The NHS plans to avoid a US-style opioid crisis by encouraging GPs to offer alternatives to antidepressants and painkillers
“We know that patients who require prescriptions for potentially addictive drugs can become dependent and struggle with withdrawal, and this new action plan helps NHS services to continue positive work in this space having already slashed opioid prescriptions by almost half a million over the past four years.” Professor Sir Stephen Powis, national medical director for NHS England
Millions of patients are to be offered help to come off antidepressants and painkillers.
Under new NHS England guidance, GPs are being urged to stop writing repeat prescriptions for patients who have become dependent on certain medication. The aim is avoid an opioid addiction crisis similar to that in the US.
The plan states that GPs will be expected to use social prescribing, sending patients to art, music or gardening classes, for example, rather than prescribing strong painkillers or antidepressants. The NHS will also create support groups and clinics to help people to come off prescription drugs and manage withdrawal symptoms such as insomnia.
New figures show that 8.4m adults in England were prescribed antidepressants in the past 12 months, an increase of 8% since 2019. Approximately 65% of people using them have been taking them for more than a year. According to a report in the Times, 23% of women and 12% of men are taking antidepressants.
The guidance states that “alternative treatments and services such as self-management approaches (social prescribing, health coaching, peer support, patient education), psychosocial interventions (psychotherapy), musculoskeletal clinics, mental health services (such as NHS Talking Therapies for Anxiety and Depression), pain clinics and sleep services can benefit patients and ensure a person-centred approach to care.”
A review of research last month found that exercise was more effective than antidepressants in managing depression.
Professor Sir Stephen Powis, national medical director for NHS England, said: “We know that patients who require prescriptions for potentially addictive drugs can become dependent and struggle with withdrawal, and this new action plan helps NHS services to continue positive work in this space having already slashed opioid prescriptions by almost half a million over the past four years.”
As well as asking GPs to be more cautious about prescribing antidepressants and painkillers initially, the NHS is urging GPs to carry out regular medication reviews to decide whether to “move patients away from potentially addictive prescribed drugs. “ Patients on antidepressants should be contacted every six months to see if they are ready to reduce their dosage, the guidance says.
The NHS also wants pharmacists to play a greater role, for example by spotting people who frequently buy codeine over the counter.
The new framework comes in response to a government review in 2019, which highlighted an increasing dependence on prescription drugs.
Professor Tony Avery, national clinical director for prescribing at NHS England, said: “Medicines offer a fantastic range of tools for NHS staff to provide patient care and treatment that can be positively life-changing, or even life-saving.
“However, we need to be alert to the risks of some medicines, particularly when used over a long period of time, and the framework we are publishing today empowers local services to work with people to ensure they are being effectively supported when a medicine is no longer providing overall benefit”.
NHS England says that, thanks to investment of almost £50 million over the current financial year, the NHS is already making significant progress in this area. The most recent data shows that in under three years the number of opioid painkillers prescribed has fallen by 8%, which is estimated to have saved nearly 350 lives and prevented more than 2,100 incidents of patient harm.
One example cited by NHS England to demonstrate the benefits of a social prescribing approach is the Living Well with Pain programme in Gloucestershire, which supports people with long-term non-cancer pain by focusing not only on managing the impact of the pain but also people’s mental health, helping to reduce reliance on pharmaceuticals.
An evaluation of the programme over the past four years has shown a significant improvement in the mental health and wellbeing of more than eight in 10 (83%) of the people who participated in the initiative.
The NHS’s decision to encourage GPs to find alternatives to antidepressants and strong painkillers is welcome. Early evidence suggests that social prescribing, which enables people to become active and meet others, can be effective in improving people’s mental health and wellbeing. These activities must be properly funded and managed, however, and should not be seen as a cheap alternative to prescription drugs.