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Scale of prescription drug addiction needs to be identified, say MPs

Pharmacist with patient

Pharmacist

Source: Racorn/Dreamstime.com

Pharmacists are well placed to identify people who come back for prescriptions more often than they should

Cases of prescription drug addiction should be recorded on the National Drug Treatment Monitoring System in order to identify the scale of the problem, according to a new report from the House of Commons Home Affairs Committee.

The committee’s report, published today (20 December 2013), says: “It is concerning that a year on from the publication of our previous report, which highlighted the lack of knowledge on this subject, there have been no improvements in the understanding or the collection of data around the issue of dependence on prescription drugs.”

The committee recommends that the Royal College of General Practitioners produces guidance for GPs who are treating patients addicted to prescription drugs, which states that all cases should be recorded in order to further clarify the prevalence of misuse.

Roger Knaggs, associate professor at the University of Nottingham and a specialist pharmacist in pain management at Nottingham University Hospitals NHS Trust, believes there is a vital role for pharmacists to play in identifying patients who might be abusing prescription medicines.

He said: “Community pharmacy is well placed to notice people who are coming back for prescriptions more often than they should be, which gives pharmacists the chance to start the conversation with patients — and with GPs — if they think there is even the potential that medicines are being misused.

“Of course, generally, people are aware of the potential addiction problems of certain prescription medicines but there needs to be better sharing of information in primary care between community pharmacy and GPs, in order to collate a clearer idea of the scale of the problem.”

Duncan Hill, specialist pharmacist in substance misuse at NHS Lanarkshire, told PJ Online that the supply of prescribed opioid medicines in the UK has risen significantly in the past few years, at a rate greater than most western countries. “It is also important to be aware that this is not just [a problem] for prescribed opioid medicines; other prescribed medicines can also be misused, such as benzodiazepines, antipsychotics and GABA [gamma-aminobutyric acid] medicines. The use, or potential misuse, of over-the-counter medicines should also be considered,” he said.

Mr Hill agreed that community pharmacy has a potential role in helping to identify patients who may be misusing or dependent on prescribed medication, adding that preferred options would vary markedly from patient to patient but could include signposting or referral to specialist addiction services where appropriate.

CCGs should collate data on visits to multiple practices

The committee recommends that NHS England should issue guidance to local clinical commissioning groups “which will lead to them taking central responsibility for the collation of data on patients visiting multiple practices to request specific drugs” and that CCG administration should be “strengthened in order for them to facilitate sharing this information with all practices and thus informing all healthcare professionals in the area”.

It also advises that medical royal colleges should establish a joint working group to examine whether local health teams are effectively communicating concerns around individuals visiting multiple practices to request specific drugs.

Howard Duff, director for England at the Royal Pharmaceutical Society, pointed out that it is important the Government also recognises that obtaining prescription medicines through illegal websites, often purporting to be pharmacies, is a significant and growing problem that needs to be tackled through international enforcement and greater public awareness.

Duncan Rudkin, chief executive of the General Pharmaceutical Council, said: “Pharmacy professionals have a critical role to play in helping patients and the public to take their medicines safely and identifying those who may be addicted to prescription medicines.”

He added: “Our standards make clear that pharmacy professionals should work closely with other health professionals involved in the patient’s treatment and care and share information with them where appropriate, after considering both the best interests of their patient and their duty of confidentiality to them.”

The committee says the number of drug-related deaths involving tramadol has increased by 300 per cent, from 43 in 2004 to 175 in 2012. In addition, it estimates that there are 1.5 million people in the UK addicted to tranquilisers.

• This article was amended on 23 December 2013 to include a comment from Duncan Hill.

 

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2013.11132133

Readers' comments (1)

  • Richard Schmidt

    The problem is not limited to prescription medicines. I understand that in earlier days, pharmacists sold laudanum (i.e. tincture of opium) over the counter [OTC] to folks wanting to host a laundanum party.  In the early days of my career, over-the-counter requests for kaolin and morphine mixture, J. Collis Brown's Compound, Gee's linctus, codeine linctus, and the like were accompanied by explanations that the person for whom the medication was intended (as often as not this being someone other than the person making the request) had a stomach upset / diarrhoea / cough that "nothing else would touch". When pharmacists started to restrict availability of these products, these long-suffering patients suddenly found that their diarrhoea or cough had become backache that required a codeine-containing painkiller.  Now, effervescent codeine-containing OTC painkillers are typically the best-selling lines in the shop.

    Pharmacists could certainly help point a finger at those who appear to be addicted to opioids and other prescription / OTC medicines. But I wonder what can be achieved by the politicians amongst us seeking to quantify the "bleeding obvious" in this way.  Nor will a restriction of the sale or supply of these substances through pharmacies provide an instant remedy for what is a global addiction problem that has seemingly been created and fuelled by the medical and pharmacy professions.

    Perhaps the first step should be to make the recording of sales of OTC opioids (and other addictive substances) on the patient's medication record mandatory, and for the linking of all medication records in order to capture data from all pharmacies that an individual might visit for their OTC opioid "fix".  But given the difficulties that government seems to have with nation-wide IT projects, I guess this isn't going to happen soon.

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