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Prescribed Addiction

Duration:
27 minutes
First broadcast:
Wednesday 27 July 2011

Prescribed Addiction: John Waite investigates the "scandal" that has left up to 1.5 million people addicted to drugs prescribed to them by their GPs. Experts in the field tell us that addicts to benzodiazepine tranquillizers, the most popular of which are diazepam and temazepam, far outnumber those addicted to illegal drugs. There's evidence that some family doctors are ignoring guidleines by prescribing the drugs for much longer than is recommended, while successive Governments are accused of turning a blind eye to the problem and offering little by way of treatment to the victims who want to withdraw.

Producer: Kathryn Takatsuki.

  • Help with Addiction

    Battle Against Tranquilisers exists to help those who are addicted to benzodiazepines, tranquillisers and sleeping pills, and drugs with similar effects, and who wish to withdraw from them, to do so as comfortably as possible, and to help them to make the changes necessary in life after withdrawal. You can call their help Line between 9am and 8pm, every day, on 0844 826 9317, or 0117 9663629, which will stay open later after Sunday’s programme.

    www.bataid.org/



    CITA, the Council for Information on Tranquillisers, Antidepressants, and Painkillers, is a charitable organisation, established to provide support and information for individuals, families, friends and professional advisors dealing with prescribed tranquillisers, sleeping tablets, and antidepressants. Call their helpline between 10am and 1pm on 0151 932 0102

    www.citawithdrawal.org.uk/



    Oldham Tranx Support Group is a local support group set up initially for involuntary tranquilliser addicts but now extended to anti-depressants, SSRIs, Z drugs and pain killers. If you, or anyone you know, needs advice, the group meets in Oldham Mondays from 11:00am - 1:00pm. If you are unable to make the group meetings you can contact them for advice, by phone on 01457 876355.

    www.benzo.org.uk/otbh.htm

  • Transcript

    THIS TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT. BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS THE BBC CANNOT VOUCH FOR ITS COMPLETE ACCURACY.

    Waite
    This week the UK's legion of legal drug addicts; people who've never taken an illegal drug in their lives but because of what's been described as a "prescribing scandal" have become hopelessly hooked. Their pushers? Those most trusted of professional their GP.

    Vox Pops
    I fear my GP. My GP is the only man who I will say yes to, no matter what he says because I am terrified that if I don't agree he will not even give me my medication.

    We trust our doctors. So it's a failure of the GP, a failure of the medical profession altogether to not warn us - I think it should say "warning: dangerous drug, highly addictive" and then there would be no question of anyone being in the mess that I am in.

    The benzo issue is a Pandora's Box, they do not want to take the lid off this, they're terrified of the general public knowing the true scale of addiction.

    Waite
    Despite estimates of up to one and a half million legal drug addicts in the UK we'll be hearing how governments and GPs who prescribe these drugs have been in denial about this addiction. The medications these people are addicted to are benzodiazepines - a group of tranquillisers commonly prescribed for insomnia and anxiety. The medical profession has known for decades that they are potentially highly addictive, yet prescriptions in England are on the increase. There's precious little help though for those already hooked on them, like 61-year-old Sue, put on the pills eight years ago.

    Sue
    The impact is absolute hell. It basically takes away any quality of life. I was a very happy outgoing person, I had many hobbies, I was a sportswoman, I had a career and now it's very seldom that I can do any of those. So the impact is life changing.

    Waite
    Last year in England alone nearly eleven and a half million prescriptions for benzodiazepines were issued, the most common being diazepam and temazepam. A very days use can alleviate symptoms but it's been known for years that dependence can quickly develop. Sue was prescribed diazepam after a family bereavement but claims she was never warned by her GP about the drug's addictive qualities until it was too late and she was.

    Sue
    I began to feel unwell, it sort of crept up on me. I didn't take the drug on a regular basis and just didn't know what was wrong with me but I started to feel numb areas in parts of my body and also I started to suffer from extra and irregular heartbeats. And then one evening I felt as though the room was spinning, I was terribly unwell and didn't know what it was. It was only when I saw a homeopath, he said well you're on these medications, come off them and I thought right, I'll do that. And then I came off the diazepam, oh I thought things feel a bit better, I'm not dizzy, well three days later I was out and I couldn't walk, I literally couldn't get back home. I was terrified. I phoned the GP up and that's when I found out I was addicted.

    Waite
    At his home 50-year-old Josh's morning routine of washing and shaving ends with taking his daily medicine. He's attempted to give up his 40 year addiction many times, all have ended in failure.

    Josh
    I would be a wreck, my quality of life would be hugely impaired as a result of not taking the medication.

    Waite
    Josh was first prescribed a benzo for his hyperactivity aged eight. Experts say coming off benzos can be harder than heroine, as Josh knows all too well.

    Josh
    You sweat - hot and cold sweats. Diarrhoea, problems in eating and holding food down. Senses of going completely mad, it's horrendous.

    Waite
    And these side effects of coming off they persist do they, they go on?

    Josh
    They do indeed. I have never found a point where I can say do you know what, today it's better. So I've never found a cut-off point myself...

    Waite
    And how long have you tried for?

    Josh
    I did a period in my life of eight weeks. Now I know that sounds a very short time, I can assure you that eight weeks is a real long time and without the support, in the end, for me, my body said do you know what, enough, I must now take a tablet, I can bear this no longer.

    Waite
    Concerns about the addictive nature of benzos go back to the mid-'80s when 20 million prescriptions a year were handed out in England. As a result, in 1988, the committee on safety of medicines recommended benzodiazepines:

    Recommendation
    Should be prescribed for just two to four weeks for relief of severe or disabling anxiety and not for the treatment of mild anxiety.

    Guidance reiterated in 2004 by the Chief Medical Officer for England and again in 2007. Even so latest figures show prescription numbers have been rising again recently and in 2010 stood at eleven and a half million. Benzos remain popular because they do help patients with anxiety and insomnia and they're cheap - the average cost of a diazepam prescription in England last year was just £1.54. But their addictive properties can be a serious drawback.

    Lader
    The problem is there are many patients who find benefit in the short term and are reluctant to stop, so they become repeat prescription receivers and that seems to slip under the radar and the GPs just keep these medications going.

    Waite
    Professor Malcolm Lader of the Institute of Psychiatry is a world renowned expert on benzodiazepines, describing them as the opium of the masses. But once on them longer term, he says, going cold turkey can be extremely difficult.

    Lader
    I estimate about 20-30% of people who are on a benzodiazepine like diazepam have trouble coming off and of those about a third have very distressing symptoms. The anxiety or the sleeplessness comes back, they feel as if they're physically ill - we talk about a flu-like illness - then they start to get some very bizarre symptoms which we technically call hypersensitivity but essentially what it is the brain is starting to wake up and it over wakes - sounds appear loud and lights appear bright, so they're wearing sunglasses indoors and they also have a symptom whereby they feel very unsteady and they will walk round the room holding on to the walls - and they really are then in a bad withdrawal state.

    Waite
    So it's by no means a piece of cake to come off these drugs?

    Lader
    No it's not, it's very difficult and the facilities are just not available and the great - I think it's a scandal - is that the NHS claims to be dealing with these people by referring them to addiction centres, where essentially they'll sit next to a street user who's injecting heroine and of course a housewife who's been put on tranquillisers by her doctor is very upset by this.

    Waite
    Sue was.

    Sue
    I sought help and was sent to a drugs misuse facility. They gave me a schedule which was quicker than the one that I'd attempted and failed. And I said well this won't work and they said well that's it, that's how you do it and we don't have any remit for treating people like you. I was even asked by one GP why I wanted to come off the drug. To me that shows the lack of understanding of the impact of the drug.

    Waite
    Unlike illegal drug users of heroin and cocaine the services to support benzo addicts who want to wean themselves off the drug are simply not there. Labour MP Jim Dobbin chairs the All Party Parliamentary Group for Involuntary Tranquilliser Addiction and just in sheer numbers, he says, this is the most serious drug problem in the UK yet successive governments have done nothing.

    Dobbin
    The response so far has been pretty negative. There's been very little progress made, the government is in denial about this whole problem. They think that these people are abusers rather than needing help and support and there's nothing in the system to help them - nowhere. Society owes these people a terrific amount because their lives have been totally destroyed through taking drugs that their GP has prescribed and it's prescription addiction.

    Waite
    Why would the government be in denial?

    Dobbin
    First of all they don't understand the problem. It's a difficult problem for any government to tackle because of the power of the pharmaceutical industry and because many of these victims have been using tranquillisers for many, many years there is an issue of compensation in the background, which frightens any government.

    Waite
    Who's accountable for this?

    Dobbin
    Well most definitely the Department of Health, they're in charge of the health of the nation and it's important really that they look at this and there's still millions and millions a year are being prescribed. But the biggest problem is the one and a half million people who are already in the system and are victims and they want their lives back.

    Waite
    Kathy Gyngell agrees, she's a drugs policy analyst at the Centre for Policy Studies. What's been happening and is happening is a prescribing scandal she says, that neither the government nor the health service has addressed.

    Gyngell
    It's been brushed under the carpet and there's been a sort of complacency. I can see that there will be a fear there but it seems to me to be rather symptomatic of the health service as we have it, which is very much a prescribing health service which defines its own success, its own productivity in terms of prescribing. So this really is hitting at a sort of real Achilles heel in the culture of the health service to admit that prescribing a pill for every ill can actually be an extremely damaging thing to do.

    Waite
    As we've heard it's not as if there haven't been warnings - in 1988, 2004 and 2007 - to limit prescribing to two to four weeks. Yet a report published just three months ago from the National Addiction Centre, which looked at the prescribing of benzos in England between 1991 and 2009, found no change in longer term prescribing, more than a third of prescriptions were for more than eight weeks and the median length of a prescribing episode exceeded the guidelines. Professor Lader senses there is movement on the part of GPs over this but not for medical reasons.

    Lader
    There is a change taking place which is that if a general practitioner prescribes for longer than the agreed time - two weeks or four weeks - they can be sued by the patient for substandard clinical care and I suspect in the longer term the prescribing of these drugs will be as much dependent on lawyers' attitudes as it will be on doctors' attitudes.

    Waite
    That change on the part of some GPs has hit Josh badly. He's the benzo addict who was first put on the drugs 40 odd years ago as a child. Until he moved house four months ago his monthly prescription was for a 180 pills, his new doctor has already reduced that and as someone who's tried repeatedly to come off the drug Josh is terrified that with no support the results could be devastating.

    Josh
    I don't trust my GP now, I'm scared of my GP...

    Waite
    Scared of what?

    Josh
    I feel that GPs - some not all - are seeking to get people like myself off of benzos so alarmingly quickly - benzo users now are being put in this little hole whereby the advice is get them off quick. I get a sense it's all about cleaning the prescribing pads. It worries me - am I then just a statistic now where at the wipe of a GP's pen my life can be literally sent into ruins?

    Waite
    But maybe your previous doctor though was the one who got it wrong - just gaily prescribing all the pills you've ever had - maybe the one now, who is saying to you look we have to confront this and you have to stop it, maybe he's the good doctor?

    Josh
    Whilst the new GP has good intentions the way in which he's doing it is anything but good. The current way in which I'm being dealt with is setting me up to fail. If I'm going to come off benzodiazepines let me have a say in that, give me some support, don't throw me out into the street and say get on with it old chap, pull yourself together, it's not going to work.

    Waite
    The answer, according to Kathy Gyngell of the Centre for Policy Studies and others, is not to keep people like Josh on their drugs forever, nor to stop their supply abruptly but to provide proper targeted support to help them to withdraw.

    Gyngell
    What GPs mustn't do is after people have been prescribed this stuff for years expect them to withdraw quickly. It's a form of cruelty and almost a form of abuse. The GP needs to be able to refer that person to a service that will help him. There are a few of these in the country but there are less than a handful. One is run by Addiction Dependency Solutions in Oldham, it is very cost effective - high success rates of getting people off and withdrawing them gently and under the correct circumstances over the right period of time.

    Actuality - ADS
    There you go, if you take a deep breath in and out. Are you feeling okay?

    I'm feeling fine.

    Waite
    The place Kathy mentioned there in Oldham is unique. It brings together two charities - one, ADS, has funding from the NHS, £58,000 a year, to supply two nurses; the other - Tranx - is a support group run by volunteers that meets every Monday and where those nurses offer psychotherapy and alternative therapies like acupuncture.

    Actuality - ADS
    I'm just going to go over to your other ear now. So if you want to take a deep breath in and out...

    Waite
    The group meets to chat over problems and is run by Barry Haslam, a former addict himself. Benzo free for 25 years now he's disgusted that, in his words, the government has its head in the sand when it comes to providing more services like Tranx.

    Haslam
    We've got one and half million long term UK addicts of benzos. It outnumbers the illicit side by about five to one and yet all the many hundreds of millions of pounds is being spent on the illicit side, it's complete discrimination against people who've become addicted through no fault of their own, through their GPs. The discrimination is so wrong that it's got to be put right.

    Waite
    You've become an expert, a leading expert, on this one way or another over a quarter of a century tell me about the impact this has on people's lives.

    Haslam
    Big impact. Here in Oldham I've unfortunately seen six suicides and about 50 attempted suicides. I can remember one weekend, especially, people wanted to commit suicide on the Friday night, the Saturday night and the Sunday night. It's just so sad that there's nothing out there - where are the services to help these people? It's also the cost to the family - you've got people being on benefit, they can't work, they can't contribute to the GDP of the country. The ones who want to come off these drugs you've got to give them a choice.

    Waite
    So you say they've got their head in the sand and always have had, why is that?

    Haslam
    They're terrified of the general public knowing the true scale of addiction and the horrors that can go with withdrawal. They're also - they're terrified of individual GPs being sued. I just find it astounding that the Department of Health can allow this to happen and it's got to be legally wrong that they will allow the deaths to happen, the addiction to take place without offering a safety net for people to come off these drugs.

    House of Lords debate
    Speaker
    The Earl of Sandwich.

    Waite
    Calls to set up more support services like Tranx have even been made in the House of Lords where the Earl of Sandwich has led a number of debates like this one in June.

    House of Lords debate
    Earl of Sandwich
    Cannot government recognise the good practice that is already out there? Set up withdrawal clinics and spread the word that these are not - they're no longer prescribed drugs, they're turning into dangerous substances which can cost lives.

    Waite
    The Earl knows from first-hand experience the traumatic impact of benzo addiction because someone very close to him is an addict.

    Earl of Sandwich
    Well it's been a tragedy for the family because he was such a promising director of a film company, he's been living a half-life for two and a half years and we are distressed day by day because his condition is always unstable.

    Waite
    So this has been devastating to the family?

    Earl of Sandwich
    It's an absolutely devastating thing and successive governments don't seem to realise that this is an emergency for thousands of people and their families and no government seems to be able to deal with it, every time you wait for a new government they commission reports, they go out to consultation, the end result for patients - nothing. And since the new government came in it's been exactly the same story - looking for information, no action.

    Waite
    Why has it been ignored all this time?

    Earl of Sandwich
    Talking to a number of doctors they don't really like to bring it up, it's too close to their ordinary work. They don't have enough guidance. It's a sort of unspoken connivance between the medical profession and the government - they just don't know how to deal with it. But they have to because there are so many people suffering and it's becoming an emergency.

    Waite
    Not, according to the Royal College of General Practitioners, however. Its chair Dr Clare Gerada claims the numbers of addicts and the problems they have withdrawing have been overstated and she describes the way GPs have been dealing with patients in recent years as a "prescribing success story".

    Gerada
    What we've seen over the last 20 years is a massive reduction in the prescribing of these medicines and actually a massive reduction in the number of people who are actually addicted to them in any shape or form. And we've also got to remember they are good medicines and they have good uses. GPs are sensibly prescribing and there are far less prescriptions being issued on a regular basis.

    Waite
    But hang on a minute - prescriptions for benzos have gone up 2009 - 10,593,000; 2010 - 11,431,000 - that's an 8% increase year on year.

    Gerada
    There's all sorts of things that can cause an increase in prescription levels of course...

    Waite
    But you just told me the prescriptions were coming down - they're going up!

    Gerada
    Okay, let's be clear. The number of prescriptions of benzodiazepines issued to patients over a long term basis for no good reason is certainly not increasing, if anything it is significantly decreasing.

    Waite
    You can't call this a prescribing success story if numbers are going up.

    Gerada
    I can call it a prescribing success story...

    Waite
    Can you?

    Gerada
    I can because what I do is I see what I see in the surgery and it's now very unusual for patients to get them on repeat prescription, we only issue them for a short term but we are also issuing them for appropriate indications such as alcohol detoxification.

    Waite
    We're still talking though about huge numbers, aren't we, of people who were prescribed these things by their GPs and now can't get off them?

    Gerada
    Okay well I would dispute that you can't get off them, I'm a GP who's been managing this problem for about 20 years and you can get off them, some patients take a number of months, some patients can do it in two to three weeks...

    Waite
    But I've heard that the withdrawal symptoms are quite horrendous, they go on for much longer than say withdrawing from heroin.

    Gerada
    I again would dispute that, I mean withdrawing from heroin is pretty uncomfortable and the patients that I see, on the whole, do not have problems coming off. Some patients may be on them for life - I mean that's not a good thing, it's never a good thing to go on medicines for life - but if you balance the risks and benefits then sometimes the benefits of staying on them far outweigh the risks.

    Waite
    So is that the answer - stay on them?

    Gerada
    For each patient we would take them on their own. I mean the answer is actually multifactorial - the answer is to have sensible prescribing, which I think we now have, is to have better treatments - so we have the talking therapies for treatment of anxiety - and is also to deal with patients who we, as doctors, have caused to be addicted and deal with those on a case by case basis.

    Waite
    But the main support out there, surely Dr Gerada, is for illegal drug users.

    Gerada
    And I think you're absolutely right there John, I think for the last three decades we've actually lacked benzodiazepine specific addiction services and I think we need to be looking at getting certainly some specialist services set up that deal with that tiny group - but it is an important group - of patients that cannot get help through other routes.

    Waite
    This has been left to fester for an awful long time hasn't it?

    Gerada
    Well I would again dispute that - I actually think...

    Waite
    But you've still got hundreds of thousands of people who are addicted and who don't want to be.

    Gerada
    And it would be nice not to have any iatrogenic addict but we used to have millions of people that were on these medicines and they were...

    Waite
    It sounds awfully complacent - it's only a few hundred thousand...

    Gerada
    I'm not at all complacent, I'm saying the issue of safer prescribing by GPs, a more sensible and appropriate prescribing, has been addressed. Clearly you will always get outliers but general practitioners prescribe, on the whole, appropriately and responsibly, albeit we can always do better.

    Waite
    Well if better prescribing is down to GPs providing those desperately needed support services for benzo addicts in England falls to public health minister Anne Milton. So what does she make of Dr Gerada's assertion that there isn't much of a problem and withdrawing from benzo addiction isn't that hard?

    Milton
    I would disagree with her, that's not the story I hear from people who are addicted to these drugs. What I hear is something very different...

    Waite
    Doesn't that sound like complacency to you - there isn't a problem, the doctors are all in line - even though I said to her benzo prescriptions were up she wasn't having any of that - doctors are across this and there isn't a problem, this has been a prescribing success?

    Milton
    That flies in the face of my experience and the evidence that I've received. I've met people who've been addicted to some of these drugs for 20 or 30 years - wrecked their lives, wrecked their jobs, wrecked their families. It's a silent addiction. We all know about illegal drugs, we all know about alcohol, we don't know about this group.

    Waite
    But you must be very disappointed because the GPs are saying - and they're on the front line - there isn't a problem, it cannot be helpful to what you have in mind?

    Milton
    The Royal College of GPs of course doesn't speak for all GPs and I have to say at this point that I have met general practitioners who are very aware of this problem. I mean one of the issues is that treatment and awareness of this is really patchy - some GPs are really, really switched on to this, recognise the problem, recognise the importance of good prescribing habits and will identify it within their own general practice. So I am disappointed if there's any denial of this because I think that there is a problem.

    Waite
    You see I've heard on the programme from your parliamentary colleague Jim Dobbin that it's the government that is in denial and successive governments have been and from another of our interviewees - Barry Haslam - that this is a Pandora's Box that governments don't want to take the lid off because it's going to cost a lot of money to put things right.

    Milton
    Well I think there has been some denial of the problem and I think that when you're talking about drugs that are legally, albeit unwisely, prescribed causing a problem - you know it's never really fitted anywhere, nobody wanted to grab hold of it - certainly not in denial now. We are going to get a grip of this and it needs to be dealt with on a number of different fronts, there's no doubt about that.

    Waite
    So what are you going to do? The number of people I've met making this programme say I'm a victim of going to my GP, I've lost my life, as it were, I want it back - what are you actually going to do?

    Milton
    We have started six to eight pilots on the treatment of illegal drug users - that will be a good way of starting off on what we might do for people who are addicted to legal drugs. It's an issue that the department wants to help support local areas to get the right treatment services set up because there is no one size that fits all, without a doubt. Also it is something that is embedded in general practice, so we have got to work with the GPs because these people, a lot of them, are getting their drug on prescription.

    Waite
    A final question then - a lot of people will be listening in today who are addicted to these drugs, they're hooked on these things, and they'll be looking to the public health minister - that's you - to give them some reassurance that their needs are going to be taken seriously. Can you give them that reassurance?

    Milton
    I can give them that reassurance. I'm taking this very seriously. It's an issue that's fallen through the cracks. We want to make sure that training and awareness is raised so that GPs know how to prescribe well and then we need to make sure that we've got the right services in place to give them the help and support they need to get off these drugs and get back and enjoy lives as they should be able to.

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