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Are GPs really to blame for prescription drug addiction?

02 Feb 2018

I’m not usually the greatest fan of Government initiatives. But the recently announced plan to review prescription drug addiction and dependence is a fair cop.

Because, without wanting to denigrate myself and my colleagues too much, it’s probably true to say that, in recent years, GPs have been responsible for turning a significant proportion of the public into junkies, merrily dishing out benzodiazepines, z-drugs, gabapentinoids, opioids and antidepressants to all and sundry.

There have been extenuating circumstances, of course. Pregabalin and gabapentin are the drugs du jour, curing everything from anxiety through neuropathy to back pain. Many of the offending opioids are actually started in hospitals and end up as repeats on the insistence of very assertive patients. And pain clinics, where we often refer patients in the hope of non-pharmacological solutions, frequently resort to sticking a pin somewhere in the BNF’s ‘potentially addictive’ section.

Besides, given the waiting lists for cognitive behavioural therapy (CBT), physiotherapy, joint replacements, psychiatry outpatients, pain clinics et al, GPs may have little choice but to print off a prescription when facing a desperate patient. So, often, that’s what we end up doing.

Clearly, then, setting up a review is one thing, but solving the problems it’s bound to highlight is quite another. Without non-drug approaches to offer, we’ll be waging a war without any ammunition.

We need man and woman-power, too. Unpicking the unholy mess that is, say, a repeat template for co-codamol 30/500, tramadol, pregabalin, zopiclone, amitriptyline and sertraline will require levels of time, energy and enthusiasm that I simply don’t have.

What I do have, though, is the promise of an in-house pharmacist via NHS England’s clinical pharmacists in general practice scheme. And I’ve just thought of something to add to the job description.

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