Pregnant woman was killed by train after doctor “failed to warn her an anxiety drug could cause suicidal feelings” Daily Mail 26 February 2015

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Salisbury Journal – APPGITA member Desmond Swayne MP criticised over prescription drug issue

Transcript of article in the Salisbury Journal–

MPs criticise Swayne over prescription drug issue

TOP Tory New Forest West MP Desmond Swayne has been slammed by an all-party parliamentary group on his response to the issue of addiction to prescription drugs in Hampshire.

Doctors have been accused of ignoring prescribing and withdrawal guidelines for addictive tranquilisers by the All Party Parliamentary Group on Involuntary Tranquiliser Addiction (APPG) after the Journal revealed that tens of thousands of prescriptions were handed out in Hampshire in the last year.

The Journal learned that benzodiazepines, better known as tranquillisers such as valium and temazepam, have been prescribed 133,541 times for a range of conditions including anxiety, insomnia, some forms of epilepsy and palliative care in Hampshire after we approached the NHS West Hampshire Clinical Commissioning Group.

There are no withdrawal services available to patients and the APPG revealed that just one patient had been successfully treated to withdraw from tranquiliser use in 2013.

Mr Swayne, minister of state at the department for international development, told the Journal last week that “NHS guidelines are important but GPs know their patients best”. Strict guidelines about the prescribing of benzodiazepine tranquillisers were issued to all GPs in 1988, warning them that the drugs are known to cause dependence if used beyond the recommended four-week maximum.

APPG co-ordinator John Perrott said: “The APPG position is that the 1.5 million patients have become addicted because doctors have not followed the 1988 CSM two to four-week prescribing guidelines.

“The guidelines were issued for patient safety because the drugs are highly addictive and have prolonged and severe withdrawal symptoms. There is no enforcement of these guidelines.

“Also, there are no withdrawal services nationally to help these patients. They are not substance misusers and have become addicted through no fault of their own.”

Mr Swayne said: “These are matters best left to clinicians rather than politicians, however many meetings of the APPG they may have attended.”

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email to Jane Ellison, Public Health minister and Duncan Selbie, CEO, PHE

Dear Jane Ellison and Duncan Selbie,

I am writing regarding the Parliamentary Question below in which Liz McInnes MP asks for the declaration of interests for members of the expert group responsible for updating the Drug misuse and dependence – UK guidelines on clinical management to be made available.

 

Prescription Drugs: Misuse                                                 27 January 2015

Liz McInnes To ask the Secretary of State for Health, if he will publish the declarations of interest submitted by members of the expert group with responsibility for updating the UK guidelines on clinical management of drugs misuse and dependence.

Jane Ellison: The expert group updating the United Kingdom guidelines for the clinical management of drug misuse and dependence consists of a broad spectrum of stakeholders, including practising clinicians, pharmacists, service users, carers, psychologists, commissioners and academics. Each is required to complete a declaration of interests and keep this updated.

Public Health England, which provides the secretariat for the group, has reviewed these declarations and on the basis of the information provided believes that no expert group members have a financial interest in the prescribing of specific medicines for the treatment of dependence.

Clinicians’ declarations will be published alongside the updated clinical guidelines by early 2016.

It is not reasonable for the public to have to wait for over a year to see if there is a legitimate objection to anyone’s inclusion on the expert group on grounds of conflict of interest when it can be addressed now. By the time the revised guidelines are published, it will be too late to do anything other than seek to have the entire findings overturned, which would be most unlikely.

Conflicts of interest are considered to be undesirable because they can give rise to bias and corruption in academic work, or the perception of bias and corruption in academic work.

Professor Strang, who is chair of the expert working group, has financial relationships with many pharmaceutical companies, including the following companies which manufacture drugs to treat dependence:

Martindale/Cardinal, the leading UK supplier of methadone and naloxone

Auralis which manufactures diamorphine

Reckitt Benckiser which manufactures Suboxone

The Department of Health has in the past ignored concerns raised about conflicts of interest. For example, the late Jim Dobbin MP wrote to Andrew Lansley MP, when Secretary of State for Health, raising concerns about Professor Strang’s non-declaration of interests with pharmaceutical companies manufacturing benzodiazepines, z drugs and codeine containing products when co-authoring the NAC report commissioned by the Department of Health to inform its policy review on addiction to medicines. These drugs were the subject of the report.

The NAC report was biased making no mention of protracted or post-benzodiazepine withdrawal syndromes; scant mention of benzodiazepine related ill-health; no inclusion of literature on tranquilliser related deaths; no mention of benzodiazepine teratogenicity or “benzo babies” causing birth abnormalities by exposure to benzodiazepines in utero; dismissed Professor Lader’s study in 1980 linking brain damage to long-term benzodiazepine use in one sentence and; “missed” 129 academic papers stating the risks associated with benzodiazepine use easily accessible on the www.benzo.org website.

Do the Department of Health and PHE acknowledge that at least one member of the expert working group has conflicts of interest and will declarations of interest for all members of the expert working group be made available now rather than at time of publication next year?

Yours sincerely,

John Perrott

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Parliamentary Questions asked by Liz McInnes MP 27 January 2015

Prescription Drugs: Misuse

Liz McInnes: To ask the Secretary of State for Health, if he will publish the declarations of interest submitted by members of the expert group with responsibility for updating the UK guidelines on clinical management of drugs misuse and dependence.

Jane Ellison: The expert group updating the United Kingdom guidelines for the clinical management of drug misuse and dependence consists of a broad spectrum of stakeholders, including practising clinicians, pharmacists, service users, carers, psychologists, commissioners and academics. Each is required to complete a declaration of interests and keep this updated.

Public Health England, which provides the secretariat for the group, has reviewed these declarations and on the basis of the information provided believes that no expert group members have a financial interest in the prescribing of specific medicines for the treatment of dependence.

Clinicians’ declarations will be published alongside the updated clinical guidelines by early 2016.


Prescription Drugs: Misuse

Liz McInnes: To ask the Secretary of State for Health, what steps he plans to take to reduce addiction to prescribed benzodiazepines and z drugs.

Jane Ellison: Public Health England (PHE), NHS England and others are working together to deliver a wide-ranging programme of work to reduce addiction to medicines. This includes completed work such as publishing a guide to commissioning services to respond to addiction to medicines, factsheets for general practitioners (GPs) (Royal College of General Practitioners) and delivering face-to-face training for GPs and other healthcare workers. Looking ahead, PHE is supporting a number of pilots of improved local commissioning.

There is now better awareness of these issues among GPs and clearer prescribing guidelines.


Tranquillisers: Misuse

Liz McInnes: To ask the Secretary of State for Health, if his Department will make an assessment of the implications for its policies of the survey of treatment services provided by local authorities for involuntary tranquilliser addicts conducted by the All Party Parliamentary Group on Involuntary Tranquilliser Addiction.

Jane Ellison: The Department has taken into account the All Party Parliamentary Group on Involuntary Tranquilliser Addiction’s survey in its deliberations in this policy area.


Prescription Drugs: Misuse

Liz McInnes: To ask the Secretary of State for Health, what steps he plans to take to ensure that patients prescribed benzodiazepines and z drugs are provided with recent Medicines and Healthcare Regulatory Authority advice on those drugs’ addiction potential and the time taken to withdraw safely from taking such drugs.

George Freeman: The Medicines and Healthcare products Regulatory Agency (MHRA) has not recently issued any new advice on the addiction potential or the safe withdrawal from benzodiazepines or “z drugs”.

Benzodiazepines and “z drugs” (zaleplon, zolpidem and zopiclone) are recognised to be associated with an addiction potential particularly when taken for longer than the recommended 2-4 weeks. Over the years action has been taken by the MHRA, the Department of Health and professional bodies to provide extensive warnings about the risks of dependence limit prescribing and issue advice about gradual withdrawal.

The risk of dependence on a benzodiazepine (or zaleplon, zolpidem and zopiclone) can increase with higher doses and longer duration of use; therefore, the time it takes to completely stop the medicine varies and withdrawal programmes may sometimes need to be individually tailored.

Patients receive a patient information leaflet in their pack of benzodiazepine (or zaleplon, zolpidem and zopiclone). The leaflet includes information and advice about their medicine, which will support the vital discussions they have with their doctor and pharmacist about their treatment or stopping treatment.

Benzodiazepines and “z drugs” are considered acceptably safe and effective when used in accordance with the approved indications and for the recommended duration of use.

An online learning module for healthcare professionals on benzodiazepines was published on the MHRA’s website in March 2013. The module’s section on dependence and withdrawal gives general guidance on the principles of benzodiazepine withdrawal. The online learning module reflects the product information for these medicines.

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BBC News – Warning over drug-driving law and prescribed medication

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European Medicines Agency recommends suspending medicines including clonazepam

GVK Biosciences: European Medicines Agency recommends suspending medicines over flawed studies

Products for which the marketing authorisations are recommended for suspension by the EMA on 22 January 2015

MHRA’s response to EMA’s recommendations to suspend medicines

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Up to 2 per cent of Germany’s population is dependent on hypnotics

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Over The Top: Tackling Medical Power

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APPGITA submission to the Labour Party Public Health manifesto

Andy Burnham MP, Shadow Health Minister, hosted two seminars at Westminster on the subject of addiction to medicines. As a result of these seminars a working group was formed, which included the late Jim Dobbin MP, chair of the All Party Parliamentary Group on Involuntary Tranquilliser Addiction.The purpose of the working group was to provide Andy Burnham and Luciana Berger, Shadow Public Health Minister, with a manifesto submission on addiction to medicines.

Jim Dobbin presented this  submission from APPGITA produced by Mick Behan to Andy Burnham in May 2014.

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Correspondence with Duncan Selbie, CEO, Public Health England

Dear Mr Perrott                                                                                                   9 January 2015

I note you have also written to Rosanna O’Connor,  and she will respond in detail to your concerns, including on the proposed pilots.

I recognise that you are not happy with this approach. Notwithstanding, I hope you will provide comment on the pilots and help shape and guide them.

Best wishes, Duncan
Duncan Selbie
Chief Executive

Public Health England

0207 654 8095

Protecting and improving the nation’s health

Dear Duncan,                                                                                                      10 January 2015

Constructive comments have already been sent repeatedly and in abundance to PHE and the NTA over the years by Professor Ashton and the late Jim Dobbin MP (APPGITA Chair). All of these have been ignored by the NTA and PHE.

PHE has also ignored Anna Soubry’s direction laid out in her keynote address at the NTA seminar on addiction to medicines.

We already have a world recognised expert in benzodiazepines in Professor Ashton and successful withdrawal charities for prescribed tranquilliser withdrawal with 30 years experience and 85% success rate with drug free withdrawal outcomes, based on the Ashton manual, whose practice simply needs to be duplicated nationwide.

Local areas do not have this expertise and neither does PHE.

Rosanna O’Connor does not take any notice, does not understand the subject and continues to adopt a substance misuse approach to involuntary tranqilliser addiction..

I will not be party to endorsing PHE’s flawed policy on addiction to prescription tranquillisers.

When this issue flares up again, which it will, I will be the first to focus attention on PHE’s role in its failure to provide appropriate withdrawal services.

I suggest that you investigate this yourself instead of relying on officials who do not understand the subject and have their own agendas and that you also visit Bristol and District Tranquilliser Project, which provides advice and support to some of the 1.5 million patients addicted to these prescribed drugs through no fault of their own.

Regards,

John

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