Dependence on prescription-only medicines (POM) and over-the-counter (OTC) drugs is much more widespread throughout the UK than previously thought, and the government needs to take action “as a matter of urgency” to determine the true scale of the problem, MPs have said.
A year-long inquiry by the All Party Parliamentary Drugs Misuse Group (APPDMG) which, they say, has “only scratched the surface of this problem,”has heard for example that many people are still receiving regular repeat prescriptions for benzodiazepines – some have been taking them for 30 years – despite guidance to doctors saying the drugs should be prescribed for no longer than four weeks at a time. Some people have been incapacitated by the symptoms associated with their dependence on or withdrawal from medication, which included panic attacks, confusion, anxiety, severe joint pain, tremors and stomach ulcers, they found.
The MPs were also shocked by evidence suggesting that a considerable number of people in the UK are addicted to OTCs containing codeine, said the APPDG’s chairman, Dr Brian Iddon, Labour MP for Bolton South East. “This issue cannot be ignored any longer. We must establish the scale of the problem and provide proper diagnosis and treatment for those affected,” he said.
A major problem is the lack of support available to people when discovering they are dependent on medication prescribed by their GP or bought from their pharmacy. Drug treatment services are not necessarily geared to help individuals with a dependency on OTCs or POMs, so small charities, support groups and online forums are frequently their only source of advice and help, the inquiry found.
A further concern is about the lack of official data recorded which could help determine the scale of the problem of OTC or POM dependency, and a key recommendation of the Group’s report is that research should be carried out by the Department of Health into the problem as a matter of urgency.
Other recommendations in the report are that: – medical students and nurses should be trained to recognise the symptoms of OTC and POM dependency; – the Department should require all Primary Care Trusts (PCTs) to provide appropriate treatment for those with an OTC or POM dependency; – information and warnings about potential dependence should be included with every sale of products containing codeine; and – the value of small support groups including, including those on-line, should be recognised and appropriate government funding allocated to ensure their continued operation.
The report was welcomed by Martin Barnes, chief executive of Drugscope, the national membership organisation for the drugs field, who said he hoped it would be the catalyst for much greater awareness of the potential harms that prescription and OTC drugs can cause. Establishing the extent of the problems associated with these medicines must be a priority, he added.
The Proprietary Association of Great Britain (PAGB), the trade association representing manufacturers of OTC medicines and food supplements, pointed out that the scale of dependency in the UK linked to OTC codeine products is unknown. Whilst virtually all researchers agree that misuse of OTCs is a small problem and that the vast majority of people use them safely and responsibly, much of the information available is anecdotal, it noted.
The PAGB’s chief executive, Sheila Kelly, also pointed out that measures introduced in 2005 included a voluntary pack size reduction and the addition of addiction warnings on the pack. “The PAGB is happy to discuss whether the warnings can be improved, but believes a further pack size reduction to 18 tablets would cause inconvenience and have no effect on addiction,” she said.
“The industry is against further restrictions on advertising as this is not the reason why people become addicted. In any case, there is very little advertising of products containing codeine,” added Ms Kelly.
A statement from the Royal Pharmaceutical Society of Great Britain (RPSGB) noted that pharmacists, and their staff, are aware of possible misuse of POM and OTC medicines, and they employ various strategies to manage sales when misuse is suspected.
However, misuse of medicines is difficult to control, especially when customers can go from pharmacy to pharmacy to make purchases, says the Society, and it calls for the development of systems to share information on local patterns of misuse, involving all health professionals to help the situation. More research and evidence should be undertaken to allow factual assessment of the scale of the problem, reasons for drug misuse and dependence to prescriptions, it adds.
