Asked by: Jim Shannon (Democratic Unionist Party - Strangford)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps he is taking to raise awareness of the long term impact of prescription painkillers.
Answered by Zubir Ahmed - Parliamentary Under-Secretary (Department of Health and Social Care)
The Medicines and Healthcare products Regulatory Agency (MHRA) is an executive agency of the Department, with responsibility for ensuring medicines meet appropriate standards of quality, efficacy, and safety.
Medicines authorised to treat pain fall with several different classes of medicine. Prescription medicines include opioids, gabapentinoids, namely pregabalin and gabapentin, and non-steroidal anti-inflammatories (NSAIDs). Other classes of medicine such as anti-epileptics or antidepressants may also be used for the treatment of neuropathic pain, a type of pain evolving from nerve damage, as recommended by the National Institute for Health and Care Excellence (NICE), with further information available at the following link:
https://www.nice.org.uk/guidance/cg173
New medicines are also available for the treatment of migraine. The MHRA monitors the safety of all these medicines and has issued warnings and updated product and patient information on the risk of addiction to opioids, with further information available at the following link:
https://www.gov.uk/drug-safety-update/opioids-risk-of-dependence-and-addiction
The MHRA is currently undertaking a review to improve the information supplied with dependency-forming medicines including gabapentinoids. If additional signals of risk arise, action will be taken to protect public health.
All medicines have side effects, although not everyone will experience them. The MHRA encourages anyone who suspects or experiences a side effect of their medicine to report it to the MHRA through the Yellow Card scheme.
NICE also provides clinical guidance called Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults, code NG 215. This guidance is available at the following link:
https://www.nice.org.uk/guidance/NG215
Additionally, NHS England has an initiative to reduce long-term opioid use, with further information available at the following link:
https://www.england.nhs.uk/long-read/reducing-long-term-opioid-use/
In March 2023, NHS England published Optimising personalised care for adults prescribed medicines associated with dependence or withdrawal symptoms: Framework for action for integrated care boards (ICBs) and primary care, which is available at the following link:
The framework includes five actions, resources and case studies to help systems develop plans that can support people who are taking medicines associated with dependence and withdrawal symptoms by:
- optimising personalised care for adults prescribed medicines associated with dependence or withdrawal symptoms;
- informing ICB improvement and delivery plans, when commissioning services and developing local policies that offer alternatives to medicines in the first place and/or support patients experiencing prescribed drugs dependence or withdrawal; and
- ensuring a whole system approach and pathways involving multiple interventions, to improve care for people prescribed medicines associated with dependence and withdrawal symptoms.
The commissioning of services to support people to safely withdraw from prescribed medicines that may cause dependence and withdrawal lies with ICBs. NHS England expects ICBs to commission appropriate services to meet the needs of the population that the ICB geographically covers. This includes taking due regard to any national commissioning and clinical guidance.
The National Health Service Business Services Authority provides data dashboards relating to painkiller prescribing, to help systems develop plans and to monitor improvement in line with the published Optimising personalised care for adults prescribed medicines associated with dependence or withdrawal symptoms: Framework for action for integrated care boards (ICBs) and primary care guidance.
Asked by: Andrew Rosindell (Reform UK - Romford)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps he has taken to reduce prescription drug-related deaths in (a) England and (b) Romford constituency.
Answered by Zubir Ahmed - Parliamentary Under-Secretary (Department of Health and Social Care)
The Government has taken decisive action to reduce prescription drug-related deaths in England by tackling overprescribing and improving patient safety. In September 2021, the Department published the National Overprescribing Review, which set out measures to ensure that patients receive the most appropriate treatment. These measures include better use of technology, more effective prescription reviews, and alternatives to medicines where clinically appropriate.
In March 2023, NHS England issued a framework entitled Optimising personalised care for adults prescribed medicines associated with dependence or withdrawal symptoms. This framework sets out five actions for integrated care boards, focusing on the early identification of risk, personalised care planning, and shared decision-making to support safe tapering of medication and alternative treatments. These steps aim to improve patient outcomes by reducing harm from dependency-forming medicines such as opioids and benzodiazepines.
Integrated care boards are the National Health Service organisations responsible for arranging the provision of health services within their area in line with local population need and taking account of relevant guidance.
Asked by: Samantha Niblett (Labour - South Derbyshire)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what support is available to patients where tapering off of Mirtazapine has been unsuccessful and subsequently they find themselves taking a drug that they know is causing them harm.
Answered by Karin Smyth - Minister of State (Department of Health and Social Care)
NHS England encourages integrated care boards (ICBs) to address inappropriate antidepressant prescribing and to consider commissioning services for patients wishing to reduce or stop prescribed medicines that can cause dependence and withdrawal.
In March 2023, NHS England published Optimising personalised care for adults prescribed medicines associated with dependence or withdrawal symptoms: Framework for action for ICBs and primary care. The framework includes actions, resources and case studies to help systems develop plans that can support people who are taking medicines associated with dependence and withdrawal symptoms. The framework is available at the following link:
ICBs are responsible for planning health services for their local population. This includes consideration of services for patients taking medicines associated with dependence and withdrawal symptoms based on local population needs.
An increasing number of non-pharmacological alternatives have become available on the National Health Service, including significant investment in NHS Talking Therapies for common conditions like anxiety and depression, with 1.26 million referrals starting a course of treatment in 2023/24. There has also been considerable investment in social prescribing, which can help people with mental health problems, and there are now over 3700 full-time equivalent trained social prescribing link workers, and over 2.5 million people have been referred to a social prescribing link worker.
Additionally, the National Institute for Health and Care Excellence has published guidelines, Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults, which is available at the following link:
https://www.nice.org.uk/guidance/NG215
The Medicines and Healthcare products Regulatory Agency is currently leading a project to improve the information supplied with dependency-forming medicines. The project aims to improve risk minimisation measures and better inform and educate healthcare professionals and patients about the risk of dependence, addiction, tolerance and withdrawal related to a wide range of medicines including antidepressants in the United Kingdom.
Asked by: Mark Pritchard (Conservative - The Wrekin)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, if he will take steps with NHS England to review the (a) volume and (b) type of antidepressants prescribed on the NHS and their (i) side effects, (ii) long-term effectiveness and (iii) addictiveness.
Answered by Karin Smyth - Minister of State (Department of Health and Social Care)
The National Institute of Care and Excellence (NICE) and Medicines and Healthcare products Regulatory Agency (MHRA) are the relevant regulatory bodies in this area. While antidepressants can be helpful for some patients, NICE guidance recommends a range of non-drug options that should be considered first for people who present with less severe mental health conditions.
For patients diagnosed with depression, antidepressants are an effective treatment method. NICE has produced guidelines on antidepressants, which are available at the following link:
To ensure antidepressant drugs are made available to patients only where the benefits outweigh the potential harms, NHS England is encouraging integrated care boards to address inappropriate antidepressant prescribing and to consider commissioning services for patients wishing to reduce or stop antidepressants.
MHRA is leading a project to improve the information supplied with dependency-forming medicines. The project aims to improve risk minimisation measures and better inform and educate healthcare professionals and patients about the risk of dependence, addiction, tolerance, and withdrawal related to a wide range of medicines, including antidepressants in the United Kingdom.
Asked by: Priti Patel (Conservative - Witham)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, if he will make an estimate of the number of people who had an addiction to a prescription drug in each of the last five years.
Answered by Will Quince
The information requested is not held. There are primary care codes (SNOMED CT) that can be used by primary care teams to record the physical and mental symptoms associated with dependence and withdrawal from prescribed drugs, although there are challenges in linking symptom and diagnostic data with prescribed medicines use.
However, in March 2023, NHS England published ‘Optimising personalised care for adults prescribed medicines associated with dependence or withdrawal symptoms: framework for action’. The framework sets out the scale of and change to prescribing of five medicines associated with dependence over time. Other sources of data such as Openprescribing also enable variation and comparisons in prescribing to be reviewed at different system levels, such as integrated care board, primary care network or practice level.
Asked by: Earl of Sandwich (Crossbench - Excepted Hereditary)
Question to the Department of Health and Social Care:
To ask His Majesty's Government whether they will fund a national helpline and website for people suffering from prescribed drug dependency, as recommended by Public Health England in 2019.
Answered by Lord Markham - Shadow Minister (Science, Innovation and Technology)
This helpline recommendation formed part of a wider set of actions to improve the support available from the healthcare system to people who are dependent on prescription drugs. NHS England has been the facilitator of system partners in their work to deliver the review recommendations. In March 2023, NHS England published ‘Optimising personalised care for adults prescribed medicines associated with dependence or withdrawal symptoms: Framework for action for ICBs and primary care’. A copy is attached. This document includes five actions, resources and case studies that will help systems to develop plans that can support people who are taking medicines associated with dependence and withdrawal symptoms.
Asked by: Crispin Blunt (Independent - Reigate)
Question to the Home Office:
To ask the Secretary of State for the Home Department, what the evidential basis is for cocaine being classed as a Schedule 2 controlled drug under the Misuse of Drugs Regulations 2001.
Answered by Chris Philp - Shadow Home Secretary
Cocaine is controlled under the Misuse of Drugs Act 1971 as a Class A drug and placed in Schedule 2 to the Misuse of Drugs Regulations 2001 (“the 2001 Regulations”).
Drugs placed in Schedule 2 to the 2001 Regulations have some known therapeutic value in the UK and are subject to strict prescribing, record keeping and storage requirements. In addition to the 2001 Regulations, the prescribing of cocaine will also be subject to the requirement of the Misuse of Drugs (Supply to Addicts) Regulations 1997, if prescribed to someone with a drug dependence disorder.
Cocaine is a licensed medicine authorised for local anaesthesia and vasoconstriction of the mucous membranes, for use in procedures such as oral and ear, nose and throat (ENT) surgery.
Asked by: Peter Gibson (Conservative - Darlington)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what guidance has been issued to Tees Esk and Wear Valleys NHS Foundation Trust to help ensure Pregabalin is not misused in patients who consume alcohol and smoke while being prescribed that drug.
Answered by Will Quince
No specific guidance has been issued. Pregabalin is a controlled substance and the British National Formulary states that healthcare professionals should evaluate patients for a history of drug misuse before prescribing pregabalin and observe patients for the development of signs of misuse and dependence.
Asked by: Cat Smith (Labour - Lancaster and Wyre)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, with reference to page 125 of Public Health England's report entitled Dependence and withdrawal associated with some prescribed medicines, published in December 2020, for what reason a helpline or website has not been funded for people who are dependent on prescription drugs.
Answered by Maggie Throup
The 2019 review recommended that the Department consider the development of a time-limited national helpline and associated website. However, the Department’s recent Spending Review settlement did not allow for funding to be allocated to this recommendation.
To support those dependent on prescription medication, the National Institute for Health and Care Excellence has issued guidelines on chronic pain and medicines associated with dependence or withdrawal symptoms. NHS England is developing a framework to support integrated Care boards on prescribing medicines which can cause dependence and withdrawal. This will inform the development of services which can offer alternatives to medicines and support patients experiencing prescribed drug dependence or withdrawal. The framework is expected to be published in autumn 2022.
Asked by: Danny Kruger (Reform UK - East Wiltshire)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, with reference to the recommendations of the 2019 PHE Prescribed Medicines Review, when he plans to introduce a dedicated national helpline and website to support people with prescribed drug dependence.
Answered by Jo Churchill
NHS England and NHS Improvement are leading a programme of work in response to the recommendations in Public Health England’s ‘Dependence and withdrawal associated with some prescribed medicines: An evidence review’. The recommendation for a time-limited dedicated national helpline and website is being carefully considered as part of this work.