Health chiefs fear that hundreds of thousands of people in England are getting hooked on prescription drugs.

The government requested a review from Public Health England (PHE) amid concern that large numbers of people were misusing prescription drugs. To assess the levels of dependency, PHE officials analysed patient data to find out exactly how many people were taking these drugs outside of hospitals and for how long. They found that half of people using strong painkillers, antidepressants and sleeping tablets have been using them for at least 12 months.

Long-term use on such a scale could be a sign of patients becoming dependent.

PHE Medical Director Professor Paul Cosford said he was worried.

“These medicines have many vital clinical uses and can make a big difference to people’s quality of life.”

However, there are too many cases where patients are using them for longer than clinically appropriate, he said. In these circumstances, the drugs could have simply stopped working effectively or the risks could outweigh the benefits. The PHE said it was unclear if the long-term use of prescription drugs was causing harm. However, each drug does have side-effects, including weight gain and can place stress on the heart, kidney and lungs.

Commenting on the figures, Professor Helen Stokes-Lampard, of the Royal College of GPs, said doctors did not like prescribing medication long-term, but were sometimes left with no choice. It indicates a severe lack of alternatives, she said.

Five classes of drugs were reviewed

Five classes of medicines were included in the review:

  • Antidepressants
  • Opioid painkillers (used for acute pain and injury, but excluding use in cancer patients)
  • Gabapentinoids (used to treat epilepsy, anxiety and nerve-related pain)
  • Benzodiazepines (mostly prescribed for anxiety)
  • Z-drugs (sleeping tablets)

Half of people who were using the drugs in March 2018 had been on them for a year or more; about a quarter had used them for at least 3 years. In addition, rates of prescribing were higher in deprived areas and among women.

Opioid-based painkillers should only be used for short periods so the fact that there were 1.2 million people on them for at least a year, with 540,000 taking them for at least 3 years, is extremely worrying, said PHE.

Antidepressants take some time to become fully effective, so it is not surprising to find people using them for a long time. However, there were nearly 1 million people using them who had been on them for at least 3 years, which rang alarm bells, PHE said. The scale of that long-term use suggested those with mild-to-moderate depression may have become dependent on them.

In addition, long-term use means tolerance could build up and treatments could stop being effective or require patients to increase the doses they were taking.

Are we heading the same way as the USA?

The misuse of prescription drugs, in particular opioid-based painkillers, is a major problem in the USA. Prescription rates have risen sharply since the late 1990s and deaths from opioid overdoses have more than doubled in the past decade.

PHE said what is being seen in England is not yet on that scale.

Prescription rates are four times lower in England than the USA and deaths from overdoses have not increased at such a rate.

However, we want to get on top of this now before we see the problems that have been seen elsewhere, said Professor Cosford.

What’s the solution?

Patients are advised to not stop taking their drugs. Any attempt to tackle dependency needs to involve a gradual reduction in use and dosage. Instead, they should speak to their GPs, who are being told to review the use of these medications and seek alternative solutions.

NHS England is investing in services such as talking therapies and so-called social prescribing, which includes exercise classes and arts-based activities, which could be more appropriate. Linking people with social activities can help reduce isolation and depression. Tailored activity programmes and physiotherapy could be used to tackle pain.

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