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16 Jun 2009 : Column 33WH—continued
11.30 am
Paul Flynn (Newport, West) (Lab): I congratulate my hon. Friend the Member for Bolton, South-East (Dr. Iddon) on his years of service on the all-party group on drug misuse. He will be sadly missed when he leaves. He has brought to that group a scientific rigour from his professional background that has been a continual challenge to the evidence-free policies on drugs, including medicinal drugs, by a succession of Governments.
I had a striking contribution yesterday from someone whom we will call “John” who illustrated vividly how society has been conditioned to believe that there is a pill for every ill. His 11-year-old daughter was asked in school to make a list of 10 medicines that she had taken, or that she knew about. Coming from a family who do not use medicines for ordinary complaints—they allow the ordinary diseases of life to take their course—she could only manage to write down one medicine while the rest of the class had no difficulty in writing down 10 that they had taken themselves. The school was so alarmed by that that it contacted my correspondent and asked him whether he belonged to a particular religious sect and whether he wanted his daughter withdrawn from the class because he might have objections to drugs. A parent who takes a purely rational approach to drugs, to the great health of their children, is treated as someone who is so exceptional that they have to be asked whether their children should be taken out of the class.
However, such drug taking is not a new phenomenon. If any of us had gone to see Dr. Freud in Vienna, he would have prescribed for us the drug that he took himself. He gave it to all of his family and every one of his patients in the belief that it was greatly beneficial and harmless. That drug was cocaine. A generation later, the drug of use for what we would now call depression or mild exam sickness was bromide, which created its own psychosis.
Going on from that, in the ’50s and ’60s, we had the dibenzodiazepines. Following that came the tricyclics and then the selective serotonin reuptake inhibitors, or SSRIs. When those drugs were introduced, they were all said to be beneficial, which they rarely were, and it was said that they would not create dependency, which they did. In fact, they all did a great amount of harm, so it is not something that is just happening now. None the
less, the examples quoted are striking and important. The pharmaceutical industry has done a great deal of good. In many ways, it has produced miracles of science. On BBC 2 tomorrow night at 9 o’clock there is a programme called “The Price of Life”, which I recommend everyone to watch. It looks at the way in which medicinal substances are marketed, created and sold. Behind the many good things that are done is a greedy, self-absorbed market that puts its profits as its highest goal.
We must look at the way in which lives have been damaged by our belief that for every moment of boredom, distress, grief, pain or discomfort, there is an answer in a pill; it is not true. I should like to talk at great length about the problems of pain. Pain is a construct, and the least successful way of dealing with it is to take a pill. There are much more sophisticated ways in which to deal with pain. I constantly say that if Beethoven had been on painkillers or Michelangelo had been on antidepressants, we would never have heard of them. Such pills are the antidote to the creative process. There are other ways in life in which we can deal with the affliction of pain. Often, the least successful and most dangerous way to do it is through using drugs that are vastly overused to the detriment of the happiness and health of millions of people.
I commend the all-party report. I had the great privilege of being invited to chair one of the group’s evidence sessions. I learned a great deal from it. I saw how people had had their lives deeply affected by the overuse and misuse of medicinal drugs. On the evidence of this report, I hope that my hon. Friend will hear that there will be a meeting with Ministers and that there can be a major advance in the way in which we dispense drugs.
11.35 am
Greg Mulholland (Leeds, North-West) (LD): It is a pleasure to serve under your chairmanship, Mr. Taylor. Like previous speakers, I pay tribute to the hon. Member for Bolton, South-East (Dr. Iddon) and thank him for providing leadership on this issue. Moreover, I echo the comments made by the hon. Member for Blaenau Gwent (Mr. Davies) when he said that this debate shows how powerful all-party parliamentary groups can be when they do their job and provide leadership on an issue. In this case, the issue was not getting sufficient public attention or leadership. I should like the hon. Member for Bolton, South-East to pass on our thanks to the whole group.
Rightly, successive Governments have spent a lot of time, energy and money dealing with the problems associated with illegal drugs. I am sure that we all support that effort. There have been different ways of approaching the problem, but the thrust has always been to deal with the social and personal impact of illegal drugs. None the less, we must start by saying that such an approach has led to the more difficult problems associated with perfectly legal drugs—prescription-only drugs and over-the-counter medicines—not receiving the attention that has so rightly been brought into focus. However, we must strike a balance between dealing with the problems associated with those drugs and allowing people to continue to benefit from their appropriate use. The all-party report provides some practical suggestions on how the issue can be taken forward.
I also want to draw attention to the all-party parliamentary group on involuntary tranquilliser addiction, of which I am a member. It focuses on a specific part of the problem. Today, the hon. Members for Blaenau Gwent and for Newport, West (Paul Flynn) described very powerfully their personal involvement in the issue. Although I have had no personal involvement in such matters, I have had to deal with a number of constituent cases, including that of Simon Kaberry, whose father, Sir Donald Kaberry, was MP for the constituency of Leeds North-West for 33 years. Whether or not I can match that length of service, we will have to see, but it has been a pleasure to work with Simon and to hear about his problems. His prescription of daytime tranquillisers, in place of sleeping pills back in the early 1990s, has ruined his life. He was defrauded of a significant amount of money, and was granted legal aid to sue those who were responsible for his negligent prescriptions. That case is still going on. That is a high-profile and extreme case, but, as we have heard, the cases of addiction are all too common. We do not know exactly how many people are addicted to prescription-only medicines let alone those who are addicted to over-the-counter medicines. Could more work be done to establish that figure? Difficult though that would be, it is important to understand the scale of the problem.
There are guidelines on prescription-only tranquillisers, including of benzodiazepines, which have already been mentioned, but are they working? We know that such tranquillisers are widely abused drugs. Wasted medication, over-prescription and mis-prescribing, as in the case of Mr. Kaberry, are potential explanations for the availability of drugs. It has been estimated that prescribing medication that is wasted costs £100 million a year, which must be a concern. Where have the substances that we are talking about today gone, and into whose hands have they been put?
As the hon. Member for Bolton, South-East said, an estimated 1.5 million people are addicted to benzodiazepine drugs and 2 million people were addicted to a broader group of drugs. He also said that some drug users are using prescription tranquillisers as part of a regular drug routine. However, other people are stuck in a cycle, having been properly prescribed drugs—at least they believe that they have been properly prescribed them. Again, people access the drugs for different reasons, which is another factor that makes the situation difficult to deal with.
The Royal Pharmaceutical Society of Great Britain has expressed concerns that there is currently no referral system specifically for misusers of prescription-only and over-the-counter medicines, yet pharmacists have an important job in signposting people to other health professionals and organisations as appropriate. Will the Minister consider action that would assist and educate pharmacists in that regard? Does he have any plans to regulate pharmacy technicians through legislation? That could also have a part to play. What training is given to pharmacists to provide them with more information on dealing with abuse of prescription-only and over-the-counter medicines, including information on identifying the signs, as we have heard that pharmacists play an important role in that area?
Another problem is that drugs are widely available in supermarkets. That will clearly be more difficult to target, but could the kind of restrictions that registered pharmacists rightly operate be at least put in place for supermarkets to ensure that people do not have easy access to inappropriate quantities of drugs that are likely to be indicators of abuse?
As with so many areas of public policy, the internet presents a difficult challenge. One problem is that by trading on the internet or in supermarkets, we lose the link that has traditionally existed between the community and the pharmacy. Pharmacy staff might have a good and close relationship with other organisations, including the doctors who prescribe the medicines and, when necessary, the local police, but supermarkets and the internet do not. It is much more difficult to monitor the patterns of purchase that suggest misuse in supermarkets and on the internet than in pharmacies.
No one is suggesting that we can turn the clock back and that drugs should not be available on the internet, but we need to review access to over-the-counter medicines on the internet. Does the Minister see any way of applying the control of entry requirements for pharmacies to online mail-order pharmacies? I do not know the answer to that question, and I suspect the Minister does not, but it might be worth considering the matter. The Royal Pharmaceutical Society has suggested that its logo could be used to identify bona fide pharmacies, whether they are existing chemists, as we call them, or supermarkets or online facilities. That could help. If the Minister thought that that was appropriate, there would need to be guidelines and a system for monitoring the logo and, especially, a system for clamping down on anyone who used the logo fraudulently. That would have to be traceable.
The debate on such drugs should now change. The practical solutions that the all-party group on drugs misuse have suggested could and should be looked at as a framework. The Government should consider the solutions—they do not have to accept all of them—and introduce measures to tackle this difficult issue. It would also make sense to look at labelling and further education so that people can become more aware of the dangers. As has been shown, many are not aware of those dangers. As the hon. Member for Newport, West said, there must be more education within and outside the medical profession about other treatments and therapies, particularly for pain. I am glad that the Government have been moving in that direction. Bringing the subject under discussion into that debate could be extremely helpful.
Bob Spink: Would there be a risk of increasing abuse if the labelling was made more explicit to increase awareness? I genuinely do not know the answer to that question.
Greg Mulholland: As with many questions on this matter, we do not know the answer—it is important to say that—but we clearly agree that the solutions must be research based. On labelling, we must be mindful of the danger that the hon. Gentleman described, but we could deal with that problem by talking about the dangers in an appropriate way.
This is an important debate. I thank the hon. Member for Bolton, South-East for introducing it and the all-party group for its report. I would like to think that we will
come back, perhaps in a year, to see how much of the report the Government have taken up. I hope that the matter will be taken very seriously by the Minister and that we see progress on this difficult but very important issue.
11.49 am
Mark Simmonds (Boston and Skegness) (Con): I am pleased to be under your guidance again this morning, Mr. Taylor.
I join other hon. Members in congratulating the hon. Member for Bolton, South-East (Dr. Iddon) on the comprehensive and detailed way in which he set out the contents of his report this morning and on the enormous amount of work that he and his colleagues have done to collate all the evidence that they took in an easily understandable way. His introduction clearly highlighted some of the key issues. He described the scale of the problem, even though further research is needed to get a more accurate handle on the numbers. He also mentioned substance displacement, as well as an issue referred to by the hon. Member for Leeds, North-West (Greg Mulholland)—internet regulation and the complex problem of regulating online pharmacies—and called for greater acknowledgement that further research is required on a range of issues.
The hon. Member for Blaenau Gwent (Mr. Davies) made an interesting contribution that highlighted his own and his family’s personal experience of the problem. He was right to raise the issue of mental health, to which I will return, and pointed out rightly that drug misuse can affect people of all ages, although one interesting fact in the report is that the majority of misusers are female. I could not find any detailed analysis of why that is, so perhaps the solutions need to address the core of the problem. The issue certainly requires further investigation and research.
Bob Spink: Some research highlights the fact that analgesics in particular are advertised in women’s magazines and programmes that women watch, whereas they are never advertised in men’s magazines. That is suggested as one reason why abusers are predominantly women.
Mark Simmonds: I am grateful for that intervention. I am sure that that is a contributory factor. It is in stark contrast to the recent report demonstrating that men are much more likely than women to die of cancer. There are interesting divergences across many of the illnesses and problems from which people in the UK suffer.
The hon. Member for Blaenau Gwent made a good point about supportive services in his constituency. I can assure him—not that it is any consolation—that in my constituency in rural Lincolnshire, we have exactly the same problem with funding streams coming to an end, normally after three years, and councils being squeezed for money to spend. There are issues across Wales and England with regard to support services.
It is clear that misuse has an impact not only on the lives of those who suffer but on the lives of their carers or wider family and community supporters. I suspect that that impact will be exacerbated by the current recession. The hon. Member for Newport, West (Paul Flynn) was right to point out that the problem is not a new one but has a long history, and to point out the
impact of pain and pain relief. I am sure that he would be the first to acknowledge that one of the main factors that seems to lead to misuse is a lack of pain management, as the report highlighted. There are clearly two sides to the issue.
There has been a great deal of debate, research and Government policy thinking on the misuse of illegal substances, but the report rightly highlights that to date, there has been no significant focus on the misuse of legal substances. Clearly both the current and—hopefully—the future Government will need to consider it more closely. There is evidence to suggest that prescription drugs are often used in conjunction with illegal substances. The two are not mutually exclusive, which makes research even more complex than it might seem at first. It might increase the effectiveness of the overall war against drugs if the misuse of some prescription and over-the-counter medicines were considered alongside the misuse of illegal drugs and, indeed, the combination not just of illegal and legal drugs, but of legal drugs and alcohol, which is another legal drug.
It is a challenging topic, and the report went into exactly the right amount of detail, highlighting analysis of the problems while including the personal experiences of some of the people to whom the all-party group talked. Some people might dismiss the problem as superficial, but it is clearly not. It is serious when it leads to loss of life and suicide, which are mentioned in the report.
Dr. Iddon: The hon. Gentleman might have seen in the pack kindly provided to us by the Library that in 2005 some 8,500 deaths resulted from the use of OxyContin, as we call it in this country, in the United States alone. That number exceeds the combined number of deaths from cocaine and heroin use that year in the United States. That is how serious the problem is becoming across the pond, and it is drifting across to this country as well.
Mark Simmonds: I am grateful for that intervention. The hon. Gentleman is absolutely right to highlight that; I did see that figure. One suggestion made in the report deserves further consideration: many coroners are saying that when suicides occur, any prescription drug that the individual was taking should be noted and investigated further.
[Mr. David Wilshire in the Chair]
In many cases of addiction to prescription medicines, the GP is aware of the situation. As the hon. Member for Bolton, South-East said in response to my intervention, GPs know their patients best, but GPs often do not feel suitably qualified to assist patients in reducing their dependence. More must be done to make GPs aware of the possibility of addiction and help them to deal with patient dependence. Part of that could involve ensuring that GPs are aware of the British national guidelines on the optimum length of prescriptions for medicines. They must also be suitably trained to prescribe alternative treatments, such as talking therapies—I will have some questions about that for the Minister in a moment—without being hindered by excessive waiting times or limited access, as currently happens too often.
Paul Flynn: I am sorry to interrupt the hon. Gentleman’s interesting speech, but I am greatly encouraged by the idea that he might have a leading role in a future Government. We know that all parties act against illegal drugs, because no one who has a vested interest in defending them can do so publicly, but if a future Government were to campaign to reduce the use and abuse of legal medicines, they would meet ferocious opposition from the pharmaceutical industry, which would denounce the Government for keeping medicines away from the public. If his party were in government, would it be courageous enough to take on the pharmaceutical companies?
Mark Simmonds: I do not see that as the issue. The issue is ensuring that over-the-counter and prescription medicines are used responsibly. Most patients in this country use access to medicines responsibly to better their lives, but we are discussing misuse. Any responsible Government should focus on misuse, which is not necessarily the same thing as attacking the pharmaceutical industry, as the hon. Gentleman suggests. The pharmaceutical industry plays a significant role in alleviating the pain and suffering of many people in this country. It is misuse that we need to focus on, not the market as a whole.
One way to do so—I know that the Government have started to think about it, and we are certainly keen to find ways to facilitate it—is to ensure that GPs and pharmacists work together more closely for the betterment of patients in their respective communities. In the Prime Minister’s constituency in Scotland, I went to a GP’s surgery with an embedded pharmacist. She holds her own surgeries, where people come to discuss what prescription medicines they are on and GPs come to her for advice. That is something that we need to consider. Some primary care trusts are reducing the number of prescriptions for medicines that could be classed as addictive. I would certainly like to see examples of best practice replicated more widely across the country. As hon. Members have said, it is difficult to get a handle on the number of people who are affected by misuse, particularly as many become dependent on painkillers after inadequate pain management strategies for existing conditions. That deserves greater focus.
Pharmacists could play a greater role in treating minor ailments and illnesses so that GPs’ time is freed up to deal with more serious cases. We support an increase in the use of medicines use reviews, which can be early indicators of unhealthy or over-extensive patterns of prescription medicine use. They also provide a good opportunity for pharmacists to discuss a patient’s use of over-the-counter medicines. As the report stated, the issue of unsupervised repeat prescriptions should be considered. Pharmacists could play a greater role in disseminating to patients information about public health, the dangers of taking too many over-the-counter or prescription drugs that might have an addictive quality, and access to local drug and alcohol teams and talking therapies.
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