Drugs: new psychoactive substances and prescription drugs - Home Affairs Committee Contents

3  Prescription drugs

22.  As part of our previous inquiry in to drugs policy, we also took evidence on the work being carried out to counter addiction to prescription drugs. A survey carried out jointly by The Guardian and Mixmag in 2011 indicated signs of an emerging 'grey market' in legally prescribed painkillers and antidepressants, often acquired from friends or dealers, or through the internet. A third of the 7,700 people from the UK who took part in the survey took prescription sleeping pills—22.4% had taken benzodiazepines such as diazepam or temazepam in the last year and 7.2% had taken the newer drugs zopiclone and zolpidem. The Global Drug Survey found that a quarter of responders had taken prescription opioid painkillers and 9% had taken other painkillers. More than three-quarters said they took them for pain relief, 24% said they took them to get to sleep and 18% said they took them for mood-changing purposes. A survey by the Family Doctor Association in 2011 had found that over half of GPs surveyed were worried about prescription drug abuse in their area. Eighty percent of the 197 GPs who responded to the survey said they were aware of prescribing to people who they thought were addicted. Half were aware of occasions when prescriptions had been sold on.[29] The 2011 Street Drug Trends survey provided further evidence of this trend with increases in the use of diazepam, Tramadol and phenazepam, in 16 of the 20 areas investigated.[30]

23.  In our 2012 report we noted that support and treatment for people who develop problems in relation to prescription-only or over-the-counter medicines would be provided by GPs, many of whom do not report to the National Drug Treatment Monitoring Service (NDTMS) and so it would be difficult to obtain a clear picture of the scale of addiction to prescription medicines.[31] This is supported from evidence from the British Medical Association which has recently started a project examining the role of medical professional in relation to addiction to prescription drugs. The project will

collate evidence on the scale of the problem, raise awareness of the harm caused by involuntary dependence to prescription medication, promote best prescribing practices, and identify policy changes necessary to improve the identification and management of patients affected by this issue.[32]

24.  When we questioned the Minister on the misuse of prescription drugs he identified two issues. The first was whether addiction was a consequence of legalised prescription of drugs (which the Department of Health was looking at). The second was whether or not prescription drugs were being misused and if so, how they were being obtained, which was an inquiry which the ACMD would be carrying out shortly.[33]

25.  It is concerning that a year on from the publication of our previous report, which highlighted the lack of knowledge on this subject, there have been no improvements in the understanding or the collection of data around the issue of dependence on prescription drugs. We welcome the announcements that the British Medical Association and the Advisory Council on the Misuse of Drugs will shortly carry out work examining dependence on prescription drugs. The geographical spread and the scale of the problem must be definitively established. We recommend that the Royal College of General Practitioners produce guidance for GPs who are treating addiction to prescription drugs stating that all cases ought to be recorded on the National Drug Treatment Monitoring System in order to further clarify the prevalence of prescription drug misuse.


26.  The ACMD has reviewed and recommended controlling four prescription drugs this year: the opioid painkiller Tramadol in February 2013; lisdexamfetamine (Vyvanse), used in the treatment of attention deficit hyperactivity disorder, in September 2013: and the sleeping pills Zaleplon and Zopiclone in September 2013. In examining Tramadol, the ACMD found that NDTMS data indicated that 200 individuals with and addiction to Tramadol had been reported since 2004. However, according the Office of National Statistics, in that time 887 people had died with Tramadol mentioned on the death certificate (although this may occasionally be in conjunction with other substances). The Government launched a public consultation on whether Tramadol ought to be controlled under the Misuse of Drugs Act 1971 in July 2013.

2004 20052006 20072008 20092010 20112012 Total
Tramadol43 5381 7983 87132 154175 887
All benzodiazepines 233190 177207 230261 307293 2842182
Diazepam 94 10189 123133 160 186 179207 1272

Deaths by Drug Poisoning 2008 & 2012, Office of National Statistics

27.  Despite a decrease of benzodiazepine prescriptions since the late 1980s, deaths related to the drugs have continued to increase since 2004. Deaths relating to a particular benzodiazepine, diazepam (Valium), doubled in the same period which, taken in conjunction with the findings of the 2011 Street Drug Trends survey, indicate an increase in its misuse. Chief Constable Bliss informed us that recently police forces around England and Wales were asked to report on the prevalence of prescription drug misuse and the involvement of organised crime in relation to supply. The collated information showed that diazepam misuse was particularly prevalent although there was little indication of organised crime group involvement in anywhere other than Northern Ireland.[34] He also informed us that when flights were grounded following the eruption of Eyjafjallajkull in 2010 and the importation of khat leaves was interrupted, there was anecdotal evidence that khat users temporarily diverted to using diazepam although there was no indication of how it was obtained.[35] Diazepam is already controlled as a Class C drug under the Misuse of Drugs Act 1971. However, both diazepam and Tramadol are easily available from online pharmacies.


28.  Chief Constable Bliss also provided us with an update on activity from the Metropolitan Police's Drugs Directorate which set out recent investigations in to the diversion of prescription drugs.

In the past 18 months in the MPS we have had several investigations involving healthcare professionals where they have sold either prescription medicine or controlled drugs under the counter to patients. Most recently we have been investigating 17 people in the London area linked to the BBC undercover investigation of pharmacies. Here we had 7 pharmacies selling medication without prescriptions. We unfortunately we were only able to prosecute 3 due to CPS advice. We also have arrested nurses and doctors who have been prescribing for themselves or family members. The most common incident for us in the MPS, Suffolk and Dorset is the prescribing of prescription medication to be sent abroad. On one occasion a registered doctor asked for out of date stock to be left outside people's houses for him to collect (like a charity bag) this was then being sent abroad to be sold. Our biggest concern is the over prescribing of medication by doctors which may be diverted by their patients. However, due to the guidelines and advice of the GMC prescribing by doctors to their patients is a grey area.[36]

However, Chief Constable Bliss noted that given the lack of involvement of organised crime groups, the misuse of prescription drugs were unlikely to be a priority for Policing and Crime Commissioners.[37]

29.  We welcome the work of the All Party Parliamentary Group for Involuntary Tranquilliser Addiction and are deeply concerned by their estimate that there are currently 1.5 million people addicted to these type of drugs, a number which is far higher than those who are in treatment for addiction to controlled drugs. However, we recognise the lack of specific data on the misuse and supply of prescription drugs for non-medicinal purposes. We acknowledge the difficulties in collating this type of information due to the sensitivity of medical data, but immediate steps need to be taken to introduce a system whereby anonymous data can be collated to fully understand where the problem lies. When we visited America, as part of our previous inquiry into drugs, we were very worried that significantly more doctors and healthcare practitioners were able to be prosecuted for the illegal supply of prescription drugs there than in the UK. We are concerned that, despite the differences in medical care structures between the two countries, healthcare professionals in the UK are able to supply prescription drugs illegally without fear of prosecution. We recommend that medical practices start an anonymous data collection of those patients who have been proven to be, or a medical professional has reasonable suspicion of being, addicted to prescription drugs and how they are being supplied. This is a first step in the collation of this type of data and we will be writing to medical professionals, such as the BMA, to understand how this best can be implemented and further used.

30.  The British Medical Association noted that there were a number of unofficial practices in place to stop patients from 'doctor-shopping' a phenomenon which is one of the causes for such a high rates of dependency on prescription drugs in the US. These included GPs being unlikely to prescribe drugs associated with addiction to a temporary patient or a new patient whose notes had not been received from their previous practice. Under the previous health service structure, Primary Care Trusts would alert all practices in the local area if there was an individual visiting multiple practices to request specific drugs. The British Medical Association told us that although there was not a formal mechanism for this to continue, they would expect local area health teams to carry out this function in the new health service structure.[38] We conclude that this practice must be formalised in order for it to continue with the structural changes in healthcare in UK. We recommend NHS England should issue guidance to local Clinical Commissioning Groups (CCGs), which will lead to them taking central responsibility for the collation of data on patients visiting multiple practices to request specific drugs. The administrative part of the CCG should be strengthened in order for them to facilitate sharing this information with all practices and thus informing all healthcare professionals in the area.

31.  The Royal College of General Practitioners and the Royal College of Psychologists produced an 'Addiction to Medicines Consensus Statement' in January 2013 which set out a number of actions needed to tackle addiction to prescription drugs and the expected behaviour of medical professionals who prescribe potentially addictive drugs.[39]

32.  There are fewer deaths and criminal acts associated with prescription medicine or new psychoactive substances than with drugs such as heroin or cocaine. There also appears to be a lack of involvement of organised crime groups in the diversion of prescription drugs or the supply of new psychoactive substances. However, we remain concerned that it is an area which is not being tackled. We recommend that the medical Royal Colleges establish a joint working group to assess the effectiveness of their consensus statement and examine whether local area health teams are effectively communicating concerns around individuals visiting multiple practices to request specific drugs following the introduction of the new health service structure. This working group should also be responsible for starting the collection and collation of data by local healthcare practices. Due to the urgency of this issue we will revisit this topic in 6 months time.

29   http://www.theguardian.com/society/2012/mar/15/recreational-drug-users-medicines-survey Back

30   http://www.drugscope.org.uk/Resources/Drugscope/Documents/PDF/Publications/KZone.pdf Back

31   Home Affairs Committee, Ninth Report of Session 2012-13, Drugs: Breaking the Cycle, HC 184-I, Para 120 Back

32   Ev 36 Back

33   Q226 Back

34   Q1-2 Back

35   Q36 & 43 Back

36   Ev 35 Back

37   Q2 Back

38   Ev 36 Back

39   http://www.rcgp.org.uk/news/2013/january/~/media/Files/News/RCGP-Addiction-to-Medicine-consensus-statement.ashx Back

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Prepared 20 December 2013