Health: Addiction to Prescribed Drugs Debate

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Department: Department of Health and Social Care

Health: Addiction to Prescribed Drugs

Lord Alderdice Excerpts
Wednesday 6th October 2010

(13 years, 7 months ago)

Lords Chamber
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Lord Alderdice Portrait Lord Alderdice
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My Lords, I am grateful to the noble Earl, Lord Sandwich, for the opportunity to explore this complicated issue in a larger way than with a simple question and answer.

I have never taken diazepam but it did help me sleep on one occasion. I had just qualified as a junior doctor and, on my first night on call, I got to my bed shortly after 12 o’clock. I was suddenly seized with the anxious thought that I could not think of a single medical emergency that I could treat on my own. Eventually it came to my mind that if a patient came into the casualty department with status epilepticus, I could simply inject diazepam until they stopped fitting and that would resolve the problem. It was not a dangerous procedure—in fact it was much the best way of dealing with the situation; it was not a toxic drug—and I was able to sleep with the knowledge that I could possibly treat it. My last words were a prayer that any patient who came in that night would have status epilepticus. I woke up at half-past seven the next morning but there had been no patients, with or without the condition, and so the diazepam, in my thinking, had helped me to get to sleep.

As a young doctor—particularly as a young psychiatrist and one who specialised in psychotherapy and worked in an addictions department—I became familiar with the whole question of benzodiazepines. The first thing to say is that although this is a group of drugs, they are not identical by any means. I remember that in those early days, diazepam and a number of other drugs of that kind had been used and it was beginning to become apparent that for many people they had addictive qualities, and a new drug, lorazepam, was sold under the drug name Ativan. We were recommended this drug because it was believed that it was much less addictive. As it turned out, it was much more difficult to get patients off it. It had a very unusual profile: you could reduce the dose of the medication by a half, even by three-quarters, without any terribly serious effect, but getting them off that last bit was extremely difficult.

The point is that benzodiazepines as a group are not all identical with each other—they have different components—and they are addictive because they are effective for many people in relieving them of their anxiety and helping them, for example, to get to sleep because some are used as hypnotics rather than anxiolytics. That is not to take away from the tragic stories which have been recounted in the debate, which are also absolutely true and the case. Many people suffer because they become dependent but we must remember that many people function and get on with their lives, get to sleep at night and operate the next day. They are able to manage with their anxieties and difficulties precisely because they have access to these medications. Therefore the idea that this is a kind of modified cocaine or something like that is to not understand the need for some of these medications.

The noble Baroness, Lady Meacher, referred to the medical use of marijuana. Given all the indications, it was interesting for how long we knew problems were arising with the use of marijuana that people refused to accept. It is only in the past few years that people have been prepared to point up the increase in psychosis among young people who use marijuana and the increase in suicidal behaviour. The idea that we should shove aside benzodiazepines and introduce medical marijuana would need a great deal more exploration. There are major problems with even medically-used marijuana and we need to be very careful about it.

My preference is to move to psychological methods of treatment and I wish to say two or three things about that. First, many patients do not want to adopt a psychological approach to treatment; they very much want a pill that will take away the unpleasantness of the difficulties of the moment. I suspect there may be some, not in your Lordships’ House this evening but perhaps at other times, who might use other ways of putting a problem to the side rather than confronting it—perhaps in the Bishops’ Bar, for example. Whatever the problems of benzodiazepines, they are generally less than the problems of alcohol addiction in various ways. We need to steady ourselves and realise there are many problems with these drugs but there are also certain benefits to a substantial number of people. That is what makes it difficult. If they were only problematic it would be easy; it is because they are helpful to some people that we have a big problem.

But there is a further component. We began to notice in Northern Ireland in the late 1960s and the early 1970s a major increase in the prescription of benzodiazepines in the areas around where there had been street trouble and riots. It was not in the areas where they were happening, but in the areas around—the penumbra, as it were—where people as a whole community were terrified about what might happen to them and their families. In other words, you were not dealing with a mental illness; you were not dealing with a personal problem; you were dealing with a societal problem of anxiety on a large scale. In the end, the only way to deal with that was to deal with things at a social level and to try to remove the fundamental problem.

Here we have a problem of the moment. The serious economic crisis that we face, the austerity that all of us experience and will experience, is going to make life more difficult for people to manage. That is just a piece of reality. So, in looking at the individual question of how we deal with the withdrawal of dependent people from drugs, there is a particular approach—a psychological approach, a medical approach and the provision of talking therapies—that we can take. However, let us not imagine that if we go down that road it will be cheaper than the prescription of medication, because it will not be. It will be more expensive to pay for the time of people. Cognitive behavioural therapy is very helpful, but it is very rarely a short-term resolution for all problems.

But one opportunity is opened up for us in the proposals of the Government for reform of the health service; that is, by devolving more control and more decision-making to a local level, particularly in relation to local councils, which also have responsibility for the provision of social care. It may, I hope, be possible for general practitioners and others in acute primary care to see the resolution of a lot of the anxieties that were raised, for example, by the noble Baroness, Lady Bottomley, whose experience as a social worker let her see how the prescription of medication was used to deal with social problems. If social services departments can co-ordinate much better with primary care, it becomes possible for general practitioners not to prescribe medications of any kind but more to relate to those whose responsibility it is to deal with social service and social care problems.

I therefore hope that the Minister will be able to tell us something about dealing with benzodiazepines, but I trust also that he will be able to fold that into the opportunities for better co-ordination between the different components of care that we need to provide for our citizens.