The NHS has unveiled a new action plan to further crack down on the overuse of potentially-addictive medicines, as latest data showed that GPs and pharmacists have helped reduce opioid prescriptions in England by 450,000 in under 4 years.
NHS England said that the new framework aims to "further reduce inappropriate prescribing" of high-strength painkillers and other addiction-causing medicines, like opioids and benzodiazepines, where these may "no longer be the most clinically appropriate treatment for patients", and in some cases can become harmful without intervention.
Professor Tony Avery OBE, national clinical director for prescribing at NHS England said: "We need to be alert to the risks of some medicines, particularly when used over a long period of time."
Royal Pharmaceutical Society (RPS) Director for England, James Davies, commented: "Whilst opioids can play an important part in helping people with chronic pain there has long been a need for alternative approaches that are safer and more effective for patients."
Drugs Prescribed Inappropriately and For Longer Than Recommended
In its review, "Dependence and withdrawal associated with some prescribed medicines: An evidence review" (2020), Public Health England (PHE) found that in 2017-18 1 in 4 adults in England were prescribed benzodiazepines, Z-drugs (sleeping pills), gabapentinoids, opioids for chronic non-cancer pain, or antidepressants. It also identified that since 2008 the number of patients dispensed either antidepressants or gabapentinoids had been increasing, with trends gradually decreasing for the other three classes – benzodiazepines, opioids, and Z-drugs.
PHE reported that prescribing patterns for all five classes of medicines were higher in women and older patients, and in areas of deprivation, and that more people were being prescribed these classes of medicines "inappropriately" and often for "longer" than good practice guidance recommended.
Within its review, PHE made a number of recommendations that included:
- Increasing the availability and use of data on the prescribing of medicines that can cause dependence or withdrawal
- Improving information for patients and carers on prescribed medicines and other treatments, and increasing informed choice and shared decision-making between clinicians and patients
- Improving the support available from the healthcare system for patients experiencing dependence on, or withdrawal from, prescribed medicines
- Further research on the prevention and treatment of dependence on, and withdrawal from, prescribed medicines
Personalised and Shared Decision Making
In the new plan, recommended actions aimed to improve outcomes in population health and healthcare, tackle health inequalities in outcomes, experience and access, enhance productivity and value for money, and help the NHS support broader social and economic development, expressed NHS England.
Professor Sir Stephen Powis, national medical director for NHS England said: "We know that patients who require prescriptions for potentially addictive drugs can become dependent and struggle with withdrawal, and this new action plan helps NHS services to continue positive work in this space."
NHS England highlighted that the number of antidepressants prescribed since 2019-20 had increased, and that the number of gabapentinoids prescribed had also marginally increased over the same period. However, in under 3 years, the number of opioid painkillers prescribed had fallen by 8%, which is estimated to have "saved nearly 350 lives and prevented more than 2100 incidents of patient harm", an NHS spokesperson said.
The numbers of benzodiazepines and Z-drugs prescribed in England had also fallen by 170,000 (13.9%) and 95,000 (10.2%), respectively, since the implementation of PHE's recommendations.
Five Key Actions
The new framework to reduce inappropriate prescribing of addiction-causing medicines included five key actions that would support GPs and clinical pharmacists to provide patients with a "personalised" review of their medicines and make a "shared decision" about whether a change in treatment is needed – such as moving patients away from potentially-addictive prescribed drugs, especially in cases where the clinical benefit for an individual remaining on a treatment decreases, explained NHS England.
Personalised care and shared decision-making – through dedicated clinics or using structured medication reviews – is a crucial component of the plan, with healthcare professionals encouraged when considering prescribing "openly" to discuss with the patient the intended outcome from prescribing, potential benefits, risk, and harm of the treatment, and decisions about whether to continue, stop, or taper treatment.
Alternative interventions to medicines should be offered to patients when a prescription for a medicine associated with dependence and withdrawal symptoms is first considered, or when the prescription is reviewed, advised the plan. NHS England explained that alternative treatments and services such as self-management approaches – social prescribing, health coaching, peer support, patient education - psychosocial interventions, musculoskeletal clinics, mental health services such as NHS talking therapies for anxiety and depression, pain clinics, and sleep services, can "benefit patients and ensure a person-centred approach to care".
The other three recommended actions involved service specification and change management, taking a whole system approach, and population health management.
Professor Powis applauded the new plan, and emphasised that it gave "clear guidance to support patients who no longer needed these drugs to provide them with routine medicine reviews and move them on to other, alternative therapies where appropriate, saving both lives and taxpayer money in the process".
'Positive Step'
Personalised and innovative support for patients who have used addictive drugs or suffer from a condition that would have historically seen them prescribed such a drug, to better manage their long-term physical and mental health, is vital, underlined NHS England.
The new framework highlighted steps that local healthcare providers can take to support people who may be taking a prescribed medicine that may no longer be the best treatment for them, and NHS England encouraged local systems to develop and adopt initiatives "tailored to the needs of their population", and that gave people "flexibility" in how to manage their condition.
"To make a difference, these actions need to be effectively prioritised in Integrated Care System (ICS) improvement and delivery plans, including when commissioning services and developing local policies," NHS England stressed.
Welcoming the new framework, Mr Davies enthused that it was a "positive step" towards improving patient care by supporting medicine reviews and shared decision making to help people reduce their use of medicines that are no longer providing much clinical benefit.
The new framework "empowers local services" to work with people to ensure they are being effectively supported when a medicine is no longer providing overall benefit, declared Professor Avery.
