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PRESCRIBING PRACTICES CALLED INTO QUESTION

Irish Times
February 24, 2009

Tranquillisers are being prescribed too often and for too long in the west, says a new study. LORNA SIGGINS reports

INAPPROPRIATELY PRESCRIBED minor tranquillisers and sedatives are draining the public purse while national guidelines on correct prescription and use are not working, according to a new report.

The study by Kealan Flynn for the Western Region Drugs Task Force says there is "clear evidence" in the west of incorrect use and prescribing, especially for women, older people and medical card holders.

A "significant" number of doctors are also prescribing to patients for long periods, encouraging addiction: some 389 GPs were prescribing for two consecutive years and 159 prescribed for eight consecutive years.

Between 2000 and 2007, about €168.9 million in State funds was spent on minor tranquillisers and sedatives, of which €90 million was for drug costs and €79 million for professional fees, the report says.

Almost 90,000 people in the same period received 1.5 million prescriptions in the west most of them were older, female and medical card holders.

This report says the 2002 national prescribing guidelines are not being followed, and recommends that this be addressed urgently.

The study refers to benzodiazepines and non-benzodiazepine hypnotics, a class of psychoactive drugs with hypnotic and sedative effects.

As it explains, benzodiazepines were first marketed as a safer alternative to barbiturates, an older class of drugs that also depressed the central nervous system, but which had been linked to suicide and accidental death, particularly when taken with alcohol to help sleep.

By the mid-1980s, there were 17 benzodiazepines on the market, including Librium and Valium, but it has since been found that regular use leads to loss of therapeutic benefit, increased dosage, unpleasant withdrawal symptoms and drug dependence. Pilots and motorists' concentration is impaired with even small doses, and the drugs have been linked to physical and verbal aggression and types of crime, according to research referred to in the study.

The study says there are "three parties to every prescription for a minor tranquilliser or sedative, with the patient being the least and the prescriber and the pharmacist being the most powerful in this relationship.

"The elephant in the room is the State-funded drug reimbursement regime, which pays a fee to both the doctor and the pharmacist for every prescription validly written, and validly dispensed, but which appears by its very nature to be singularly ill-equipped to deal with inappropriate prescribing and dispensing," the study says.

It says the "absent friend" has to be the electronic monitoring system that would alert prescribers, pharmacists and public health authorities in "real time" to be vigilant at all times in the interests of the individual and the community.

It says the Health Service Executive, Medical Council of Ireland and the Pharmaceutical Society of Ireland should work closely to identify and address known or suspected cases of inappropriate prescribing and dispensing. It also says that consideration should be given to making the current good practice prescribing guidelines binding on all prescribers.

Movement of minor tranquillisers and sedatives into a higher control schedule should also be considered, it says.

The report was one of three presented to Minister of State for Drugs Strategy and Community Affairs John Curran in Galway late last week. An assessment of regional needs in relation to substance misuse in the Traveller community by Marie-Claire Van Hout of Waterford Institute of Technology found evidence to suggest that fewer Travellers than settled people are using drugs.

Illegal drug taking is most prevalent among young men in the Traveller community, while minor tranquillisers and sedatives are mostly abused by women. It says that drug education and prevention for the community needs more attention.

A third study on substance use in new communities by Colette Kelly, Cliona Fitzpatrick and Saoirse Nic Gabhainn of NUI Galway's health promotion research centre describes how migrant workers, asylum seekers and refugees are often cut off from supports especially those who are isolated from their families and have poor English language skills.

Welcoming the reports, Mr Curran said the research would inform the work of the Western Region Drugs Task Force and would "help to provide a better response to the needs of communities".


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