Estimated reading time: 4 Minutes
20 May 2019
In March 2019, the Assembly’s Petitions Committee published its report ‘Prescription drug dependence and withdrawal – recognition and support’ (PDF, 476KB), which the Assembly will debate on Wednesday 22 May 2019.
The petition collected 213 signatures and states:
We call on the National Assembly for Wales to urge the Welsh Government to take action to appropriately recognise and effectively support individuals affected and harmed by prescribed drug dependence and withdrawal.
Prescription drug dependence
There are several classes of prescription-only medicines which have been associated with dependency and misuse. The petition itself expresses specific concern over antidepressants, such as Selective serotonin reuptake inhibitors (SSRIs) and Serotonin and norepinephrine reuptake inhibitors (SNRIs), and their association with dependency and withdrawal problems.
One main theme of the petition is a call for greater recognition of the problems associated with prescription drug dependence, in particular amongst policymakers and health professionals, specifically:
- acknowledgement of the problem of prescription drug dependence, its scale and the impact that it has on people affected; and
- acknowledgement, or agreement, of the specific types of medications that can cause dependence and withdrawal issues.
Dependence on, and misuse of, prescription and over-the-counter medicines has acquired a higher profile as a public health issue over recent years. The Committee found that dependence on prescription medicines, and the harm and adverse effects that this can have on individuals, were recognised across all the evidence it received from the Welsh Government, health boards and professional bodies.
The Committee recommends that greater recognition should be given to prescription drug dependence at a national level in both policy and strategy. This should include a clearer distinction between substance misuse and prescription drug dependence, and identification of specific actions to help prevent dependence upon prescription medications and support people affected.
The petitioner calls for antidepressants to be formally recognised as having the potential to “cause dependence to a level equal to” other prescription-only medications acknowledged as being associated with dependence.
However, there is a debate around this issue and varying points of view were given by health boards, with some referring to “discontinuation effects” rather than withdrawal effects. A number of medical professionals wrote to the Committee to support the petition and to specifically call for greater action in relation to antidepressants.
The Committee report refers to a recently published review that covers the withdrawal effects associated with antidepressants, but the findings have been challenged.
A recommendation is made asking the Welsh Government to confirm and explain its position on whether SSRI and SNRI antidepressants should be formally recognised as potentially leading to problems of dependence and withdrawal.
A number of guidelines for the prescribing of medication have been produced, but the petitioner has questioned the basis and adequacy of current guidelines related to antidepressants, such as those produced by the National Institute for Health and Care Excellence (NICE). At the time the report was published, NICE guidelines for the treatment and management of depression were being reviewed and a new version is expected in December 2019.
The petitioner has also specifically called for SSRI and SNRI antidepressants to be added to the list of drugs that are targeted for reduction as a way to reduce the prevalence of dependence on prescription drugs. The then Cabinet Secretary for Health and Social Services committed to investigating the scope and need for further guidance and whether a national prescribing indicator might support clinical decision-making in relation to antidepressant use.
The Committee made some recommendations in this area that covered:
- restating and emphasising that antidepressants should not be routinely prescribed for mild depression in guidance to health professionals and sufficient alternative treatment options should be available across Wales;
- additional guidance on the safe tapering of prescription medications, and
- whether SSRI and SNRI antidepressants should be added to the list of drugs targeted for reduction, and the introduction of a national prescribing indicator.
A central element of the petition relates to a perceived lack of support available to people using or trying to withdraw from prescribed medication.
Although the Committee heard about the support services currently in place in health board areas, a major contention of those supporting the petition is that the majority of existing support and advice services are not specific to prescription drugs, but are instead generally focused on substance misuse.
The petitioner and others have called for the introduction of specially designed services for prescribed drug dependence to be accessible across Wales.
The Committee was told about Betsi Cadwaladr University Health Board’s Prescribed Medication Support Service, which consists of prescribed medication therapists (nurses and counsellors) based within GP surgeries who work proactively with pharmacists and GPs to identify and contact particular client groups who may benefit from advice.
The Committee recommends that the Welsh Government should investigate the potential for a national rollout of a service such as that mentioned above and a further recommendation is made on creating opportunities for a coordinated strategy and greater information-sharing between health boards in relation to prescribed drug dependence.
A need for support services to include different professional groups, including pharmacists, GPs and community mental health teams was highlighted to the Committee, and a recommendation is subsequently made specifically in relation to pharmacists.
The Welsh Government has a national drug and alcohol helpline, DAN 24/7 and a new harm reduction website in Wales is to be launched. The Committee recommends that the Welsh Government should conduct and publish an assessment of the sufficiency of the advice available to people experiencing prescription drug dependence and withdrawal through the DAN24/7 helpline, including the adequacy of training for operators. The Welsh Government is also recommended to ensure that the availability of advice related to prescribed drug dependence is promoted appropriately.
Welsh Government response
The Welsh Government’s response (PDF, 612KB) to the report accepts nine of the ten recommendations (recommendation 7 is accepted in principle). Recommendation 6 has been rejected and the response provides an explanation of the reasons for this decision.
Article by Rebekah James, Senedd Research, National Assembly for Wales