Home > Dail Eireann debate. Written answer 36 - Prescriptions data [Opioids and sedatives] [37968/16].

[Oireachtas] Dail Eireann debate. Written answer 36 - Prescriptions data [Opioids and sedatives] [37968/16]. (01 Dec 2016)

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36. Deputy Gino Kenny asked the Minister for Health his views on the monitoring of trends in the prescription of psychoactive psychotropic drugs here, especially to children, over the past 20 years; if his attention has been drawn to concerns regarding the rise in problems associated with prescribed medications, especially opioid painkillers and benzodiazepine sedatives in terms of drug dependency and overdose, including fatal overdose; the measures being taken to address the rise in prescription rates and associated problems regarding prescription medications; and if he will make a statement on the matter. [37968/16]


Minister for Health (Deputy Simon Harris): My Department is aware of reports on trends indicating the increased use of psychotropic drugs. We are also aware that in recent years that the nature and scale of drug misuse has changed, with an increased prevalence of poly-drug use, as well as use of benzodiazepines, and other prescription or non-prescription medications. Treatment figures indicate an increase in the number of people seeking treatment for benzodiazepine use.


The fourth national drug prevalence survey, carried out in 2014/15, examined the use of psychotropics such as sedatives and tranquillisers (which include benzodiazepines) in the adult population aged 15 or over; 14% of those surveyed reported having used such drugs at some point in their lives. The number of drug-related deaths is one of the key indicators used to measure the consequences of problem drug use. The number of deaths where benzodiazepines were implicated increased by 24%, to 160 in 2013 compared with 129 in 2012. Two fifths of poisonings in 2013 involved benzodiazepines.


The drugs prevalence survey also found that more than 6 in 10 (61.5%) Irish people report having used “other opiates” at some stage in their life. However these reports do not include information on the source of these drugs; whether they have been prescribed for them or sourced illicitly.


The Medical Council is the statutory body for the registration and regulation of doctors engaged in medical practice. The Council has set out specific requirements for doctors regarding prescribing of drugs at section 42 of its Guide to Professional Conduct and Ethics for Registered Medical Practitioners (2016). While the Guide is not a legal code, it sets out the principles of professional practice and conduct that all doctors registered with the Medical Council are expected to follow. At 42.3 it states that when prescribing medications, doctors must comply with Misuse of Drugs legislation and other relevant regulations and/or guidelines. Whilst at 42.7 the Guide advises that doctors must be aware of the dangers of drug dependency when prescribing benzodiazepines, opiates and other drugs with addictive potential.


In 2013 the Irish College of General Practitioners published guidance for its members on diagnosing and managing mental health difficulties in children and adolescents. In June of this year the Early Warning Emerging Trends (EWET) subcommittee of the National Advisory Committee on Drugs and Alcohol, with the agreement of my Department, wrote to health care professionals highlighting the need for vigilance when prescribing and dispensing pregabalin and gabapentin, as these drugs present a risk of addiction and a potential for illegal diversion and misuse. Prescribers were advised to always undertake a risk benefit assessment prior to prescribing either of these medicines for patients under their care.


Specifically in relation to benzodiazepines there are prescribing guidelines in place at national level for both general practitioners (GPs) and psychiatrists. The Good Prescribing Practice for Clinicians guidelines were published in 2002 to guide GPs about prescribing benzodiazepines. Standards of practice should ensure short term use of benzodiazepines, using the lowest dose possible and, where their use has been for longer than four weeks, clear evidence of education on reducing with a view to discontinuing. If this is not possible there should be clear documentation on reasons for continuing the prescription.


The College of Psychiatry issued a Consensus Statement on the Use of Benzodiazepines in Specialist Mental Health Services in 2012. The College recommends that members who prescribe benzodiazepines should follow good practice guidelines for their use. This includes conducting regular audit of practice.


The HSE has written to all GPs outlining their levels of benzodiazepine and other hypnotics prescribing on the GMS scheme in an initiative to encourage better quality prescribing of these drugs. This was in line with a recommendation from my Department’s 2002 Report of the Benzodiazepine Committee. GPs received individualised and confidential reports every three months. The reports, compiled from PCRS data on the number of benzodiazepine and hypnotics prescriptions dispensed by pharmacists, allowed GPs to see exactly how many times they have prescribed these drugs in the preceding months. Most benzodiazepines and the so-called “z-drug” zolpidem are already controlled under the Misuse of Drugs Acts. Regulations and Orders made under the Misuse of Drugs Acts specify the level of control which apply to these substances.


The Misuse of Drugs (Amendment) Act 2016 was passed by the Oireachtas in July. Stricter controls will apply to certain psychotropic drugs including phenazepam, lisdexamphetamine, zopiclone and zaleplon. Controlling these substances in the Act was part one of a two-step process. The Act provides for the revocation and remaking of various Regulations and Orders which had been confirmed by the Misuse of Drugs (Amendment) Act 2015. Work on drafting various new Regulations and Orders is complex and technical in nature but is at an advanced stage and is expected to be completed in the coming weeks. Among other things, these new Regulations will introduce stricter prescribing and dispensing rules on a number of psychotropic drugs including benzodiazepines and z drugs.

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