One in four adults prescribed addictive medications

Public Health England carried out a review into the prescribing of five medications including benzodiazepines (mostly prescribed for anxiety), Z drugs (sleeping tablets with similar effects to benzodiazepines), gabapentin and pregabalin (together called gabapentinoids and used to treat epilepsy, neuropathic pain and anxiety), opioids for chronic non-cancer pain and antidepressants. These medications were chosen as they are associated with a risk of dependence, withdrawal or both.

The review was designed to look into prescription drug dependence and how to address it. In 2017 to 2018, 11.5 million adults in England, more than a quarter of the adult population (26%), received one or more prescriptions for any of the medicines included in the review. 7.3 million people (17% of adults) received antidepressants, followed by 5.6 million (13%) who received opioid pain medicines.

Prescribing rates for antidepressants have increased from 15.8% of the population in 2015-2016 to 16.6% in 2017-2018. Gabapentinoids increased from 2.9% to 3.3%. Prescribing rates decreased slightly for all three other medications.

Women were 1.5 times more likely than men to receive a prescription, with rates generally increasing with age. People living in deprived areas were more likely to be prescribed the medications and for a longer period of time.

Of those who started a prescription in June 2015, most patients received their prescription for three months or less. However, a significant proportion are continuing on these medications for at least a year, ranging from 4% of those starting a prescription for benzodiazepines in June 2017 to 19% of those starting gabapentinoids.

Over time, the number of those who started and have continued to take medications has accumulated. Of those receiving a prescription for one of the five medications in March 2018, around half of people in each medicine class were estimated to have already been receiving a prescription for 12 months continuously by that point. Just under a million (930,000) people had received a prescription for antidepressants continuously between April 2015 and March 2018. Over half a million (540,000) had continuously received opioid pain medicines.

Aside from antidepressants, all of the medications included in the review are usually only prescribed for short-term use for acute conditions. Clinical guidelines specify that benzodiazepines should not usually be prescribed for longer than 2 to 4 weeks and yet 120,000 people in England received a prescription for them continuously between April 2015 and March 2018.

The review did not look at how many people were experiencing dependency but established that a large number of people are taking prescription medications for far longer than recommended.

Public Health England has released recommendations based on its findings in order to limit harm to those who are receiving prescriptions. There is a risk of harm to the individual, including increased suicide risk, if the medications are prescribed inappropriately for long periods of time.

Among their recommendations, Public Health England calls to improve clinical guidance, push for further research and make more data available on medicines which can cause dependence or withdrawal. It also recommends improving support and information available to patients experiencing dependence or withdrawal from prescribed medications.