Tackling Prescribed Drug Dependence and Withdrawal

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Today, Matt Hancock MP, Secretary of State for Health and Social Care has received a petition signed by 12,300 people calling for him to take specific action to help resolve the problem of dependence and withdrawal from prescribed medications.

This follows a report published by Public Health England, showing that one in four adults in England has been prescribed a benzodiazepine, z-drug, gabapentinoid, opioid or antidepressant in the past twelve months, with up to a third of these receiving a prescription for at least three years. Many of these long-term users report distressing and protracted difficulties when trying to come off the drugs. Yet there is little practical help available to those suffering and a lack of knowledge and experience amongst medial professionals.

The official guidance from the National Institute for Health and Care Excellence is to ‘withdraw slowly’ but this is near impossible using standard dosage tablets. Because of this, General Practitioners are giving advice to patients which they simply cannot follow.

In the Netherlands, a solution to this issue has been developed which has proven to be highly successful. So-called ‘tapering strips’ package tablets that gradually reduce in dosage and they are available for a wide range of psychotropic drugs. One critical aspect of this work is that it has been developed completely independently of the pharmaceutical manufacturers.

The petition sent to Mr Hancock includes over 1,000 comments from people with personal experience of prescribed drug dependence and mental health professionals who have witnessed the difficulties that some patients can have when stopping the drugs.

“My daughter is currently going through horrendous withdrawal symptoms after taking SSRI’s for 19 years. She has tried and failed to come off these drugs many times. Each time she has had to fight for support for guidelines and advice from doctors who are unable to provide it due to lack of information and a complete understanding of the drugs they prescribe. In fact their guidelines are to reinstate the SSRI drug if withdrawal is too difficult, which of course it is. It is hell for the person tapering and their families who watch helplessly. Much more needs to be done for them.”

The petition asks that the Department of Health and Social Care works collaboratively with the Royal College of Psychiatrists and the Royal College of General Practitioners to trial tapering strips for UK patients suffering dependence and withdrawal.

“I have worked in mental health for 30 years and know how desperately this is needed. It could save many lives.”

Signatures come mainly from the UK, but over 100 countries are represented, demonstrating that this is a worldwide issue.

*****

Rt Hon Matt Hancock MP

Secretary of State for Health and Social Care

Department of Health and Social Care

39 Victoria Street

London, SW1H 0EU

September 10, 2019

 

Dear Mr Hancock

Tackling Prescribed Drug Dependence and Withdrawal

Psychiatric drugs are a mainstay of our response to mental health concerns, yet all of the focus is on the initiation of drug treatment and very little on the end of treatment. We argue that this needs to change for the good of the individual, the prescriber and the NHS.

We enclose a petition, signed by over 12,300 people, who want to bring to your attention the plight of people struggling to withdraw from psychotropic drugs and propose a solution. Options for those who do want to come off are limited, and people are typically reduced to pill cutting or crushing because small dosage tablets are not available and liquid forms are prohibitively expensive. This leads to unnecessary suffering and, inevitably, more visits to the doctor.

You will be aware that Public Health England has recently reported on the issue of dependence on prescribed drugs1 in the light of the growing evidence about the extent of this problem, but we need practical solutions in addition to revised guidelines. Both the Royal College of Psychiatrists2and the US Food and Drug Administration3state that abrupt discontinuation should be avoided and that opioids (FDA) and antidepressants (RCPsych) should be tapered gradually over a period of months. Yet gradual tapering remains impossible for most people.

Maastricht University User Research Centre has developed a method by which patients can easily and gradually reduce their dosage of certain antidepressant, antipsychotic, benzodiazepine or opioid medications. In a recent study of 895 people who wanted to withdraw from an antidepressant, and of whom 97% had experienced withdrawal effects, 71% were successful in coming off their medication when using tapering strips.4

Our request is simple: Please trial tapering strips in a sample of GP surgeries and/or psychiatric clinics around the UK with a view to implementing them across the NHS.

What are the potential benefits of adopting tapering strips across the NHS?

Benefits for the NHS

  • Managing the withdrawal process will reduce the prescription costs for BNF Chapter 4 drugs. In 2018, this was £1.5 billion, the highest of any of the BNF chapters.5
  • Some classes of BNF chapter 4 drugs (notably antidepressants and antipsychotics) are associated with weight gain with long-term use. Managing withdrawal will help lower the consequential burden on the NHS caused by prescription drug-related obesity and related health problems.

Benefits for GPs and Psychiatrists

  • General Practitioners and psychiatrists are under pressure and have limited time to engage with a person who has decided they wish to come off the drugs. The availability of an ‘off-the-shelf’ solution for withdrawal will allow targeted, specific support. Current NICE guidelines state that a person should withdraw gradually, yet offer no practical methods to achieve this aim.
  • With the difficulty of withdrawal taken care of, the treating doctor can focus on patient recovery rather than on the treatment itself.

Benefits to Individuals

  • This option will be empowering to a person who has made a choice to reduce their reliance on medications and to be supported in that process by their doctor. Putting control back in the patient’s hands is good for the individual as is reducing the societal medication burden.
  • Providing an easy to follow withdrawal method helps the young, the elderly, the less able and anyone who doesn’t want to spend time weighing pills or measuring liquid formulations.

We hope that you will see from the petition and the following selection of comments how urgently a solution to this issue is needed, how many could be helped by its adoption and the consequent benefits for the NHS in doing so.

Working with our colleagues in Europe, the UK has the opportunity to be a world leader in tackling prescribed drug dependence. Please let us be bold and take that opportunity.

We would be happy to provide further information if required.

Yours sincerely

James Moore, person with lived experience

Doctor Peter Groot, User Research Centre NL, UMC Maastricht and UMC Utrecht – lead developer of tapering strips and person with lived experience

Professor Jim van Os, UMC Utrecht

Professor John Read, Professor of Clinical Psychology, University of East London

cc:

Wendy Burn (President of the Royal College of Psychiatrists),

Helen Stokes-Lampard (Chair of Royal College of General Practitioners)

References:

  1. https://phe-newsroom.prgloo.com/news/dependence-on-prescription-medicines-linked-to-deprivation
  2. https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2019/05/29/rcpsych-calls-on-nice-to-update-its-antidepressant-withdrawal-advice
  3. FDA identifies harm reported from sudden discontinuation of opioid pain medicines and requires label changes to guide prescribers on gradual, individualized tapering. https://www.fda.gov/drugs/drug-safety-and-availability/fda-identifies-harm-reported-sudden-discontinuation-opioid-pain-medicines-and-requires-label-changes
  4. Van Os, J, Groot, PC, Antidepressant tapering strips to help people come off medication more safely, retrieved online from https://doi.org/10.1080/17522439.2018.1469163
  5. https://digital.nhs.uk/data-and-information/publications/statistical/prescription-cost-analysis/2018

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