Home affairsWritten evidence submitted by the British Medical Association [DFU 04]

Thank you for your letter dated 25 November 2013 regarding the follow up to your report, Drugs: Breaking the Cycle. I reply outlining our thoughts on the issues that you highlight in your letter.

The BMA’s Board of Science published a report Drugs of dependence: the role of medical professionals in January 2013. Whilst the main focus of this report is on illicit drugs, it highlights that the use of various novel psychoactive substances is becoming increasingly prevalent in night-life setting and amongst specific populations such as the lesbian, gay, bisexual and transgender (LGBT) community.

Our report found that whilst there is only limited information on the use of psychoactive substances in the general population, they appear to be used more by younger age groups, and are increasingly being sought as an alternative to illicit substances such as ecstasy. In light of the rate at which these new substances are coming onto the market, it is not yet clear whether they will be more or less harmful than the psychoactive substances already commonly used. It is our view that the focus of the policy response to these new substances should be on understanding the risks associated with their use, as well as educating against risk behaviour.

The Board of Science is in the initial stages of a project considering the role of medical professionals with regards addiction to prescribed medications. We are planning to work collaboratively with a range of stakeholders to 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. We are also exploring an e-learning module on the subject with the aim of improving doctor’s knowledge and understanding in this area. I would hope that the areas you highlighted in the letter in relation to NHS systems will be reflected in this planned work.

Your letter also asked whether information collection systems in the NHS are sufficient to monitor “doctor shopping”. Anecdotal evidence from our members suggests that most GP practices would be wary of prescribing drugs of addiction to anyone who is a temporary patient without first checking with their normal registered practice if possible. This would also be the case for a newly registered patient if the notes were not available. For a small number of patients, the Primary Care Trust (PCT) used to alert all practices that there was an individual going into a number of different practices asking for particular drugs. Whilst there is not a formal mechanism for doing this, individual practices raise concerns about this. We would expect local area teams to continue to do this in the new health service structure.

Regarding the monitoring of over-prescription of potentially addictive drugs, I should highlight that all prescribing activity is collected centrally and is closely monitored by Clinical Commissioning Group (CCG) prescribing advisors. This process should highlight any unusual variance in controlled drug prescription and may trigger a review.

Whilst I am not aware of any figures held about individual GPs treating patients w1th addictions, a large numbers of GPs are involved in shared care drug treatment schemes and the numbers of patients seen in these schemes will be collected by the CCGs. Unfortunately, I do not know of how these data are used and analysed. You may also find it useful to seek views from the Royal College of General Practitioners on this.

I hope this information is of use to you in your follow up inquiry.

Professor Sheila the Baroness Hollins
Chair, BMA Board of Science

December 2013

Prepared 19th December 2013