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17 Jan 2007 : Column 346WH—continued
The information gathered as part of the review did not provide sufficient evidence on efficacy, in particular, for the continued provision of co-proxamol when that was weighed up against the public health concerns. The review noted that the previous strengthened warnings to doctors and patients about the hazards of co-proxamol had proved ineffective. I note the point made by my
hon. Friend the Member for Aberdeen, South about whether the national campaigns are too piecemeal and not effective, but we communicate in part directly with health professionals. Over and above what we do nationally about patients and the public, we have sophisticated methods of communicating directly with health professionals. Even with that direct line of communication, it was felt that those health professionals were not taking the matter as seriously as they should have been through the normal measures. It was believed that the risks of co-proxamol outweighed the benefits of allowing the medicine to remain on the market.
During the review, the CSM considered strengthening warnings on the product information, restricting the pack size, an education and communication programme to alter prescribing behaviours, restricting the indication for the treatment of chronic pain, restricting prescriptions for second-line use, restricting prescriptions to specialist use only and rescheduling co-proxamol as a controlled drug. All the issues that my hon. Friends raised were considered as part of the discussions, but the CSM felt and advised that none of the measures was capable of effectively minimising the risk.
We all take the prevention of suicide seriously: 4,500 people take their own life in England every year—I am sorry that I do not have the figures for Wales for my hon. Friend the Member for Newport, West (Paul Flynn)—and we have a national suicide prevention strategy. It was extremely encouraging to see in April 2006 that progress is being made on our national suicide targets. The third annual report showed that the most recent suicide rate, for the three years from 2002 to 2004, has been reduced by 6.6 per cent. from the 1995 to 1997 base line. The report outlined areas where progress was being made, including in the phased withdrawal of co-proxamol. As I said, it is a cause of accidental as well as deliberate harm. It is estimated that a fifth of the co-proxamol self-poisoning deaths each year were unintentional. On that basis alone, we can assume that more than 100 lives have been saved to date as a result of the action to withdraw co-proxamol.
There are many alternatives to co-proxamol and that is reflected in the steady fall in the prescribing of that medicine. Over the phased withdrawal period, we expected to see prescribing decline. Co-proxamol prescriptions
have fallen from more than 7.2 million in 2004 to approximately 1.5 million in 2006—about an 80 per cent. drop in usage over the past two years. Northern Ireland has phased out co-proxamol altogether.
That steady decline in usage has doubtless been supported with pain management guidance from the CSM and the National Prescribing Centre, which demonstrates that health care professionals and patients are making informed choices about appropriate pain relief. However, I recognise that a small group of patients are finding it difficult to change from co-proxamol or that alternatives appear not to be effective or suitable.
Before the CSM review, co-proxamol was widely used. As I have said, there were 7.2 million prescriptions in England in 2004. We received 367 letters during the past two years from patients concerned by the decision. However, that number of letters represents a small minority given the overall benefits that we think will be gained by the withdrawal of co-proxamol. For those patients, the continued provision of co-proxamol through normal prescribing may continue until the end of 2007. We have confirmed with manufacturers that the manufacture of co-proxamol will continue after that date. The main manufacturer has informed us that it is its firm intention to continue to manufacture co-proxamol following the cancellation of the licences, so supplies will be assured.
There will be scope, as always, for the prescription of unlicensed co-proxamol. Clear provision in legislation gives the right to prescribers to prescribe off-label or unlicensed medicines if it is judged to be in the best interests of the patient. If there is clear clinical need, it will still be possible to prescribe co-proxamol, but in a more targeted way with a stronger focus on the risk-benefit judgment for the patient—and the patient will be involved in the decision.
That, I think, is the best way forward. My worry about going down the route suggested by my hon. Friends, which was considered by the CSM in its review, is that it might lead to a regression, prescribing the drug when it might not be necessary rather than prescribing it only for the small minority for whom co-proxamol seems to be the only answer. There is flexibility in the system for it to continue to be prescribed.
It being Five o'clock, the motion for the Adjournment of the sitting lapsed, without Question put.
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