HOUSE OF COMMONS OFFICIAL REPORT
PARLIAMENTARY DEBATES (HANSARD)
See also: 7 December 1999 · 30 June 1999
Benzodiazepines
4 December 2001
Original Text
Andrew George: To ask the Secretary of State for Health:
(1) how many patients (a) have been prescribed benzodiazepines and (b) were considered to be clinically dependent upon them during each year since 1971; [15588]
(2) what advice his Department issued with regard to the (a) daily dosage, (b) time limit of dosage, (c) possible side-effects and (d) tendency to addiction of those prescribed benzodiazepines during the last 25 years; and what assessment he has made of such advice issued by medical advisory bodies; [15586]
(3) what recent assessment his Department has made of the impact on NHS patients of prescribing benzodiazepines; [15590]
(4) what assessment he has made of the impact of medical practice to prescribe benzodiazepines to some patients with a spectrum of mental health disorders in respect of (a) recovery from illness, (b) worsening of illness, (c) onset of known side-effects and (d) addiction to these drugs; [15587]
(5) how many (a) benzodiazepine doses have been administered and (b) prescriptions for benzodiazepines have been written for each year since 1971. [15591]
4 Dec 2001 : Column: 169W
The numbers of prescriptions for benzodiazepines from 1980 to 2000 are listed in the tables. However the number of prescriptions cannot be used to determine the number of patients receiving benzodiazepines. Information is not available on the number of patients considered to be clinically dependent upon benzodiazepines.
Information on the daily dosage, time limit of dosage, possible side effects and tendency to addiction of benzodiazepines is present in the Summary of Product Characteristics, and the Patient Information Leaflet, which is produced by the manufacturer and approved by the Licensing Authority. The Committee on Safety of Medicines, and previously the Committee on the Review of Medicine have issued advice on all these aspects in relation to benzodiazepines use to healthcare professionals in the United Kingdom on a number of occasions in the drug safety bulletin "Current Problems in Pharmacovigilance" and in the British Medical Journal. These publications are listed and copies will be placed in the Library.
Current Problems in Pharmacovigilance 1978 - thrombophlebitis associated with diazepam.
British Medical Journal, 1980: 910-912. Systematic review of benzodiazepines.
Current Problems in Pharmacovigilance 1981 - Unexpected severe psychotic effects with Halcion.
Current Problems in Pharmacovigilance 1985 - Respiratory depression and hypotension with Midazolam (Hypnovel).
Current Problems in Pharmacovigilance 1988 - Benzodiazepines, dependence and withdrawal symptoms.
Current Problems in Pharmacovigilance 1995 - Side effects may impair driving.
Current Problems in Pharmacovigilance 1997 - Avoid benzodiazepines during pregnancy and lactation as they may cause side effects in the exposed babies.
Mental Health Foundation 1994 "Guidelines for the Prevention and Treatment of Benzodiazepine Dependence".
Department of Health 1999 - "Drug misuse and dependence - guidelines on clinical management".
We are not aware of any audit of the impact of such advice.
No recent assessment has been made of the impact on national health service patients of prescribing any particular group of psychiatric drugs. Volume of benzodiazepine prescribing in the community is monitored and the measure has been included as a high level performance indicator.
No assessment has been made of the impact on medical practice of prescribing benzodiazepines, nor has any assessment been made of the impact of the information and advice provided on medical practice.
The number of prescriptions dispensed in the community for benzodiazepines in England since 1980 is given in the tables. Data prior to 1980 are not available. Information about drugs prescribed and dispensed in hospitals is not available.
| Prescriptions (1000) | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1980 | 1981 | 1982 | 1983 | 1984 | 1985 | 1986 | 1987 | 1988 | 1989 | 1990 | |
| Temazepam | 1,014 | 1,709 | 2,431 | 2,896 | 3,378 | 5,133 | 5,802 | 6,242 | 6,129 | 5,946 | 5,985 |
| Diazepam | 7,300 | 6,604 | 5,812 | 5,147 | 4,449 | 4,374 | 4,217 | 4,071 | 3,622 | 3,331 | 3,147 |
| Nitrazepam | 7,362 | 6,910 | 6,596 | 5,912 | 5,368 | 5,001 | 4,657 | 4,383 | 3,850 | 3,523 | 3,188 |
| Lorazepam | 2,033 | 2,487 | 2,928 | 2,957 | 2,736 | 2,590 | 2,607 | 2,395 | 1,756 | 1,452 | 1,227 |
| Chloridiazepoxide | 1,834 | 1,694 | 1,516 | 1,294 | 1,112 | 1,007 | 893 | 816 | 697 | 604 | 548 |
| Oxazepam | 587 | 675 | 654 | 612 | 561 | 609 | 646 | 621 | 511 | 406 | 399 |
| Lormetazepam | -- | 32 | 163 | 346 | 442 | 122 | 160 | 191 | 194 | 169 | 163 |
| Clonazepam | 40 | 48 | 55 | 72 | 77 | 93 | 99 | 107 | 111 | 111 | 127 |
| Loprazolam Mesylate | -- | -- | -- | 2 | 50 | 19 | 71 | 125 | 127 | 144 | 160 |
| Clobazam | 275 | 330 | 381 | 378 | 396 | 109 | 42 | 39 | 48 | 59 | 53 |
| Triazolam | 402 | 795 | 855 | 782 | 906 | 1,200 | 1,468 | 1,576 | 1,635 | 1,530 | 1,513 |
| Alprazolam | -- | -- | -- | 127 | 261 | 63 | -- | -- | -- | -- | -- |
| Bromazepam | -- | -- | 9 | 76 | 151 | 32 | -- | -- | -- | -- | -- |
| Clorazepate Dipotassium | 945 | 930 | 971 | 971 | 1,016 | 216 | -- | -- | -- | -- | -- |
| Flunitrazepam | -- | -- | 7 | 86 | 188 | 54 | -- | -- | -- | -- | -- |
| Flurazepam Hydrochloride | 1,885 | 1,833 | 1,860 | 1,700 | 1,628 | 376 | -- | -- | -- | -- | -- |
| Ketazolam | 37 | 105 | 135 | 138 | 118 | 27 | -- | -- | -- | -- | -- |
| Medazepam | 198 | 176 | 159 | 140 | 108 | 25 | -- | -- | -- | -- | -- |
| Prazepam | -- | -- | 12 | 55 | 55 | 12 | -- | -- | -- | -- | -- |
| Total | 23,912 | 24,329 | 24,544 | 23,962 | 22,999 | 21,062 | 20,662 | 20,565 | 18,680 | 17,274 | 16,510 |
| Annual change (percentage) | -- | 1.7 | 0.9 | -2.4 | -4.0 | -8.4 | -1.9 | -0.5 | -9.2 | -7.5 | -4.4 |
| 1991 | 1992 | 1993 | 1994 | 1995 | 1996 | 1997 | 1998 | 1999 | 2000 | |
|---|---|---|---|---|---|---|---|---|---|---|
| Temazepam | 6,428 | 6,914 | 6,651 | 6,345 | 6,063 | 5,540 | 5,252 | 5,043 | 4,878 | 4,697 |
| Diazepam | 3,254 | 3,225 | 3,220 | 3,288 | 3,411 | 3,600 | 3,798 | 3,989 | 4,108 | 4,293 |
| Nitrazepam | 3,186 | 3,074 | 2,902 | 2,721 | 2,582 | 2,539 | 2,426 | 2,333 | 2,210 | 2,095 |
| Lorazepam | 1,137 | 1,018 | 932 | 867 | 818 | 785 | 758 | 743 | 728 | 715 |
| Chloridiazepoxide | 542 | 503 | 467 | 449 | 438 | 428 | 423 | 414 | 402 | 384 |
| Oxazepam | 378 | 352 | 328 | 311 | 300 | 304 | 306 | 300 | 289 | 272 |
| Lormetazepam | 181 | 215 | 218 | 208 | 201 | 234 | 249 | 252 | 246 | 210 |
| Clonazepam | 137 | 144 | 152 | 160 | 168 | 181 | 196 | 213 | 231 | 253 |
| Loprazolam Mesylate | 195 | 239 | 230 | 219 | 213 | 221 | 215 | 211 | 200 | 191 |
| Clobazam | 66 | 67 | 67 | 68 | 70 | 74 | 74 | 82 | 85 | 93 |
| Triazolam | 1,123 | -- | -- | -- | -- | -- | -- | -- | -- | -- |
| Alprazolam | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- |
| Bromazepam | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- |
| Clorazepate Dipotassium | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- |
| Flunitrazepam | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- |
| Flurazepam Hydrochloride | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- |
| Ketazolam | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- |
| Medazepam | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- |
| Prazepam | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- |
| Total | 16,626 | 15,751 | 15,167 | 14,638 | 14,266 | 13,905 | 13,698 | 13,580 | 13,378 | 13,204 |
| Annual change (percentage) | -- | -5.3 | -3.7 | -3.5 | -2.5 | -2.5 | -1.5 | -0.9 | -1.5 | -1.3 |
Notes:
1. The prescription information was obtained from the Prescription Cost Analysis (PCA) system. Please note that the data up to 1990 are not strictly consistent with data from 1991 onwards. Figures for 1980-90 are based on fees and on a sample of 1 in 200 prescriptions dispensed by community pharmacists and appliance contractors only. Figures for 1991 onwards are based on items and cover all prescriptions dispensed by community pharmacists, appliance contractors dispensing doctors and prescriptions submitted by prescribing doctors for items personally administered. Also included are prescriptions written in Wales, Scotland, Northern Ireland and the Isle of Man but dispensed in England. The data do not cover drugs dispensed in hospital or private prescriptions.
2. Benzodiazepines are those drugs defined within the British National Formulary sections 4.1.1, "Hypnotics", 4.1.2. "Anxiolytics", and 4.8. "Antiepileptics".
4 Dec 2001 : Column: 171W
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