Are addiction clinics the answer for those hooked on prescription pills?

Millions of us are swallowing potentially addictive pills to deal with chronic pain and depression. According to a review by Public Health England (PHE) published last month, in the past year 11.5 million patients were given at least one prescription for opioid painkillers, antidepressants, sleeping pills or tranquillisers.

All these drugs can be addictive— and with opioids the risk rises every day you take them, according to a 2017 study by Professor Bradley Martin of the American Centre for Disease Control.

He calculated that if patients were initially given a five-day supply, there was a 10 per cent risk they would still be taking opioids a year later. ‘ Being prescribed a 30- day supply increases your chance of still being on those pills a year later by nearly 50 per cent.’

Furthermore, researchers at the University of East Anglia this week revealed that in the UK, the number of over- 65s taking antidepressants has more than doubled in two decades — even though there has been no increase in the numbers with depression.

The prescription figures raise fears action is desperately needed to tackle a ‘ hidden epidemic’ of people dependent on prescription pills who are offered little or no help or advice to come off them.

‘We are certainly taking a lot of pills,’ says Dr Cathy stannard, a pain specialist with NHS Gloucestershire Care Commissioning Group. ‘ Pain and addiction are complicated topics and for some, strong opioids work very well. But if people are taking them in high doses for a long time, that is usually a sign they are not working and those people need help to gradually come off them.’

one recommendation of the PHE review was new guidelines for doctors on when they should intervene to help patients come off the drugs. Another was to set up a 24-hour advice helpline.

But there are other, more radical ways to tackle the problem, according to a recent report by Dr Jessica Y. Ho, an assistant professor of gerontology and sociology at the University of southern California.

one approach is specialist drug treatment centres. Developed initially for people addicted to illegal drugs, these can be ‘very successful’, says Dr Ho. But in the UK, the number of such centres has fallen since a decision in 2010 to hive them off from the NHS and make them the responsibility of local government.

This has been a disaster, according to Dr stannard. ‘With budget cuts of 40 per cent, the councils just can’t afford to fund them and many have had to close,’ she says. ‘it’s a false economy, as the costs of treating the effects of addiction are huge.’

in the past, there have been no dedicated centres for those addicted to prescription drugs.

‘The increased prescribing of these potentially addictive drugs shows the urgent need for [dedicated centres],’ says Harry shapiro, director of Drug Wise, the information charity, who also sits on NHS and Parliamentary addiction advisory groups.

There is a huge demand for such centres. The UK Addiction Treatment Group (UKAT), a company that still provides addiction services for councils, is treating 45 per cent more people for prescription drug addiction than it was three years ago, according to nuno Albuquerque, the head of its treatment programme.

‘GPs are already overstretched and most lack the resources and time to offer much more to these patients than repeat prescriptions,’ he says.

CENTERS can offer a more holistic approach — for instance, UKAT provides talking therapy, yoga, diet advice and acupuncture.

Dr Ho says the evidence supports greater use of nondrug treatments. in Portugal, she says, where people addicted to illegal drugs are offered free therapy, exercise and art under a treatment programme that also involves switching them to substitute medication, the number of addicts was halved in ten years.

The best way to wean patients off prescription drugs, an emerging consensus suggests, is gradually to reduce the dose — known as tapering — over months or even longer. But it can be difficult to make precise reductions when pills come in standard doses.

Acknowledging this, a Dutch organisation has started marketing strips of very small doses of 24 prescription drugs.

‘it’s an important option,’ Dr Ho told Good Health, but added: ‘it should involve your doctor to monitor you.’

As for prevention, besides stricter guidelines for doctors, better information is needed about the drug combinations many patients take that can create new problems.

‘ Combining opioids with antidepressants increases patients’ sensitivity to pain,’ explains Harry shapiro, ‘ which means they want higher doses, making it even harder to quit.’