Dear Una O’Brien, 24 April 2015
Further to my email of yesterday I have since received a response from the Chartered Society of Physiotherapists (below).
The links show that the Department of Health supported deregulation of benzodiazepine prescribing allowing physiotherapists, chiropodists and podiatrists to prescribe temazepam, lorazepam and diazepam. These proposals were underway in 2009 and developed during 2011 – 2012 but were not disclosed during the Department’s policy review on addiction to medicines including prescribed benzodiazepines.
Would you please explain why the proposals, the “public consultation” and amendments were not disclosed during the policy review or in the Department’s dealings with the All Party Parliamentary Group on Involuntary Tranquilliser Addiction?
Dear Mr Perrott, 24 April 2015
Thank-you for taking the time to write to the CSP.
The decision to allow physiotherapists to independently prescribe was taken by Government, after a period of Public Consultation, in 2013. This included the decision in principle, made by The Advisory Committee for the Misuse of Drugs which advises the Home Office, to allow physiotherapists to prescribe from a limited list of 7 controlled drugs. The Home Office recently announced plans for the Misuse of Drugs Regulations 2001 to be amended to incorporate this recommendation.
The issues you raise about training and regulation are all covered in the Public Consultation documents and the Government Reponses to the Public Consultation these changes which occurred in 2011 and 2012:
Physiotherapist have been able to use controlled drugs in their practice via other medicines mechanisms for many years and the introduction of very limited independent prescribing is the next step in delivering effective health care. There is to date, no evidence of physiotherapists misusing these prescribing privileges . Only approximately 500 of our 53,000 members are registered as prescribers, and not all physiotherapists will choose to undertake this activity.
Pip White BSc, MSc, MA(Law), MCSP| Professional Adviser | Chartered Society of Physiotherapy, 14 Bedford Row, London WC1R 4ED
(Also sent to the Society of Chiropodists and Podiatrists)
Dear Sir/Madam, 23 April 2015
I am writing about the recent decision to allow chiropodists, podiatrists and physiotherapists to prescribe controlled drugs including the benzodiazepines temazepam, lorazepam and diazepam under The Misuse of Drugs (Amendment) (No. 2) (England, Wales and Scotland) Regulations 2015.
These drugs are highly addictive and were the subject of the recent Department of Health policy review on addiction to medicines. Doctors have ignored the 1988 CSM 2 – 4 prescribing guidelines which has caused mass addiction to prescribed tranquillisers in the UK dwarfing numbers addicted to illegal drugs. There are more deaths and hospital admissions caused by prescription drugs than illegal drugs. Withdrawal from benzodiazepines is often more prolonged with more psychological and physical withdrawal symptoms than heroin. There are no NHS tranquilliser withdrawal services with patients addicted to prescribed tranquillisers forced to cope on their own or seek help from under half a dozen charities including CITAp in Liverpool which is due to close soon due to lack of funding.
These are patients who have become addicted through following medical advice and are not to be confused with illicit drug users.
You may not be aware but there has been a campaign of nearly 30 years against the mis-prescribing of these drugs, more recently by the All Party Parliamentary Group on Involuntary Tranquilliser Addiction. Campaign work is documented on these websites – www.appgita.com andwww.benzo.org.uk
I would be grateful if you would clarify the following please:
- Why was it thought necessary that physiotherapists would need to prescribe these three benzodiazepine drugs?
- What conditions will they be prescribed for?
- What training are physiotherapists to be given regarding prescribing these drugs safely?
- Doctors have ignored the 1988 CSM 2 – 4 tranquilliser prescribing guidelines causing an estimated 1 million patients to be on these drugs long-term, some for decades, with most likely to be addicted.
The Department of Health’s recent policy review included a consensus statement on addiction to medicines http://www.rcgp.org.uk/news/2013/january/~/media/Files/News/RCGP-Addiction-to-Medicine-consensus-statement.ashx
Point 6 states, “Longer term prescribing can increase the risk of dependence, and with some medicines, such as tranquillisers like benzodiazepines, should only be considered under exceptional circumstances and with regular review by practitioners with suitable expertise and understanding of the risks.”
What safeguards have been put in place to avoid further iatrogenic addiction caused by physiotherapists?
- Will physiotherapists be directed to the Ashton manualhttp://www.benzo.org.uk/manual/before prescribing benzodiazepines so that they understand ADRs and withdrawal symptoms and the pharmacology of these drugs?
Campaigners and patients are very concerned about deregulation of the prescribing of these drugs and any further information you can give would be appreciated.