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Prescription Drugs: Dependence

Volume 790: debated on Monday 19 March 2018


Asked by

To ask Her Majesty’s Government whether they have plans to provide a network of support, nationally and locally, for people affected by dependence on prescribed drugs.

The Government take seriously the issue of dependence on prescription drugs. The Public Health Minister has commissioned Public Health England to review the evidence on the scale and nature of the problems with some prescription medicines, and how those problems can be prevented and treated. The review is due to report in spring 2019.

My Lords, I very much welcome the review, but there is a real problem: many, many patients are suffering huge damage as a result of overdependence, often because they have been prescribed a particular medicine for too long a period. There appears to be woeful ignorance among many people in the health service about this impact of dependence. There are no national programmes for supporting people. Instead, people rely on local charities, which are grossly underfunded. Does the Minister not think it is time for a national action plan, a national helpline and support for local charities, and to get the NHS to start taking this seriously?

I agree with the noble Lord that it is a serious issue. A NatCen study found that there has been a doubling of the use of serious painkillers. Indeed, deaths due to opiates of all kinds have risen by about two-thirds in the past five years; of course, that is illegal as well as legally procured drugs. We agree that there is a problem. That is why the review is taking place. It is premature to say what the outcomes of that review will be, but undoubtedly we need a comprehensive approach to dealing with this problem, because it is getting worse.

My Lords, I welcome this major review of prescription drug addiction. Does the Minister agree that the review must also look at the provision of alternatives to prescription drugs and the culture change needed to make that happen?

My noble friend is absolutely right. It is not just about getting people off these drugs who are wrongly on them, it is about making sure that they do not go on them in the first place unless that is absolutely necessary for their treatment.

Is the Minister aware that there is a dispute between the Royal College of Psychiatrists and a significant group of academics, doctors and patients over the length of antidepressant withdrawal? Does the Minister agree that substantial research is needed quite urgently, including on withdrawal protocols, to ensure that patients can withdraw safely and slowly? I declare an interest, having experience of this in my own family.

The noble Earl highlights a very important issue, and I reassure him that the review will look not only at the nature and causes of dependence on the drugs in scope, which include antidepressants, but at the correct and most evidence-based treatments for withdrawal.

Will the review by Public Health England be able to look specifically at alternatives to prescribing drugs, such as acupuncture, which is shown to be very effective in the relief of pain and reducing symptoms of anxiety, and perhaps also mindfulness, which has been shown to improve the mental health of very many people?

I can attest to the benefits of both those courses of treatment. The review will look at prevention of dependency in the first place and in doing so will look at alternative courses of treatment. Of course, in the end there is a balance to be struck between the clinical needs of the patient and the right course of treatment. It is about making sure that clinicians are as informed as possible.

My noble friend mentioned that many of the services for people who are addicted to prescribed drugs are provided by the charitable sector. He also mentioned that many of those services are under threat or have closed down because of a lack of local authority funding. Will the Minister consider what can be done to replace those vital services? Will the charitable sector, which is doing such good work in this area, be consulted in the course of the review?

I completely echo the noble Baroness’s praise for the charitable sector. We have some very high-quality treatment centres in this country, provided both by the state and by charities. They do a fantastic job. In the most recently published figures, local authorities’ actual spend on funding for adults for drug misuse was about £490 million a year, so a substantial amount of money is going in. Of course, we need to make sure that it is getting to the people who are addicted to prescription drugs as well as illegal drugs.

My Lords, can the Minister explain the difference between dependence and addiction, as anyone who is on life-saving drugs is dependent upon them? Where does the definition come between that and addiction?

My noble friend has just given a much better and more incisive answer than I could have given. There is a distinction; the point here is that these are drugs that people have started to take because they have needed them. I should point out one area that is not included in the review; it is not looking at cancer and terminal pain, because we need to make sure that there is appropriate pain relief for people who are in the last stages of their life.

My Lords, is the Minister aware of the very powerful evidence from the United States that one of the most effective ways of reducing dependency on opioids is to legalise cannabis for the relief of pain? Cannabis is far less addictive and far less dangerous, yet it is incredibly effective for large numbers of patients.

I would definitely be straying into Home Office territory by commenting on that. I would point out that cannabis remains illegal in this country and that the PHE review’s scope is to work within the drug strategy set out by the Home Office.

My Lords, does the shortage of mental health services in the NHS and the cuts to local authorities not mean that GPs often have no alternative but to prescribe drugs? Should the Government not address the shortages in both those areas?

I think the link between mental illness and GP prescribing will be investigated in the review. We know that we need to do better in mental health services in this country, but it is worth pointing out that we are increasing investment and introducing new waiting-time standards, so services are getting better.

My Lords, is there not a case for a wider review of addictions in general? Public Health England did a review of alcohol and the Government ignored the report. A public health review in this area may be ignored entirely and there is nothing to make the Government do anything about it. We have just heard about what is happening with gambling; the Government have succumbed to the blandishments of the gambling industry and are not doing what many people in this House wanted on it. It is another addiction. Should we not have a review right across the board on addictions?

The Government are taking steps to deal with addiction in a number of areas. We are obviously focusing on prescription drugs and the dependence on them. I hope the noble Lord will welcome the review and have the opportunity to contribute to it, as I know he feels strongly about these issues.