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Galvin, Brian (2009) Use of minor tranquillisers and sedatives in the WRDTF area. Drugnet Ireland , Issue 30, Summer 2009 , pp. 10-11.

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The first in a series of three reports commissioned by the Western Region Drugs Task Force (WRDTF), this study1 analysed treatment and prescription data relating to the use of minor tranquillisers and sedatives2 in the west of Ireland, and interviewed addiction service providers and a number of people recovering from addiction to these drugs.  

The early section of the report provides the legislative and regulative background to current prescribing practices. Department of Health and Children guidelines3 define correct usage and good prescribing practice. A short literature review looks at the evidence of incorrect use of tranquillisers and sedatives internationally and the harmful consequences of this, including higher levels of risk-taking, fatal overdoses, and poorer health and psychological functioning.
 
 Treatment and prescribing data
The study analysed data from the Health Research Board (HRB) National Drug Treatment Reporting System (NDTRS).  These showed that of the 973 cases who entered treatment between 2001 and 2006, 114 (11.7%) reported problem benzodiazepine use.  Only nine cases (less than 1%) reported benzodiazepines as a main problem drug.  The vast majority of cases entering treatment for benzodiazepine use reported at least one other problem drug. The report points out that those presenting to a GP with an addiction to minor tranquillisers or sedatives are more likely to be referred for treatment to the HSE Mental Health Services than to the HSE Addiction Services.  As the HSE Mental Health Services have only recently begun submitting treatment data to the NDTRS, there are probably a number of cases being treated who are not included in the treatment data analysed in this report.4 
 
The study also looked at prescription records held by the HSE Primary Care Reimbursement Service (PCRS).  Analysis of these data showed that 89,721 individuals were prescribed minor tranquillisers and sedatives between 2000 and 2007.  Almost 88% of prescriptions dealt with by the reimbursement service were for medical card holders. The number of people being prescribed these drugs rose from just below 25,000 to just over 33,000 during this period.  These data would suggest that the 2002 prescribing guidelines have had little impact on prescribing practice in this region.
 
Focus group and health personnel interviews
The author arranged a focus group with six clients of an addiction treatment centre, five of whom had been addicted to a minor tranquilliser or sedative, and one to codeine. Alcohol was the main problem drug in all cases. The focus group revealed that none of the five clients was aware of the risks of dependence on drugs when they were prescribed minor tranquillisers.  It was also clear that it was easy to get a prescription and easy to have it repeated.  None of the participants in the focus group had been offered alternative therapies. 
 
The author interviewed six addiction counsellors in HSE West Mental Health and 10 substance misuse counsellors in HSE West Drug Service.  Both of these groups of service providers expressed broadly similar concerns.   The issues raised were: 
  • Inappropriate prescribing: Many people have become dependent on minor tranquillisers and sedatives as a result of being maintained on them long after the optimum therapeutic period.
  • Individual choices in misuse: People prescribed these drugs may not fully understand their addictive potential or the consequences of taking them incorrectly.  In cases of alcohol and minor tranquilliser co-dependency, the emphasis in treatment is invariably on alcohol and it is difficult to deal with the addiction to the prescribed drug.  Sharing of prescriptions among family members is also an issue.
  • Public policy and remuneration issues: Health authorities and professional regulatory bodies have failed to take action to deal with the problem use of these drugs. Payment of professional fees from reimbursement schemes is not conditional on appropriate prescribing or dispensing.
  • Diversion and leakage: As a result of over-prescribing of minor tranquillisers and sedatives, a large amount of these drugs become available for illicit use and this drives a thriving black market.
  • Key service issues: The counsellors agreed that only a very small proportion of those who have an addiction actually present for treatment.  The treatment figures do not provide a true picture of the problem.
 The study concludes that there is excessive and inappropriate prescribing of minor tranquillisers and sedatives in the western region.  Despite the introduction of good practice guidelines in 2002, spending on these drugs by the public health service doubled between 2000 and 2007.  The author points to the failure of this service to control three drivers of incorrect use: pricing, prescribing and distribution.  There is limited control of distribution and prescribed drugs are easily diverted to the black market.  There is very limited non-medical support to addicts and very little co-ordination between primary care, mental health and community service providers, making it more difficult to identify and deal with problem drug use.
 The report makes a number of recommendations, including more rigorous regulation and tighter controls on distribution.  Doctors and pharmacists need to be educated on the consequences of over-prescribing and on addiction-related issues, and individuals need to be provided with better information to enable them to make informed decisions regarding their use of these drugs.
 
 1. Flynn K (2009) Minor tranquillisers & sedatives: use and misuse in the west of Ireland. Galway: Western Region Drugs Task Force.
2. Minor tranquillisers and sedatives is the term used throughout the report to refer to a class of psychoactive substances that includes benzodiazepines and related drugs.
3. Department of Health and Children (2002) Benzodiazepines: good practice guidelines for clinicians. Dublin: Department of Health and Children.
4. The appointment of a GP and a pharmacy liaison nurse in the region has resulted in a substantial increase in the number of cases reported to the NDTRS since 2006.
Item Type:Article
Issue Title:Issue 30, Summer 2009
Date:2009
Page Range:pp. 10-11
Publisher:Health Research Board
Volume:Issue 30, Summer 2009
EndNote:View
Accession Number:HRB (Available)
Subjects:B Substances > Sedatives or tranquillisers (CNS depressants)
B Substances > Opioids (opiates) > Opioid product > Codeine
E Concepts in biomedical areas > Substance by legal status > Prescription drug (medicine / medication)
VA Geographic area > Europe > Ireland > Mayo
VA Geographic area > Europe > Ireland > Roscommon
VA Geographic area > Europe > Ireland > Galway

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