The Herald newspaper recently posted an article about a person who had long term problems with prescribed medication. The lady has launched a video and a petition to the Scottish Government, asking for a review of the use of Benzodiazepines. Having Nitrazepam prescribed in 1975 for depression, she underwent continuous problems afterwards, with epilepsy, weight loss, suicide attempts and repeated hospital admissions.
It was only with a change of GP in 2012 that her life improved: the new GP suggested tapering off her Nitrazepam medication. This resulted in severe headaches, inability to tolerate noise and bright sights, and other problems. Thankfully, the situation improved and the lady is now does not feel depressed and is able to think positively. However, further correspondence in the paper suggested that the withdrawal process from these medicines is not always handled properly – there can be serious worsening of conditions if reduction of the medication is done too quickly.
The Government Position
A government spokesperson replied to the person’s concerns, stating that there were already guidelines in place to manage benzodiazepine medicines, and that GPs and clinicians should be
‘Providing on-going support and advice to patients prescribed medicines that are known to be addictive or with other long term effects. Where patients are concerned about the effects their medicines are having on their general wellbeing they should discuss this with their GP as soon as possible and alternative treatments that may be available.’
One difficulty with this is that patients may often be reluctant to be seen to challenge to authority of their doctor, and come to reconcile themselves to ongoing problems. Another is that GPs with high workloads may not carry out the careful review of continued suitability of regular prescriptions. In the case of these psychoactive drugs, not having such safeguards can have severe long term outcomes as appeared to happen in this situation.
Duty of Prescribers
The guidance to GPs for repeat prescription medicines is very clear. The General Medical Council guidance from 2013 emphasises the need to consider whether repeat prescribing is necessary; to ensure that the medicine continues to be safe, appropriate and tolerated; and that there should be discussions with the patient about the continued appropriateness of the medication, with regular formal reviews at specified dates.
In the above situation and others in my experience, it appears these processes either did not occur or did not have the intended benefits of safe and appropriate treatment.
The guidance indicates a partnership relationship where patients and their GPs can regularly discuss any problems with their medication. This ongoing discussion may not always occur, and perhaps there is a need for public policy to strengthen directions and guidance to ensure that it does occur.
Duty of Carers
In care services, this points to several issues we need to be aware of. Firstly, the regularly prescribed medication must be regularly reviewed for its continued suitability. Not doing this brings the risk of poly pharmacy, where the unfavourable side effects of one medication is countered by yet another prescribed medication, resulting in a vicious circle of over-medication.
People responsible for other people’s care need to ensure that the people they care for are able to discuss and resolve any medication issues with the prescriber, and that continued medication is regularly reviewed. If the person is not able to do this themselves, then good care clearly requires that the person is supported to have appropriate medication and treatment for their condition.
