Sunday, December 20, 2009

Letter to the Department of Health

Thursday 26 November 2009

RT. Hon. Mike O’Brien MP

Minister for Health Services

Department of Health

All Party Parliamentary Group on Involuntary Tranquilliser Addiction

Dear Mike,

I have received a letter from you dated 30 October 2009 in response to my letter to Gillian Merron on the subject of Involuntary Tranquilliser Addiction. Unfortunately your reply does not answer the content of my letter. The reply is a summary of a Department of Health policy position and is a standard information letter which has been sent out for several years in response to enquiries and complaints from MPs and members of the public on this subject. The correspondence clerk seems to be unaware that the policy changed some months ago. The DoH has accepted that change is necessary on this subject and is conducting a review of policy on addiction to prescription drugs. The review was announced by Gillian Merron in response to PQ264896 and was explained and debated in Westminster Hall on 16 June 2009 and in the House of Lords on 3 November 2009.

Your correspondence clerk also provided me with benzodiazepine prescription totals for the years up to 2005, with a comment for me to note that benzodiazepine prescription numbers had fallen, if 1995 is taken as a base year. However these are not the latest figures. On 18 May 2009 in answer to Parliamentary Question 274692 Dawn Primarolo MP provided a benzodiazepine prescription total of 11,439,000 for 2008 which is an increase on 2005 (11,252,113) and shows a recent upward trend. Also, I have written as chair of the All Party Parliamentary Group on Involuntary Tranquilliser Addiction which means all prescribed tranquillisers and so the relevant figure should be the total benzodiazepine prescriptions plus the number of Z tranquilliser prescriptions. In the same answer to PQ 274692 Dawn Primarolo gave the Z drug prescription total for 2008 as 5,665,000. This gives a grand total of 17,104,000 tranquilliser prescriptions for 2008, the highest total figure since 1992.

An article in the Independent newspaper of 31 October 2009 entitled “Action on Britain’s pill addiction” reports a DoH spokesperson making a similar claim, that prescribing of benzodiazepines had declined substantially in the last ten years. The spokesperson is also reported by the Independent to have referred to the “misuse” of prescription medication, thereby characterising involuntary tranquilliser addicts as drug misusers, with an inference that they are responsible for their own addiction. The overwhelming majority of tranquilliser addicts are involuntary addicts and not drug misusers at all. They have been introduced to these highly addictive drugs by trusted GPs and psychiatrists with no proper warning of the dangers involved. Patients are led to believe that the drugs are a medicine, they have no opportunity to make an informed choice and become addicted through no fault of their own. Therefore use of the term misuse is regarded by involuntary tranquilliser addicts as an insult and a stigmatization.

This issue has arisen before, in 2007 the same terminology was used by Rosie Winterton MP whilst Health Minister in correspondence with campaigner Barry Haslam of Oldham. In response to a complaint by Michael Meacher MP Rosie Winterton apologised, in a letter dated 17 March 2007.

The use of this word is significant and is connected to the old policy on addiction to prescription drugs. Applying the term drug misusers to involuntary tranquilliser addicts includes them within a particular psychological model in which drug misuse is seen as a chronic relapsing condition. Misusers are considered resistant to treatment and in need of an indefinite maintenance dose.

However, addiction to tranquillisers is not caused by flaws or weaknesses in the people addicted, it is caused by negligent prescribing and by the extreme addictiveness of the drugs. Organisations such as the Council for Involuntary Tranquilliser Addiction (CITA), Battle Against Tranquillisers (BAT), the Oldham Tranquilliser project and the benzodiazepine cessation project in Belfast demonstrate continuously that the misuser label is wrong. These specialized tranquilliser withdrawal services have consistently withdrawn tranquilliser addicts safely and successfully for many years.

The withdrawal methods used by all these organisations are based on the slow tapering method developed by Professor Heather Ashton in her benzodiazepine withdrawal clinic at Newcastle University in the 1980s. The withdrawal is based upon scientific understanding of the pharmacokinetic properties of each drug and recognition of their high potential to cause addiction. Each patient is provided with proper information on their drug or drugs. Withdrawal may take from six months to two years. An individualized and flexible withdrawal schedule is designed for each patient and the patient is given regular face to face support and reassurance.

Addiction to prescription drugs is a serious illness and has become a worldwide medical problem. Professor Ashton’s tapering method has been adapted for withdrawal from other addictive prescribed drugs such as SSRI anti depressants. It is used worldwide and her withdrawal manual has been translated into several languages. It is a valid and important medical treatment which originated right here in the U.K. yet it has been repeatedly overlooked by the Department of Health.

In my opinion this method should be adopted by the Department of Health as best practice. This treatment should be provided in special clinics throughout the National Health Service using the existing clinics and their staff as a foundation. I welcome the current review by the Department of Health on their policy on addiction to prescription drugs as an opportunity to introduce this treatment.

Unfortunately there are groups which oppose the introduction of tranquilliser clinics. The enquiry and report by Brian Iddon MP and the All Party Parliamentary Drug Misuse Group was useful in that it helped to bring this issue to the attention of the Department of Health. However the reports section on tranquillisers is misleading and the recommendations do not include a network of withdrawal clinics. Consequently it was necessary for the APPGITA, of which I am chair, to produce an alternative report. This APPG was set up specifically to deal with the tranquilliser problem. We have access to a great deal of experience and expertise from clinics, campaigners, ex-addicts and Professor Ashton. Brian Iddon’s group have no such experience, qualification or knowledge on this subject. Their report dilutes the evidence of the enquiry witnesses, under reports the tranquilliser problem and makes inadequate recommendations.

The purpose of this letter is to try and clarify some of the complex issues around tranquilliser addiction, to urge ministers to take heed of the advice made available by the APPGITA and to ask them to use the current review as the opportunity to introduce specialized tranquilliser withdrawal clinics as a successful, cost effective treatment for addiction to a prescription drug. As chair of the APPG I would value a discussion on the content of this letter in order to arrive at a clear and transparent view on the real problems faced by victims of this iatrogenic illness.

I have enclosed a copy of the APPGITA alternative report. This letter is for the personal attention of the Minister.

Kind regards

Jim Dobbin MP

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