Significant concerns have been raised regarding how medicines with a risk of dependence or withdrawal are managed and how care is experienced by patients.

About the research

Public Health England and the British Medical Association [1, 2] have called for change regarding how medications with a risk of dependence or withdrawal are managed.

These medications include benzodiazepines, z-drugs, gabapentinoids, opioids for chronic non-cancer pain and antidepressants. The scale of prescribing of these medications has been identified as a public health issue in the UK [1]. Public Health England highlight inappropriate prescribing of these medications and prescribing for longer than good practices guidelines recommend, increasing the likelihood of dependence[1]. Poor patient care has been cited to include inadequate information provided to patients, and deprescription regimes that are poorly managed resulting in significant withdrawal symptoms and patient distress [2, 3].

This project brought together healthcare professionals working within general practice as well as patients prescribed medications with a risk of dependence or withdrawal [4]. The aim of the research was to understand the experience of prescribing, and being prescribed, these medications and to identify priorities to improve the experience of care for patients. The results of this research have clear implications for policy.

Key findings

These findings are based on in-depth individual interviews conducted with 15 healthcare professionals and 20 patients from five GP surgeries.

• Patients reported a lack of information about the medication they were prescribed, including potential risks, and how medication would be managed and deprescribed.
• Patients prescribed medication with a risk of dependence or withdrawal wanted continuity of care. Not being able to see the same healthcare professional was reported to prevent partnership working and meant patients felt less able to engage in shared decision making in relation to their healthcare.
• Patients wanted access to alternative non-pharmacological treatment (e.g. talking therapies, pain management services). Healthcare professionals reported long waiting times and limited NHS provision of such services.
• Patients reported a lack of support during deprescription (the process of gradually reducing and stopping medication); many healthcare professionals were uncertain how to deprescribe these medications and reported inadequate time to fully support patients.

Policy implications

• GP practices should be incentivised to conduct a ‘mini-review’ of medication shortly after initial prescription. Information on potential risks and the plan for treatment should be reiterated at this review.
• In line with calls from Public Health England, the British Medical Association and the All Party Parliamentary Group for Prescribed Drug Dependence, this study echoes calls for the creation of a dedicated helpline and website to provide detailed accessible medication-related information to patients.
• NHS England should make continuity of care a priority for patients prescribed medicines with a risk of dependence or withdrawal. Continuity of care should be a particular priority during the process of deprescription.
• GP practices should be incentivised to create a continuity of care plan for their practice. This should outline plans for how continuity of care will be achieved for patients prescribed medications with a risk of dependence, taking account of ‘critical periods’ for continuity, such as medication reviews and during deprescription.
• Ensuring patients are offered alternative non-pharmacological treatments and services (e.g. talking therapies, pain management services) is highlighted in good practice guidelines, but limited provision can prevent access to such services. The availability of these services at a local level needs to be mapped. Where service provision is identified as limited, the development of services needs to be a priority for ICB action and delivery plans.
• GP practices should be incentivised to create specialised deprescription clinics. These clinics should have input from both GPs and clinical general practice based pharmacists. The creation of deprescription clinics would enable early identification of patients who may benefit from reducing or stopping medications, help to safeguard against unnecessary long-term prescription and would provide more support for patients when stopping medicines. Patients should be assigned a designated healthcare professional from the clinic whom they can contact where necessary.
• Support needs to be made available to healthcare professionals in managing represcription from medicines with a risk of dependence or withdrawal. We recommend that each ICB has a specialist pharmacist available who can provide advice and guidance to healthcare professionals in managing deprescription from these medicines.

For further information download the summary report [PDF], the Medication Addiction Guidance For Professionals [PDF] and the information guide for patients [PDF]

SOURCES

[1] Public Health England, Dependence and withdrawal associated with some prescribed medicines:An evidence review. 2019, PHE.: London.
[2] British Medical Association, Prescribed drugs associated with dependence and withdrawal – building a consensus for action. 2015, BMA.: London.
[3] Guy A, Brown M, Lewis S. The Patient Voice: an analysis of personal accounts of prescribed drug dependence and withdrawal submitted to petitions in Scotland and Wales. 2018, All-Party Parliamentary Group for Prescribed Drug Dependence.: London.
[4] Seddon J, Friedrich C, Wadd S, Dicks D, Scott S, Robinson A, Walker C. Improving patient experience for people prescribed medicines with a risk of dependence or withdrawal: co-designed solutions using experience based co-design. BMC Primary Care. 2024 Jan 6;25(1):17.