is every bit as dangerous as withdrawal from illegal drugs, more should be done, for example, to print warnings in bolder lettering on packaging, to put notices in doctors’ surgeries and to make the public and the patient more aware of this issue as well as making doctors more aware?
I agree that dependence on prescription medicines can be just as devastating and debilitating as dependence on illegal drugs. The round table on addiction to medicines has agreed actions to improve public and professional awareness of the risk of dependence. They include a review of the updated warnings on prescription painkillers by the Medicines and Healthcare products Regulatory Agency and the development of further materials for GPs and other healthcare practitioners to support patients in understanding the risks.