To ask Her Majesty’s Government what changes have been made in the training of junior doctors and nurses in the long-term effects of prescription drugs and in the availability of services to those suffering from addiction to and withdrawal from such drugs.
My Lords, recent changes to key documents governing the training of doctors have strengthened the requirements for their training in the long-term effects of prescribed drugs. The training of student nurses, due to the introduction of new educational standards, has been strengthened. Services to treat dependants, including for addiction to medicines, are commissioned locally. Information on changes to the availability of services locally to those suffering from addiction to and withdrawal from prescribed medicines is not collected centrally.
My Lords, prescribed medicines can be every bit as dangerous as hard drugs, and the length of withdrawal can be much longer—up to three or four years, as I know from personal experience. Their victims lead a half-life and are out of the range of the NHS, with only the voluntary services to help them. Despite what the Minister has just said, which is encouraging, does he agree that the training being given to the younger generation of doctors and psychiatrists, and even the older ones, is still inappropriate and inadequate? What can the Government do to strengthen this training and to reinforce what the voluntary sector is already doing?
My Lords, I am sure that the noble Earl will be encouraged to know that a lot of work is going on in this area. The Centre for Pharmacy Postgraduate Education, the Royal College of General Practitioners, Public Health England and others are developing information and educational materials and training on addiction to medicines for GPs and other healthcare professionals. In fact, the Royal College of General Practitioners published a consensus statement in January in which a wide range of professional organisations signed up to tackling this serious issue. I know that the Board of Science of the British Medical Association has also discussed it. I hope that the noble Earl will be encouraged that there is genuine activity in this area.
My Lords, many years ago when I was chairman of the General Medical Council’s education committee before I became its president, I received in the course of two months 32 letters each demanding that the special interest groups that wrote to me should have their conditions and concerns included in the undergraduate medical curriculum. Does the Minister accept that the range of medical knowledge is now so vast that basic medical education over five or six years does no more than simply enable graduates in medicine to benefit from postgraduate or vocational training having acquired skills and knowledge in principle which will help them to do that? Can he assure us that this extremely important matter raised by my noble friend now figures in postgraduate training of doctors, and not least in the mandatory vocational training programme of three years which must be undertaken by all intending general practitioners?
I do, of course, agree with the noble Lord. I am sure that we have to be realistic about the extent to which every GP can be fully informed about this area. I can only say that it has risen in prominence in recent years, not least thanks to the efforts of the noble Earl. There is growing concern that this particular cohort of patients has been poorly served in the past and that is why the extent to which these drugs are being prescribed has diminished significantly over recent years.
My Lords, will the Minister confirm that the Committee on Safety of Medicines and the Royal College of Psychiatrists said many years ago that benzodiazepines are unsuitable for long-term use and should be prescribed for periods of two to four weeks only? And will he revisit a Written Answer he gave me recently saying that there was no connection between benzodiazepine addiction and suicide, when there is 30 years of eminent research to show that that is indeed the case? I declare an interest as the patron of Battle Against Tranquillisers, the foremost charity campaigning in this area, whose mission statement is:
“To lessen the harm caused by benzodiazepine and z drug tranquilizers and sleeping pills”.
My Lords, of course I will revisit that Answer, and I will come back to the noble Baroness if I find cause to correct what I have said. However, I agree with her that the risks associated with long-term use of tranquillisers have been well recognised for many years. There are several authoritative sources for guidance for prescribers on this issue. I believe that that guidance is having an effect because, as I said, the prescribing rate has considerably diminished of late. There is no shortage of guidance out there. There is the national formulary, which already describes the importance of gradual withdrawal from benzodiazepines, and there is a wide variety of other impartial and trustworthy information resources to support prescribing.
My Lords, GP training is important but for a user the crucial thing is the availability of the services. Will my noble friend tell the House whether services for those addicted to prescription drugs are readily available within each CCG area and where one might find details of such services?
My noble friend will be encouraged to know that Public Health England has published a commissioning guide for the NHS and local authorities which sets out its expectation that support should be available in every area for people with a dependency on prescription or over-the-counter medicines. Local authorities are now, as she is aware, responsible for commissioning services to support people to recover from dependence in line with local need. Most of the support available for people who are addicted to prescription drugs is with their GP and not in services treating those addicted to illegal drugs, but there is a range of services available.
To better understand the size of the problem, will the Government consider adding a box to the yellow card, which has been successful in reporting adverse drug reactions, to state that the doctor suspects that this person may have dependence on the drug? That would provide ongoing epidemiological monitoring.
My Lords, the noble Earl will be aware that in the past few years nurses have been given much more authority, once they have been properly trained and authorised, to prescribe medicines. Can he confirm that the measures he has talked about will apply to nurse prescribers as well as to doctors?