Dear Jasmine Ganesh,
Thank you for your reply (below) of 6 May 2015.
You say that “Therefore, at the time of the review, there would have been no patients in receipt of controlled drugs prescribed by allied health professionals” but this is not the point.
The point is that when the Department announced a policy review on addiction to medicines in July 2009 it was at the same time leading contradictory work to deregulate the prescribing of the addictive drugs which were the subject of the review, including the benzodiazepines temazepam, lorazepam and diazepam. To claim that the drugs in question were not actually prescribed by allied professionals at the time of the review is just playing with words.
In 2009 the Department produced a scoping document and in September 2011, Ministers agreed to a public consultation on proposals for independent prescribing by podiatrists and physiotherapists. The subsequent risk assessment in 2012 was led by the Department of Health.
On page 5 the Policy objective is described in the following terms “The objective of introducing independent prescribing for podiatrists is to enhance patient care by improving access to medicines through an increased and more flexible approach.”
Would you explain why on the one hand the Department was conducting a policy review on addiction to medicine including benzodiazepines and on the other hand leading contradictory work to deregulate the prescribing of these drugs?
Secondly, would you please explain how the introduction of independent prescribing for podiatrists and physiotherapists will enhance patient care by improving access to medicines (including lorazepam, diazepam and temazepam) through an increased and more flexible approach as stated in the Department’s impact assessment, when many hundreds of thousands of patients have already become addicted caused by doctors not complying with existing prescribing guidelines?
Thirdly, in answer to a PQ by my MP Eric Ollerenshaw (below), George Freeman said “The Department is looking into the feasibility of commissioning further research on patterns of long-term prescription of dependency-forming medicines, including analyses of relevant prescribing data.”
Why is the Department allowing further deregulation of the prescribing of these drugs when by its own admission it has no idea how many patients are addicted to them? There is plenty of evidence on the harms caused by benzodiazepines so surely their prescribing should be more controlled, not less? Research by benzodiazepine expert Professor Ashton and also by BBC Panarama in 2001 pointed to over a million patients on these drugs long-term, with most likely to be addicted.
Would you also provide more information regarding this feasibility study?
Lastly, regarding your comment that “the Department of Health and Public Health England have undertaken to address this important issue”, no effective action has been taken to date and my survey of PCTs in 2012 proved that 83% of local areas had no prescribed tranquilliser withdrawal services and my survey of 152 local authorities conducted in 2013 proved that involuntary tranquilliser addiction is not being treated and that it is still incorrectly treated by DH and PHE as a substance misuse issue.
Your email of 6 May 2015
Our ref: DE00000933295
Dear Mr Perrott,
Thank you for your further correspondence of 23, 24 and 25 April to Una O’Brien about prescription medicines. I have been asked to reply.
In 2011, two reports on addiction to prescription and over-the-counter medicines were published, and are available to view at:
A consensus statement was then published in January 2013, which predated the decision to amend regulations to allow independent prescribing of controlled drugs by allied health professionals. Therefore, at the time of the review, there would have been no patients in receipt of controlled drugs prescribed by allied health professionals. From previous correspondence, you will be aware of the work that the Department of Health and Public Health England have undertaken to address this important issue.
Now that Parliament has been dissolved before the General Election, any future decisions about this matter will be for the incoming Government.
I am sorry I cannot be more helpful.
Ministerial Correspondence and Public Enquiries
Department of Health
The Department of Health has provided the following answer to your written parliamentary question (227804):
To ask the Secretary of State for Health, whether the General Practice Research Database includes data on the prescribing of tranquillisers; and if he will use this database to calculate the number of patients with a long-term dependency on tranquillisers. (227804)
Tabled on: 17 March 2015
The CPRD GOLD primary care database (former GPRD) includes information about all prescriptions issued in primary care for a subset of approximately 8% of the United Kingdom population. This database has previously been used to study prescribing of anxiolytic, hypnotic and psychotropic medication, commonly referred to as tranquilisers.
It would be possible to use the database to estimate the number of patients in the UK with a long-term dependency on prescription tranquilisers. However, as dependence will not be systematically identified by general practitioners, expert clinician advice would also be required to develop a definition. This could be based on frequency of prescribing and medication strength but could also include clinical codes for medical conditions including indications for these products, drug dependency and substance abuse, if recorded.
This work would represent a research project and as such, a scientific protocol would need to be submitted to the Medicines and Healthcare products Regulatory Agency’s Independent Scientific Advisory Committee for assessment and possible approval.
Even with such an approach, the rate of drug dependency in the population could only be estimated, and in order to assess whether this estimate was a true representation of the actual rate of drug dependency in this population, a validation study would be encouraged.
The Department is looking into the feasibility of commissioning further research on patterns of long-term prescription of dependency-forming medicines, including analyses of relevant prescribing data.
The answer was submitted on 24 Mar 2015 at 16:16.
DH response 18 May 2015
Our ref: DE00000934760
Dear Mr Perrott,
Thank you for your further correspondence of 12 May to Una O’Brien and the Department of Health about prescription medicines. Please accept this as a response to each of your emails.
I was sorry to read that you were not satisfied with the Department’s earlier response of 6 May (our ref: DE00000933295), and note your continuing concerns about independent prescribing by podiatrists and physiotherapists.
The Addiction to Medicine review was set up to consider the extent of drug dependence and harm, and the service responses to it. The legislative changes made to allow appropriately qualified and registered physiotherapist and podiatrist independent prescribers to prescribe some benzodiazepines were undertaken to enable patients who might benefit from these medicines to have readier access to them. These are not contradictory positions, as the work of the review and current guidance applies to any prescriber, including any allied health professionals (AHPs) who are independent prescribers.
The changes only apply to independent physiotherapist and podiatrist prescribers, not all AHPs. Prescribers are expected to follow current guidance on the prescribing of benzodiazepines and to only use them when there is a clear, clinical need. They will also discuss the effects of the medication with the patient before a decision to prescribe is made. The possibility that increased availability on these restricted terms could lead to increased dependence and demand for services is slim.
You will be aware from previous correspondence of the actions that the Department, Public Health England, the relevant Royal Colleges and others have taken to increase awareness of the addiction potential of some medicines, such as benzodiazepines, and to ensure that local health services are aware of their obligation to meet the needs of anyone in their populations who has become addicted to a prescribed or over-the-counter medicine.
There are entry requirements to ensure only advanced practitioner physiotherapists and podiatrists can enrol on prescribing education and training programmes. The programmes are based on demonstrating competencies as detailed in the single competency framework for all prescribers.
Applicants for the programmes must:
– be registered with the Health and Care Professions Council;
– be professionally practising in an environment where there is an identified need for the individual to regularly prescribe independently;
– be able to demonstrate support from their employer/sponsor, including confirmation that the entrant will have appropriate supervised practice in the clinical area in which they are expected to prescribe;
– be able to demonstrate medicines and clinical governance arrangements are in place to support safe and effective independent prescribing;
– have an approved medical practitioner to supervise and assess their clinical training as a prescriber;
– normally have at least three years relevant post-qualification experience in the clinical area in which they will be prescribing; and
– be working at an advanced practitioner or equivalent level.
Further information about the training programme is available online at:
Once successful applicants have been trained and their registration with the Health and Care Professions Council is annotated to record their training as an independent prescriber, physiotherapists and podiatrists will be covered by local governance arrangements. These include the responsibility of controlled drugs accountable officers for registering prescribers of controlled drugs, issuing prescriptions pads and monitoring prescribing patterns. The arrangements may also include use of local, organisation and personal prescribing formularies.
The changes in prescribing described above are largely aimed at addressing ‘one-off’ episodes of care, with immediate supply/administration of a single dose, or as part of end-of-life care. In addition, the changes do not represent a large-scale expansion of prescribing, with independent prescribing being introduced to address specific patient or service needs and not across the whole physiotherapist and podiatrist workforce. These changes add a flexible approach to prescribing and will enhance patient care by allowing AHPs who are independent prescribers to:
– maximise the treatment intervention through better pain management;
– improve quality of care in palliative services – fine tuning the needs of the patient as they change;
– manage pain in pre and/or post-operative treatment;
– improve quality of care through the potential to reduce controlled drugs as the benefits of the physical treatment and health outcomes are recognised;
– prevent delays in early intervention for first time and acute setting patients; and
– treat specific episodes or long term conditions.
The changes in prescribing are not deregulation. Regulations have been amended with the aim of enhancing patient care by making better use of the skills of these highly experienced healthcare professionals. The following case studies describe real life circumstances in which flexibility in who can prescribe temazepam, lorazepam and diazepam would enhance patient experience:
Case Study – temazepam
Temazepam may be prescribed for the management of acute anxiety prior to undergoing scanning diagnostics for the investigation and management of spinal pain and/or other long term musculoskeletal conditions. Patients are often managed in physiotherapy-led spinal services whereby the physiotherapist requests an out-patient diagnostic scan as part of the patient pathway. When the patient suffers from acute anxiety and/or claustrophobia, performing the scan may not be possible without some sedation. The patient may be prescribed 10mg to take the night before the scan, followed by another 10mg one hour prior to the procedure.
Case Study – lorazepam/diazepam
These may be used in palliative or end of life care for the management of acute anxiety or respiratory distress at the end of life. The physiotherapist is often the healthcare professional with expertise in managing respiratory function, and managing anxiety may be part of managing the decline in respiratory function. Dosage will be according to British National Formulary guidelines and individual patient circumstances where either long or short acting sedation is required.
With regard to your concerns about commissioning further research on patterns of long-term prescription of dependency-forming medicines, as the commissioning process is not yet complete, the Department is unable to provide this information.
I hope this reply is helpful.
Ministerial Correspondence and Public Enquiries
Department of Health