Putting the emergency brakes on a runaway train

Nearly 64,000 Americans died from a drug overdose in 2016 alone. Opioid overdoses accounted for more than 42,000 of these deaths, more than any previous year on record.

In response, the US government launched an initiative to tackle the crisis. The first part of this involves reducing the demand and over-prescription, including educating Americans about the dangers of opioid misuse. The second part involves cutting down on the supply of illicit drugs by cracking down on the international and domestic drug supply chains. The third part involves helping those struggling with addiction through evidence-based treatment and recovery support services. In 2018, the SUPPORT Act was passed, which is the single-largest legislative package addressing a single drug crisis in history. To curb over-prescription, a Safer Prescribing Plan has been launched that aims to cut opioid prescription fills by one-third within three years.

Prescribing issues are not limited to opioids. In September, the Medical Council issued advice to all doctors prescribing benzodiazepines, z-drugs and pregabalin to follow best-practice guidelines and to only prescribe benzodiazepines or similar drugs when absolutely required.

The President of the Medical Council, Dr Rita Doyle, said: “The impact of inappropriate prescribing of benzodiazepines, z-drugs, pregabalin and other controlled drugs is having a significant impact on patient safety and wellbeing.

“While benzodiazepines may have a role in the treatment of a patient on a time-limited basis, caution and strict monitoring are required when they are prescribed. Patients who become dependent upon benzodiazepines should be referred to the appropriate drug treatment services and provided with appropriate supports.

“As a Council, we acknowledge and appreciate the challenges faced by practitioners, the difficulties some practices are experiencing in terms of benzodiazepine and z-drug usage, and the demands from some patients for this and similar types of medication.”

In this issue of the Medical Independent, we have a feature examining the issue. One GP found the Council’s statement unhelpful, feeling that it was unsupportive to doctors. It was pointed out that prescriptions for benzodiazepines are often made within the hospital system and the target audience of the Council’s statement was not clear.

Long waits for counselling and therapeutic services were also noted. Prescriptions are often made as a result of the difficulty in accessing such services.

Dr Doyle said that the statement was not just targeted at GPs. While she said only a small number of doctors have poor prescribing practices, the Council felt it had to issue the statement in the interests of patient safety.

The problem of opioid and benzodiazepine addiction is multifactorial and any solution needs to recognise this complexity. But doctors have an important role to play if the issue is to be comprehensively tackled.