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Chief medical officer plans dosage
crackdown to reduce dependence

The Guardian
Wednesday, February 11, 2004
James Meikl, health correspondent

The chief medical officer has warned doctors that far too many tranquillisers are being prescribed, exposing thousands of patients to potential addiction and damage to their health.

Professor Sir Liam Donaldson is concerned that many GPs are not following 16-year-old guidance that is meant to stop excessive prescription. Drugs such as Valium and Librium - once popularly known as "mother's little helper" - should only be used for a month at the most and only for people with distressing symptoms of anxiety.

The government is poised to introduce new restrictions on the use of common tranquillisers prescribed to an estimated 1 million people a year in an effort to reduce the perils of even mildly anxious patients becoming addicted to the sedatives.

Patients will have to return to their pharmacists several times to collect capsules or tablets over the course of treatment to help reduce dependence on the drugs and tackle the black market which sees legally dispensed medicine being siphoned off for the illegal drugs trade.

About 170,000 people are thought to misuse the tranquillisers known as benzodiazepines or "benzos" each year, often using drugs obtained from GPs either by exaggerating daily consumption or multiple registration with different GPs. Benzos were implicated in 222 drug-related deaths in 2001, nearly four times the number linked to amphetamines and one in 13 of all drug-related deaths.

Patients who would not necessarily be aware they were criminally supplying illegal drugs are also said to be a factor. One campaigner for still tighter rules said that "little old ladies" went for repeat prescriptions before selling on the drugs to younger relatives.

Prof Donaldson claims some success in reducing usage, from 15.8m prescriptions by GPs in England in 1992 to 12.7m in 2002. But he recognises that 30% of these are still for 56 or more tablets, suggesting "a high number of patients are receiving long-term treatment". This, he adds, is dangerous, exposing patients to risk of traffic accidents, dependence, and, among older patients, debilitating falls.

Prof Donaldson says primary care trusts must ensure recommendations to monitor and review use of benzodiazepines, last made in 1988, are "still being implemented".

The Department of Health confirmed yesterday that it planned to introduce "instalment dispensing" of the tranquillisers to minimise access to excessive doses. A spokesman said this would allow "a GP to write a single prescription that the pharmacist is able to dispense over several days. The scheme will give more control to doctors and reduce the risk substantially of a patient misusing the drug". Pharmacists will receive extra payments under the new controls.

Doctors who fail to observe clinical guidelines can face disciplinary action from NHS trusts or, if their behaviour is regarded as unprofessional, from the General Medical Council. But there has been mounting concern in recent years that the potential for misuse of the drugs has not been adequately recognised by doctors too ready to continue prescribing them.

The government has also promised to try to reduce waiting times for "talking treatments" for anxiety so that psychological therapies might be used instead.

But campaigners say the measures do not go far enough.

Heather Ashton, emeritus professor of clinical psychopharmacology at Newcastle University, says the drugs are making patients dependent at all stages of life, with older people taking them as sleeping pills or being administered them to keep them quiet in retirement homes.

Psychiatric patients are kept on them, she says, long after discharge from hospitals, while pregnant women may be in danger of passing on health problems to their babies.

Tougher rules against supplying, introduced in the recent legislation which downgraded cannabis in the dangerous drugs hierarchy, would not help, she said. "Prosecuting old ladies is just ridiculous. They get their temazepam, sell it to their nephews and go off playing bingo. They only keep one or two for themselves."

Prof Ashton added: "Doctors are also extraordinarily frightened of people with anxiety. They don't know what to do about it." She said money was needed for other health professionals to help wean people off the tranquillisers. There should also be more specialist clinics. Prof Ashton also questioned whether there was much true success in reducing prescriptions. She argued that some patients had merely been moved to a different class of drugs which had similar problems of dependence.

Barry Haslam, a recovered addict from Oldham and founder of the Beat the Benzos campaign, said: "This is nowhere near far enough. Doctors don't want to be dictated to. Benzo addicts get their fix from GPs. If they went out robbing and causing mayhem, the government would have acted years ago."

He and Chris Davies, Liberal Democrat MEP for the north-west of England, met European health commissioner David Byrne to press for EU-wide action. Mr Davies said millions of people were being turned into lifelong addicts "by doctors who continue to ignore prescribing guidelines". In some cases the problem was a social one, not medical. "If you are not in control of your life, at the mercy of money lenders, violent husbands or whatever, you look for a way out."

The charity Turning Point said: "GPs need a lot more support dealing with someone they think has a problem. They need to know where they can refer people."

Addiction dangers of benzo drugs

Benzodiazepines are tranquillisers, with diazepam (including Valium) and temazepam being the most commonly prescribed. The government says 12m prescriptions were issued by GPs in England alone in 2002, a figure to which must be added private and hospital prescriptions.

Heather Ashton, emeritus professor at Newcastle University, suggests there may be 1 million long-term, prescribed users in the United Kingdom.

She said a survey about five years ago indicated 186 long-term "benzo" users in every GP practice in Newcastle and figures from other major towns and cities showed similar problems.

The drugs are meant to offer short-term relief from anxiety and are also used to help people sleep. But they can quickly become addictive. Official guidance to doctors says they should not be used for more than two to four weeks, and only for patients with severe or disabling anxiety that causes "unacceptable distress" or to treat severe or disabling insomnia in patients "who are extremely distressed".

They can cause confusion, lethargy and poor coordination and can affect people's ability to drive. With alcohol or other, illegal, drugs, they can cause medical complications and be a serious hazard to health.

But stopping treatment quickly can cause very similar symptoms to those they are meant to stop, such as anxiety and insomnia. Patients have to be weaned off.

Benzos are also regularly used by drug abusers, often to chill out on the club scene, with people coming down off acid, speed or ecstasy. Addicts extract liquid from temazepam capsules and inject it as a substitute for heroin. This is highly dangerous, as the liquid can block veins and lead to amputations.

The Home Office estimates 174,000 people use the drugs illegally each year, nearly a quarter of them aged 16-24. A 10mg temazepam tablet can change hands for 1 on the black market. They are class C drugs, with penalties for supply recently increased to 14 years.


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