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Miss Begg:
In making a risk analysis and a public benefit analysis of the withdrawal of co-proxamol, will she also consider the following point, which she will probably be unable to deal with this evening? Those who previously used co-proxamol, and who were active and in work, might lose their job and be unable to work as a
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result of its withdrawal and their failing to find an equally effective alternative. My constituents' fear is that they will therefore be a burden on the state, instead of contributing to it.
Caroline Flint: It is important that all the alternatives are looked at. We need to ensure, in respect not just of co-proxamol but of other drugs, that GPs have the most up-to-date and most effective pain management care for their patients. Sometimes drugs become a matter of custom and practice, because it is the one thing that the general practitioner knows about, so he or she continues to prescribe it despite evidence that there are better alternatives. I understand what my hon. Friend is saying: I will reflect on what she said and write to her on that issue.
What I am saying this evening is that the primary issue is that we stand by the decisions made by the Committee on Safety of Medicines, while at the same time recognising that, for a minority who have gone through all the alternatives, there may be a clinical need to continue with the prescribing of co-proxamol.
Miss Begg: My hon. Friend is a Minister in the Department of Health, so the calculation may be done on health grounds, but there may be social costs to the withdrawal of the drug, which may not have been factored in with respect to the health costs of keeping the drug going. There could be costs to society if people fail to get an effective drug and co-proxamol is withdrawn.
Caroline Flint:
I understand what my hon. Friend is saying. Yes, we have to weigh up all the different factors. However, the information that I provided earlier this evening about the impact of this particular drug on the number of people who die through either accidental or planned overdose is a very serious issue. I understand that all drugs have risks, but we face huge challenges that cannot be overcome through treatment if someone overdoses by accident. Some people, unfortunately, seek to commit suicide, but they may rethink that option if they have a chance of getting treatment—after being saved, as it were. That raises many questions about co-proxamol. From the evidence that I have seen, the option of having treatment, thereby saving life, is much reduced by the accidental or intentional use of this drug when it leads to an overdose. We have to take all those factors into consideration.
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As I have already said, it is a complex issue that has focused the minds of many people in establishing what is the best thing to do. No one lightly takes removing a drug from the market when it has become part and parcel of how many people, whether they are in or out of work, cope with their daily lives. I referred earlier to an article in Pulse, which made it clear that GPs are engaging with patients in a sensitive way in planning the withdrawal of co-proxamol in favour of alternatives. The fact that there has been a decline, from 438 to 20, in the number of people who cannot deal with any alternative drug shows that progress can be made, although we must be mindful of the minority for whom alternative treatment may not be an option. There is a process that must be gone through but, as I said, GPs or prescribers retain the ability to prescribe co-proxamol.
I shall write to my hon. Friend about some of the issues that she has raised, and particularly about the question of stocks. Clearly, it is important to determine what the future holds for those people for whom co-proxamol is the only drug that can give them the relief that they need.
I welcome the opportunity to hold this debate. Sometimes, regulation must balance the preferences of the few with the needs of the many, but that is not to say that we do not take account of the individual requirements that my hon. Friend has expressed so ably. I hope that she and organisations such as Arthritis Care are reassured by my acceptance of the possibility that co-proxamol will continue to be prescribed where there is a clear clinical need because alternative treatments are unsuitable.
The Government are sensitive to the problem and accept that pain management is a complex matter. We expect health professionals to engage fully with patients on the range of drugs that are available to manage their pain, and we know that patients have considerable interest in complementary and alternative medicines for the management of pain.
The way forward is to ensure that the relationship between health professionals and patients is developed. It is not good enough for GPs or prescribers to sign off a patient on drugs for many years without any discussion of pain management. The relationship must be a progressive one: it may change with time, but both patient and prescriber must feel that they have attempted to make the best possible progress.
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