Nearly 12 million people – about one in four adults in England – are taking medicines for pain, depression or insomnia, which they can find hard to stop, according to a government review.
Too many people are being prescribed medicines that can cause dependence, says Public Health England (PHE). Half have been on these medicines for a year or more and more than a fifth for over three years. Prescribing rates are 1.5 times higher for women than for men.
There may be good reasons for people to use antidepressants over a long period, but the widespread prescribing of opioid painkillers, benzodiazepines and sleeping pills needs to change, the review says. GPs should instead consider social prescribing, from talking therapies to joining a choir.
The biggest numbers are on antidepressants, which are taken by 7.3 million people in England, or 17% of the adult population. About 930,000 people have been on them for at least three years. Those who stop need to do so with the help of a doctor and taper their dose gradually to avoid withdrawal symptoms.
But long-term antidepressant use is necessary for some. More worrying, say the experts, are the half a million people who have been on opioid painkillers for more than three years for chronic conditions such as lower back pain and joint pain. The drugs are addictive and paracetamol or ibuprofen work as well or better, say experts. Opioids should be kept for acute pain, such as in cancer.
The review looked at five categories of drugs – antidepressants, opioid painkillers, benzodiazepines mostly prescribed for anxiety, gabapentinoids for neuropathic pain and z-drugs for insomnia. Prescribing of both opioids and benzodiazepines is dropping, but only after rising for many years.
Peter Burkinshaw at PHE, one of the authors said: “The long-term prescribing of opioid pain medicines and benzodiazepines is not supported by guidelines and is not effective.”
They found poorer people were more likely to be at risk of long-term prescription and more people were on the medicines for protracted periods in the north-east and north-west of the country, Burkinshaw said. “Prescribing rates are higher and duration is longer in areas of deprivation in England,” he said.
Fellow author Rosanna O’Connor, said: “We know that GPs in some of the more deprived areas are under great pressure but, as this review highlights, more needs to be done to educate and support patients, as well as looking closely at prescribing practice and what alternative treatments are available locally.
“While the scale and nature of opioid prescribing does not reflect the so-called crisis in North America, the NHS needs to take action now to protect patients.”
PHE officials urged people who were taking these medicines not to stop them abruptly, but if they were worried to speak to their GP.
Prof Helen Stokes-Lampard, the chair of the Royal College of GPs, said family doctors needed better access to alternatives to drug treatment. Most prescriptions were short-term and opioids were on the decline, but the review showed “the severe lack of alternatives to drug therapies for many conditions – and where effective alternatives are known and exist, inadequate and unequal access to them across the country”, she said.
GPs did not want to put patients on long-term medication, but for some it was the only thing that helped with distressing conditions such as chronic pain, depression and anxiety, she said.
The report recommends new guidance for GPs and better information for patients on the risks and benefits of the medicines, as well as improved data collection and a national helpline for worried members of the public. The National Institute for Health and Care Excellence said it was working on a guideline for the NHS on the safe prescribing and withdrawal of prescribed drugs.
The Royal College of Psychiatrists welcomed the report. “The findings of this review must be carefully listened to,” said Prof Wendy Burn, its president. “These drugs are important to the health and wellbeing of many patients when prescribed properly, but guidance for doctors needs to be updated to reflect the experience of patients who experience negative effects of withdrawal.”
“Antidepressants can bring significant benefits to many people’s lives. In all treatments, medicines which do good can also have negative effects. As the review acknowledges, long-term antidepressant use can be entirely clinically appropriate. However, patients must be supported to come off any prescription medication if they choose to and it is safe for them to do this.”
Prof John Read from the University of East London, who represented the British Psychological Society on the PHE inquiry and was joint author of an influential review for MPs on the withdrawal problems with antidepressants, said this was a hugely important report.
“We especially welcome the thorough research review documenting the alarming numbers of people experiencing withdrawal effects from prescribed medicines, and the recommendations for urgently needed services and a phone line to support people struggling to come off these drugs, including antidepressants,” he said.
“We also value the emphasis placed on increasing accessibility to talking therapies for the problems that the drugs are currently prescribed for.”
