(Title Image: National Assembly of Wales)
Petition P-05-784: “Prescription drug dependence and withdrawal” (pdf)
Submitted by: Stevie Lewis
Published: 21st March 2019
“Antidepressants and other prescription medications can be a lifeline to many people. However, there is a growing body of opinion that it can be difficult to stop using some medications and that not enough advice is available to patients at the outset.
“What is clear is that we need to do more to improve the support and information that is available to people who are prescribed these medications.”
– Committee Chair, Janet Finch-Saunders AM (Con, Aberconwy)
1. There’s particular concern over dependence on anti-depressants
There are a number of drug categories (sedatives, pain-killers etc.) which can lead to addiction; some common over-the-counter drugs, particularly those which use opioids – like Nurofen Plus (codeine) – can lead to dependence and withdrawal. The Petitions Committee were particularly concerned over anti-depressants and the withdrawal symptoms associated with them.
While the petition specifically called for greater recognition of prescription drug addiction, the Committee received evidence from both BMA Cymru and the Health Minister, Vaughan Gething (Lab, Cardiff S. & Penarth), that there is an awareness amongst health professionals and the NHS generally that prescription drugs can and do lead to addictions.
The Welsh Government’s substance abuse plan has specific measures to deal with prescription drug abuse, with Health Minister saying Wales was “ahead of the game” in that regard.
However, there wasn’t universal agreement on the idea anti-depressants are potentially addictive amongst health boards; Abertawe Bro Morgannwg rejected the idea outright, while Hywel Dda did accept a problem.
2. There’s a high volume of prescriptions for medicines which can cause an addiction
While some health boards have steadily decreased the number of prescriptions for potentially-addictive medicines, prescriptions for anti-depressants have increased across the board.
Bangor University’s Prof. David Healy told the Committee that 10% of the Welsh population take anti-depressants and 80-90% of those are on the treatment for a year or more – some for over a decade.
The BMA said there wasn’t enough data to determine if there was a serious problem across the UK as a whole, but called for better support systems for patients who experience withdrawal or an addiction to prescription drugs. The petitioner also called for specialist services.
Betsi Cadwaladr health board said they have such a service which is provided in order to prevent prescription drug addicts being re-directed onto substance misuse programmes for narcotics and alcohol; the majority of people (58%) using this service were prescribed benzodiazepines (sleeping tablets), while just 2% used anti-depressants – which could be a sign of lack of recognition of anti-depressant addiction in itself.
3. Guidance on the use of anti-depressants requires an update
The Welsh Government issued guidance on the use of some anti-depressants in July 2016 and the official policy is to only prescribe them based on clinical judgement and after full consideration of alternatives to medicines (where appropriate).
The Committee was, however, told there was a conflict with NICE guidelines – said to be “inaccurate and inadequate” because they didn’t fully take into account the depth and length of possible withdrawal symptoms.
The BMA called for “clear guidance on tapering and withdrawal management”. The Health Minister told the Committee he was willing to consider new guidance and a “prescribing indicator” so the NHS can properly monitor trends in the use of anti-depressants to inform clinical decisions.