Professor Ashton’s comments on the latest draft of the consensus statement (15 May 2012)

  • It is wrong to consider addiction to over-the-counter medicines together with iatrogenic addiction to prescribed tranquillisers and hypnotics.  The two populations of drug users are completely different and, though both may be addicted, the causes of the addiction and the management required are also different.
  • The following comments are confined to prescribed benzodiazepine and Z-drug users who have become addicted as a result of long-term prescriptions from their doctors.
  • The list of proposed signatories to the consensus statement includes no medical or scientific benzodiazepine and Z-drug experts and no patients or service users.  Such a committee is not qualified to give advice to the doctors or the public on this subject.
  • Advice on the prescribing of benzodiazepines has been circulated to doctors repeatedly and from many sources, for instance in 1980, 1988, and 2004.

January 1988 – Committee on Safety of Medicines, Current Problems 21

–      “Benzodiazepines are indicated for the short-term relief   [two to four weeks only] of anxiety
… occurring alone or in association with insomnia …”

–           “Benzodiazepines should not be used alone to treat depression or anxiety associated with depression.  Suicide may be precipitated in such patients.”

–          “They should not be used for the treatment of chronic psychosis.”

(The 1980 advice of the Committee on the Review of Medicines is repeated in this document)

January 2004 – Department of Health, Chief Medical Officer.  CMO’s Update 37

–          Benzodiazepines should be prescribed for “just two to four weeks for relief of severe disabling anxiety …” or for “severe or disabling insomnia”.

–          “Long-term use exposes patients to risks such as road traffic accidents, dependence, and in the older population, debilitating falls”.

Both the 1988 and 2004 (DOH) statements cite the ‘Ashton Manual’ as references (Benzodiazepines: How They Work and How to Withdraw, Professor Heather Ashton 2002 www.benzo.org.uk)

  • British National Formulary, produced by the British Medical Association and the Royal Pharmaceutical Society and circulated to all doctors (Sept. 2011)

–          Every benzodiazepine listed as a hypnotic or anxiolytic carries as indications “short-term use” and a further general statement is given: “Benzodiazaepines are indicated for short-term relief (two to four weeks only) of anxiety …”

–          The Z-drugs (hypnotics) are not licensed for long-term use, but only for 2-4 weeks.

  • Consensus statement:  “For people with some conditions such as serious mental health issues, longer-term prescribing of suitable benzodiazepines may be appropriate.”  This statement contradicts the Department of Health’s own advice given in the 1988 and 2004 communications.  It does not specify which benzodiazepines are “suitable” or which “conditions such as serious mental health issues” are referred to, having already advised against the use of benzodiazepines in chronic psychosis, severe anxiety, and depression (1988) and warned of the risks of long-term use (2004).  Such advice will tend to perpetuate and possibly increase the continued practice of long-term benzodiazepine prescribing by GPs and prevent trials of dosage reduction or withdrawal in the present estimated 1.5 million long-term prescribed benzodiazepine users.
  • Consensus statement : … “all patients should be treated with dignity and respect …”.  This patronising advice from a committee is insulting to doctors whose universal aim has always been to help patients.  Medical etiquette , enshrined in their early days of medical school, is to treat ALL patients with dignity, respect and empathy.
  • Consensus statement “When agreeing to a course of treatment, patients should take their medicines as advised by their doctor and pharmacist …”.  In the case of prescribed long-term benzodiazepine users, who have always been compliant with their doctors advice, this is the very factor that has caused their addiction.
  • “We will strive to deliver improvements to prevent addiction to medicines and to support those who have developed problems to recover”.  There is no mention of the practical arrangements or the funding necessary to achieve these aims.

Conclusion”

It is questionable whether the representatives of the bodies intended as signatories of the consensus have the authority or the expertise to commit their organisations to the comprehensive  advice given in the draft consensus.

Potential signatories may wish to consider carefully the above comments before signing the consensus.

Heather Ashton
Emeritus Professor of Clinical Psychopharmacology.

Academic Psychiatry, Wolfson Research Centre,
Institute of Neurosciences, Newcastle University,
Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK

Click here to view a PDF copy of the letter

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