The recommendations of the All Party Parliamentary Drugs Misuse Group Report
The full report can be read by clicking here
RECOMMENDATIONS
1. Training for Medical Professionals
1.1 That the British Medical Association (BMA), the GMC and the Royal
College of Nursing (RCN) should ensure that all medical students and nurses
are trained to recognise the symptoms of physical dependence and addiction
to drugs including over-the-counter and prescription medications.
1.2 That the BMA, GMC and RCN should make training in substance misuse
part of the continuing professional development of GPs and nurses, as
information on this topic is being uncovered all the time.
1.3 That the BMA and GMC should ensure that medical students receive
comprehensive training in good prescribing practice and are taught the skills
to help them to deal with anxious or depressed patients to allow them to move
away from the “pill for every ill” prescribing attitude.2. Awareness
2.1 That the MHRA, working with the professional associations, must promote
better awareness amongst doctors and other health professionals about the
guidelines on prescribing and encourage them to work together to try to
reduce the number of people taking these potentially problematic drugs.
2.2 That, when GPs prescribe drugs which are known to have the potential to
cause physical dependence or addiction, they must explain these potential
risks to the patient.
2.3 That the MHRA and the pharmaceutical industry must put warnings about
potential dependence on the boxes of products containing over-the-counter
codeine as well as prominently in the PIL.
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2.4 That the MHRA and the DoH should seek to raise awareness about the risk
of developing dependence problems with codeine-containing painkillers, either
over-the-counter or on prescription.
2.5 That the advertising and promotion of codeine-containing products must
end.
2.6 That the DH must undertake a campaign to encourage patients to take
more responsibility for their own health and prescription choices. This
campaign must also extend to the use of online pharmacies and the potential
risks people expose themselves to when they buy from fraudulent online
pharmacies.
2.7 That the MHRA, DH, RPSGB and other interested parties must work
together to tackle fraudulent online pharmacies. An assessment of online
pharmacy usage and the impact of the RPSGB logo for legitimate sites needs
to be undertaken.
2.8 A joined-up approach between Customs, Police and Internet Service
Providers must be taken to tackle the problem of fraudulent drug sales
globally.3. Prescribing and Monitoring
3.1 That the MHRA must be rigorous in ensuring that all pharmaceutical
companies monitor their products through clinical trials and after their
introduction into general practice, and report to the MHRA problems of
physical dependence and addiction. Full information about clinical trials,
including those abandoned, should be publicly available.
3.2 That the DH sets up procedures to monitor the prescribing habits of
doctors, particularly with a view to preventing prescribing outside the BNF and
DH guidelines. GPs who prescribe outside the guidelines must be required to
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justify their decision to the PCT. Pharmacists should be encouraged to flag up
to PCTs doctors who are regularly prescribing to their patients outside these
guidelines.
3.3 That, when GPs prescribe drugs that are known to have the potential to
cause physical dependence or addiction, such as opiate-containing products
and benzodiazepines and related classes of drugs, they should set up
procedures to monitor the patient. Monitoring could, for example, be carried
out by a practice nurse or a pharmacist working within or alongside the
practice. The practice of repeat prescription without review for these drugs
must end.
3.4 That the MHRA should restrict access to codeine-containing painkillers,
such as Nurofen Plus, by reducing pack sizes (to 18) and making them only
available after consultation about the problem with a pharmacist.
3.5 That PCTs should play a greater role in ensuring doctors, healthcare
professionals and patients are all aware of the ways to report adverse drug
reactions. For example, the BMA publication “Reporting adverse drug
reactions: a guide for healthcare professionals” should be made available to
every healthcare professional.4. Recognition and Research
4.1 That more research must be undertaken in the field of dependence to
prescription and over-the-counter medication to determine the scale and
related implications of the problem.
4.2 That more research must be undertaken into anxiety, depression and pain
control to ensure that appropriate treatments are being offered to patients.
4.3 That more research is undertaken in the field of dependence and
addiction to both licit and illicit drugs to ensure that lessons are being learned
and that appropriate help and support can be provided.
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4.4 That better records, particularly with regard to suicides and drugs being
taken, are kept to allow research and monitoring to be undertaken in this area.5. Treatment
5.1 That, for patients who are already physically dependent or addicted to a
prescription or over-the-counter medicine, GPs should be required to assess
the situation and help the patient whenever possible to withdraw from the drug
using the available guidance, or should refer them on to a support
organisation or a treatment centre.
5.2 That the DH should require PCTs to provide appropriate treatment for
those addicted to these drugs. We believe that it would be inappropriate to
refer patients for treatment to DAATs for the reasons given in this report. We
recommend that a centre be established in each region and that these should
work on a ‘hub and spoke’ model so that patients in each PCT area can be
referred to clinics where specialist advice is available.
5.3 That PCTs should ensure that pathways for treatment of patients
presenting with a dependency should be as flexible as possible and
accessible. Patients should be able to refer themselves to these treatment
centres. The APPGDM encourages PCTs to undertake preventative action in
reducing the number of addicts in their area, as well as working with those
who become dependent.
5.4 That the value of local support groups for those who have become
physically dependent or addicted to prescription or over-the-counter
medication should be recognised by Government and its agencies. Online
support groups and those providing 24-hour services are particularly valuable
in our opinion and should receive appropriate funding.
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