A draft NICE guideline on 'Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults' says healthcare professionals should discuss with patients the risks associated with addictive medications.
Around 11.5m adults in the UK received a prescription for a medicine 'associated with dependence or withdrawal symptoms' over the course of 2017 and 2018, including antidepressants, benzodiazepines, and Z-drugs such as zopiclone, opioids, gabapentin and pregabalin. Prescribing of these medications varies nationally, but is highest in the north east of England and lowest in London.
The draft guideline comes after a review published last month called for an overhaul of repeat prescribing and structured medication reviews amid evidence that one in 10 prescriptions issued in primary care were unnecessary.
Addictive medication
The guideline says patients who are taking addictive medications should be offered support from healthcare professionals to reduce their doses or to come off them, warning that many will find the process difficult and that it could take 'several months or more'.
NICE says that 'people who are taking, or considering coming off, dependence forming drugs should have regular review meetings by phone, video or face to face with their doctor, nurse or pharmacist to consider their options'.
Healthcare professionals are urged to make clear to patients that they will be available to support them throughout the withdrawal period and that discussions about the process should be informed by a separate NICE guideline on shared decision-making.
GPs reviewing addictive medications with patients should check whether the condition for which the medication was prescribed has resolved, whether it still benefits the patient, consider the balance of harms and benefits, the patient's view on stopping it and whether 'problems linked with dependency' have developed.
GP workload
NICE said it had been told by NHS England that it was 'working with the government to consider how the role of pharmacists can be increased to help relieve the potential extra workload on GPs'.
The guidance warns that complete withdrawal may not be achievable initially and that dose reduction may be a better first step, and warns against stopping medicines abruptly 'unless there are exceptional medical circumstances'.
Experts behind the guidance have also offered advice for prescribers who find that patients do not wish to stop taking a medication even though continuing is 'not in their best interests'.
Dr Paul Chrisp, director of the centre for guidelines at NICE, said: 'Many people continue to be prescribed these dependence forming medicines despite evidence that the risks associated with adverse advents of taking them outweigh their benefits. People are being harmed and we cannot ignore it.
'Although these medicines can provide lasting symptom management for a proportion of people taking them, they do not work for everyone.
'Having the right strategy for withdrawing safely from these medicines is key and that is why these evidence-based guideline recommendations are required to support healthcare professionals and patients.'
A consultation on the draft advice will be open until Thursday 2 December 2021.
