Re-classification of prescribed addictive drugs for insomnia, ADHD or pain

25th July 2014

Re-Classification of Certain Prescribed Drugs

Earlier this month zaleplon and zopiclone were reclassified under the Misuse of Drugs Act as Class C, Schedule IV substances, joining the same classification as the third member of the ‘z-drugs’, zolpidem. The Advisory Council on the Misuse of Drugs issued a statement that “these drugs have a legitimate medical use, but people should be under no illusion, taking them without prescription and medical advice can be dangerous.”

The drug reclassification has occurred to prevent misuse of the drug for recreational purposes and ought not to have implications for legitimate therapeutic users under medical prescription, which are most typically for the treatment of insomnia. 

With the change in legislation there have been fears that legitimate dosages might be reduced by prescribers, or patients will request a reduction or halt. However, withdrawal from z-drugs can lead to serious side effects when associated with high dosages and prolonged use. One study revealed the following symptoms from reduced dosage (Hajak et al., 2003):

• Anxiety

• Tachycardia

• Tremor

• Sweating

• Rebound insomnia

• Flushes and palpitations

• Derealisation and

• Convulsions

The National Institute for Clinical Excellence (NICE) is currently writing guidelines on prescriptions of controlled drugs to be published in December 2015 which will include the protocols for z-drugs. If you are a therapeutic user of one of the ‘z-drugs’ or other controlled drugs, and/or are concerned about this issue, please register as a stakeholder with the institute and submit your opinions: http://www.nice.org.uk/mpc/medicinespracticeguidelines/CDGPG.jsp.

References

https://www.gov.uk/government/news/acmd-advises-the-government-on-the-control-of-prescription-drugs.  

Abuse and dependence potential for the non-benzodiazepine hypnotics zolpidem and zopiclone: 
a review of case reports and epidemiological data, Hajak et al., 2003 Addiction, 98, 1371–1378

Overprescribing antidepressants- hear psychiatrist Joanna Moncrieff on BBC radio4

Antidepressants broadcast to hear - information below taken from BBC Woman's Hour web site - Dr Joanna Moncrieff who wrote the book "The Myth of the Chemical Cure" defends the fact that antidepressants are psychoactive drugs that may affect the way we think but do not solve our problems. No mention on this broadcast of the problems of withdrawal from the SSRI antidepressants. For Professor David Healy's SSRI withdrawal protocol email APRIL and we will send you a copy.

"A third of women have taken antidepressants at some point in their lives, according to a survey carried out by the women’s group Platform 51. And nearly half of women currently on antidepressants have been on them for five years or more. Are GPs too quick to prescribe tablets for depression? Once on them, how easy is it for women to stop? How regularly do patients need to be monitored by their GPs? And what are the alternatives to drugs? Jenni will be joined by Dr Joanna Moncrieff, a Psychiatrist at University College, London and Dr Clare Gerada, Chair of the Royal College of GPs."

http://www.bbc.co.uk/programmes/b012krr5#synopsis

Available now on BBC iPlayer at the above link
Listen to the latest programme


Government enquiry into benzodiazepine addiction highlights a need for withdrawal services.

A Press Release from Jim Dobbin MP Chair of the All Party Parliamentary Group on Involuntary Tranquilliser Addiction discusses the need for research into and introduction of effective withdrawal services. We mentioned this in our post on 27th June 2009.


"Sky News and the Times are reporting today that Michael Jackson's death has been ruled to be a homicide and that the drugs found in his body included the anaesthetic Propofol but also the benzodiazepine tranquillisers Ativan (Lorazepam),Valium and Midazolam.

I would like to comment on the dangers of the benzodiazepine tranquillisers involved. In 2004 the Canadian Ativan data sheet contained the warning that "Use of benzodiazepines,including lorazepam may lead to potentially fatal respiratory depression." It also contained a seven day addiction warning and suicide warning ,for lorazepam.

Phil Woolas M.P. wrote to Sir Alastair Breckenbridge, Chair of the U.K. drug licensing authority the MHRA,in 2004 asking for similar warnings to be introduced into the U.K. product information.The warnings were never introduced and in fact no product information sheet for lorazepam tablets was published at all in the U.K. in 2009, despite the increased number of licenses issued.

Tranquilliser related deaths in the U.K. are running at some 300 per year,in some years they have exceeded the total number of deaths for all class A drugs added together ,according to Home Office figures.In answer to a Parliamentary question the Department of Health reported that in 2008 over 17 million tranquilliser prescriptions were issued in the U.K.,an increase on 2007. My question is how many people have died a Michael Jackson type death in the U.K.,and elsewhere, but with no homicide investigation or any other kind of investigation.

Tranquillisers are highly addictive yet the Department of Health provides no withdrawal treatment at all except for one worker in Belfast and two in Oldham. The All Party Parliamentary Group on Involuntary Tranquilliser Addiction (APPGITA) is campaigning for the introduction of specialized tranquilliser withdrawal services by the Department of Health.We are also campaigning for medical research into the damage caused by tranquillisers,a review of the benzodiazepine product licenses ,which were issued with no assessment of safety or efficacy and a no-fault drug compensation scheme for patients who suffer drug injuries.

Jim Dobbin M.P."

In light of these recommendations, we should be aware of two interesting studies which involved Professor Heather Ashton (who spoke at APRIL’s 2008 conference) and discussed two effective approaches that also save money.

The cost-effectiveness of two brief interventions for helping people to withdraw from long-term benzodiazepine use are addressed in the following two papers by Nick Heather and colleagues in 2004 and Christine Godfrey and coworkers in 2008. These interventions consisted of a letter that was sent to patients advising a gradual withdrawal as well as a brief GP consultation.

The earlier paper reports that both interventions are effective in leading to a reduced intake of benzodiazepines.

http://www.benzo.org.uk/amisc/rndoi.pdf


The later study found that of the two interventions, overall the letter was the most cost-effective. The authors estimate that the savings for that particular authority in Newcastle and North Tyneside would be a minimum of £4.9 million.

http://www.benzo.org.uk/amisc/rndce.pdf


It would be interesting to make an estimate of financial savings and reduction in human suffering and iatrogenic illness, that could be made nationally using these interventions.

Tweet