Dear Earl Howe,
I would like to ask you for clarification on various comments you made in response to Amendment 203 of the Health Bill moved by the Earl of Sandwich on 30 November 2011 regarding addiction to prescribed tranquillisers.
In this debate you stated that “There is access to support and treatment services for addiction to medicines in most local areas but some local areas are woefully short of such services.”
Your statement that there are local services is not true and despite your assertions, when the office of Anne Milton has been asked for contact details of these services, wrong telephone numbers have been provided or PCTs such as Wandsworth and South Gloucester have been given. However, when contacted these drug treatment centres denied having any provision for prescribed only tranquilliser addicts and stated that they referred these patients to the withdrawal charities. There is also no provision in Cumbria or Lancashire as I have researched these areas as well, and campaigners in other areas of the UK have also sought help and found none. If you are referring to DAATs then these organisations by their own word do not treat prescribed only tranquilliser addiction and routinely turn these patients away.
Would you therefore please supply contact details for all these services which you say are available in most areas, because all the evidence points to the contrary?
You further stated that “We believe that local bodies, with their greater knowledge and understanding of local health needs, are best placed to assess the needs for services in general.”
Again, evidence gained by contacting local drug teams has shown that there is little or no local provision or understanding of tranquilliser use and withdrawal, and far from having a greater knowledge, they in fact have little or no knowledge at all and only treat illicit use, mainly opioids and cocaine to which all their funding is directed. Most of these are governed by the NTA who have a less than 2% long-term quit rate in their specialised area of opiates.
The medication is the same nationally and so is the treatment, so what logic is there in placing responsibility locally when the experience and expertise lies with the few overstretched withdrawal charities which have a high long-term quit rate and whose best practice should be promoted nationally?
You further stated “We do think that the outcomes framework, which does not appear in this Bill but overarches everything that we are doing, will expose poor practice. It will expose those groups of the population that are not being well served, and the commissioners will be called to account for their actions or lack of actions.”
How can you expose poor practice when you do not know what good practice is in the first place with which to make a comparison?
Also, your department has shown no inclination to research this current best practice and has instead sought the advice of those who least understand the subject including Professor Strang, who has undeclared conflicts of interest with many manufacturers of addiction drugs and who failed to meet the original terms of reference in his confused NAC review. The terms of reference were listed in a FOI email (attached) from your department to Professor Strang on 6 October 2009 and were as follows:
Subject: DH Addiction to Medicines Review
Dear John,
I have recently joined the drugs team at the DH leading work on a review into addiction to prescription and over-the-counter medicine. We would like to commission a literature review on the subject and one or two larger pieces of research at a later stage. The focus would be on addiction to benzodiazepines, hypnotics and codeine-based painkillers.
There are four issues which we are particularly anxious to address in the literature review:
a) how many people are truly dependent on prescription medicine? (an estimate of 1.1m Benzo addicts was made to the parliamentary inquiry on the subject recently but there doesn’t seem to be a firm statistical basis for the estimate;
b) What are the long-term health effects of dependence on Benzos, sleeping pills and painkillers;
c) What support is available for people suffering adverse effects from Benzo/hypnotics/painkillers?
d) To what extent are doctors complying with prescribing advice? (are they contributing to the problem by repeat/over-prescribing?
Professor Strang failed to quantify the problem; his report stated that there was no evidence of long-term damage but this is because there has been no research. He failed to mention protracted withdrawal syndromes or post-benzodiazepine withdrawal syndrome or Professor Ashton’s supplement on long-term damage and in fact only referred to her twice briefly; he failed to contact various withdrawal charities including the Bristol and District Tranquilliser Project who are inundated with patients seeking support and advice and; he failed to identify current mis-prescribing. He also did not review available literature as he was instructed but frequently just copied extracts instead.
There is abundant literature on this subject on benzo.org.uk and even the NHS CKS guidelines your department recommends refers to this website for equivalent tables and the Ashton manual.
Why have the department not requested a return of the fee paid for the NAC review?
In 1981, the ad hoc Medical Research Council meeting attended by academics including Professors Lader and Tyrer and Dr Pamela Mason, a Department of Health observer, recommended that “research should be continued into the factors which determine long-term usage and dependence, and into methods of withdrawing benzodiazepines from dependent patients” and that “the risks of dependence could be reduced by more trained prescribing of benzodiazepines”.
Now, 30 years later, still no appropriate action has been taken and I ask you why not?
In 1986 Dr Anna Higgitt, Senior Policy Advisor at the Department of Health said “the sooner the medical profession faces up to its responsibilities towards these iatrogenic benzodiazepine addicts, the sooner it will regain the confidence of the anxious members of our community”.
No appropriate action followed this statement either. Again, can you explain why not?
You inform us that actions points will be followed up in 4-6 months which were derived from a meeting where service users and providers were sidelined and reported that iatrogenic tranquilliser addiction was discussed in scant detail.
On Radio 4 “Face the Facts” in August this year Dr Gerada denied there being a problem and disputed the severity of withdrawal symptoms and has shown no inclination to tackle the problem since, yet the RCGP have been given responsibility for various action points. Anne Milton said “I would disagree with her, that’s not the story I hear from people who are addicted to these drugs. What I hear is something very different…” Have you discussed any action to address Dr Gerada’s complacency?
On the same programme Anne Milton said “That flies in the face of my experience and the evidence that I’ve received. I’ve met people who’ve been addicted to some of these drugs for 20 or 30 years – wrecked their lives, wrecked their jobs, wrecked their families. It’s a silent addiction. We all know about illegal drugs, we all know about alcohol, we don’t know about this group.”
So if you “don’t know about this group”, why do you not consult people who do know, for instance the withdrawal charities?
Anne Milton further stated “We want to make sure that training and awareness is raised so that GPs know how to prescribe well and then we need to make sure that we’ve got the right services in place to give them the help and support they need to get off these drugs and get back and enjoy lives as they should be able to.”
This does not address those patients with long-term or permanent damage who will not get their lives back and it is not just prescribing that is the problem, it is withdrawal, with doctors enforcing abrupt, dangerous withdrawals and threatening patients with de-registration when they bring the BNF guidelines to their surgeries.
Why does your department not enforce these guidelines which have been ignored to such an extent and for so long that they might as well not exist and what action are you taking regarding ignoring the withdrawal guidelines?
Furthermore, what action will you take to help those whose lives have already been wrecked, who have lost their jobs and homes and families as Anne Milton described and have lived with painful symptoms which serve as a constant reminder of the mistake they made when they turned up at the surgery years or decades ago?
Yours sincerely,
John Perrott