November 7th 2007
Published online on BCNC 4th January 2007
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Front Cover
David McKeown.
Prescribed Medication Misuse Nurse for Greater Belfast.
David McKeown, Belfast Addiction Service |
Page 1
Benzodiazepines.
David McKeown, Belfast Addiction Service |
Are Benzodiazepines a Help or a Hindrance?
I would suggest that they are both.
If used correctly they are one of the most fantastic drugs on the market, but sadly all too often they are widely abused.
When Leo Sternbach discovered the formulae for this family of drugs I am sure he had no idea of just what he was unleashing unto the world in terms of addiction.
Page 2
History of Benzodiazepine use in Northern Ireland.
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Benzodiazepines were seen as a safe alternative to the widely used Barbiturates.
They started being introduced in Britain in the mid to late 60's.
In Northern Ireland we had not only the introduction of these drugs but "The Troubles".
Doctors started prescribing these "wonder drugs" as people started presenting with anxiety related to the troubles.
There was no information relating to any long term side-effects, so doctors kept prescibing these highly addictive tablets in ever increasing amounts.
Page 3
Growth of the Problem.
70's and 80's
Families and Neighbourhoods
David McKeown, Belfast Addiction Service
As the troubles raged on in Northern Ireland so to did the prescribing of these drugs.
By now whole families were taking these drugs and when the family ran out they could nip next door and borrow some.
In fact to a massive 212% higher than national average.
By the mid seventies some information was beginning to leak out into the public arena about possible dangers of long term use and addiction. Few if any practitioners kept prescribing them in huge quantities.
You begin to see how the problem started and quickly exploded.
Page 4
Response to the Problem
Tighter controls on prescribing
Better education of doctors and medical students.
Better education of the public.
David McKeown, Belfast Addiction Service
By the late 80's early 90's, there was a substantial body of evidence to warn against long term use of these drugs but for us in Belfast the dye was cast in that getting long term users off these drugs was going to be extremely difficult.
It appeared every surgery in Belfast had/has a significant problem with benzodiazepine users.
The response was to try to tighten up on prescribing.
To educate doctors and medical students that these drugs should only be used on short term basis.
Through various campaigns to educate the public that not every illness requires a pill.
However little was done to help those already addicted and by now there was thousands.
Page 5
Scale of the problem
Four Surgeries.
One surgery chosen at random from each compass point in the city.
North Belfast West Belfast Size of Practice 2299 Size of Practice 1300 No. of G.Ps. 2 No. of G.Ps. 1 No. of Patients on benzos. 131 or 5.6% No. of patients on benzos 139 or 10.6% South Belfast East Belfast Size of Practice 7000 Size of practice 7500 No. of G.Ps. 4.25 No. of G.Ps. 5 No. of patients on benzos 318 or 4.5% No. of patients on benzos 550 or 7.3%
David McKeown, Belfast Addiction Service
To try to give an idea of the extent of the problem we have randomly selected 4 surgeries in Belfast.
Here I show the size of the population each surgery covers with how many doctors and the number of patients on a benzodiazepine script for longer than 3/12.
I have then calculated that figure as a percent of the practice population.
This gives you an idea of the scale of the problem we face in Belfast.
Page 6
Scale of the Problem.
338,000 population in Belfast.
93 G.P. Surgeries in Belfast.
272 G.P's in Belfast.
David McKeown, Belfast Addiction Service
According to the 2001 census there is approximately 338,000 people living in the Greater Belfast area, with 93 G.P. surgeries looking after this population.
In total about 272 G.Ps.
Page 7
My Role.
S. - Stabalise the patients use of the drug.
- T. - Treat the underlying condition.
E. - Educate both patients and doctors alike.
- W. - Withdraw the patient from the drug.
David McKeown, Belfast Addiction Service
The need for my post was clearly evident and my role is to identify areas of greatest need and offer my services to the hard-pressed GPs in trying to help them deal with this difficult and often demanding group of patients.
There are four main elements to my role and these are;
1. To stabilise the patients use of the drug.
2. To treat any underlying condition.
3. To educate both patients their families and healthcare professionals in appropriate use of these drugs.
4. To where possible withdraw the patient from the drug.
Page 8
The Future.
Education, Education, Education.
Education and support of our Medical and Healthcare professionals.
- Educate and support our patients who have become addicted to benzodiazepines.
Educate and support of our school children in the use of benzodiazepines and others prescribed medications.
David McKeown, Belfast Addiction Service
The way forward as I see it lies in both education and support of the following groups;
Medical Staff.
Patients.
School Children.
Only with on-going education and training can we hope to get people away from the idea that there is a chemical solution to every human problem.
Page 9
The Future cont'd
Re-classification of Benzodiazepines
David McKeown, Belfast Addiction Service
I also believe we need to fight to get these drugs re-classified from a class "C" drug to a higher classification because then doctors will sit up and really think before prescribing these drugs again and again.
And patients must be encouraged to take a greater responsibility for what they are taking into their bodies.
They can only do this by asking questions about their medications.
Simple questions like;
What is it?
What is it supposed to do?
Are there any side-effects?
When do I come off it?
Page 10
David McKeown.
One Prescribed Medication Misuse Nurse for Belfast.?
- HELP!
David McKeown, Belfast Addiction Service
In conclusion I am only scratching the surface of what is a huge problem in Belfast.
Things are changing for the better but the change is very slow.
Doctors are becoming reluctant to start new prescriptions for benzodiazepines.
Patients are becoming more inquisitive about their medications.
But there remains many many patients who require our help and support.
Thank you.
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