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H O U S E OF C O M M O N S
APPGITA - All Party Parliamentary Group for
Involuntary Tranquilliser Addiction
House of Commons, London SW1A 0AA
Letter from The Rt Hon Gillian Merron MP,
Minister of State to Jim Dobbin MP,
March 3, 2010
March 3, 2010
Jim Dobbin MP
House of Commons
London SW1A OAA
Thank you for your further letter of 2 February about tranquilliser addiction and for the enclosed lists of scientific articles.
I am pleased to read of your general support for our review of addiction to medicines. However, I am disappointed to read of the concerns you express about the contributions made to the review, both internal and external, and of the complaint you have made to the Equality and Human Rights Commission.
The aims of the review are set out in the Terms of Reference, which you have seen. As requested, they are set out again at Annex A. The objectives of the individuals engaged in the review are a confidential human resources matter and may not be disclosed.
The National Addiction Centre (NAC) has been commissioned to carry out an expert, systematic review of the published evidence in the field and to report its findings to inform the review being carried out by the Department. The NAC's Terms of Reference are attached to this response at Annex B. I have arranged for your list of scientific articles to be forwarded to the NAC team working on the literature review.
The NAC works to improve understanding of addiction to all drugs whether legal or illegal, as well as alcohol and tobacco, and to develop effective preventative and personalised treatment interventions.
The NAC is well-placed to carry out the evidence review as its staff are very well qualified in the area of addiction. Professor Strang is the Director of the NAC at the Institute of Psychiatry, King's College London and is also heading the establishment of the new Addictions Clinical Academic Group within the new King's Health Partners Academic Health Sciences Group. Dr Reed is a Clinical Research Worker and Specialist Registrar in Addictions at the NAC. Professor Malcolm Lader is Emeritus Professor of Psychiatry at the Institute of Psychiatry, so his views will naturally be taken into account. It is clear from the terms of reference that there are no grounds for expecting Professor Heather Ashton's publications to be overlooked, or for the literature review to be narrowly focused. As you will also see from the terms of reference, neither clonazepam nor clobazam is excluded from the literature review or the overall review.
One of the aims of the Department's review is to strengthen the coordination of policy on this area within the Department of Health. That is why we are liaising with all relevant branches of the Department, including pharmacy, mental health and the Medicines and Healthcare products Regulatory Authority (MHRA). It is important that we do so if we are to have a coherent policy strategy for the future.I was also very sorry to read of your criticism of Departmental officials working, as I have a high regard for their work and the advice that we receive from them.
In relation to the MHRA, the Government's response to the Health Select Committee (HSC) report which was quoted in your letter stated that:
The creation of the MHRA and its new openness, the raft of new legislation with the increased power to act to protect public health and, last but not least, the in creasing patient voice, are part of a programme of planned change.
The latest review of the Agency by the Department of Health paints a very different picture from the HSC's report of five years ago.
Concern about the safety of tranquillisers such as benzodiazepines, especially in relation to risk of dependence, has led to action by the Department of Health, the MHRA and other professional bodies to limit prescribing, and provide extensive warnings about the risks of dependence and advice about gradual withdrawal. The product information for prescribers and the Patient Information Leaflets for all benzodiazepines contain warnings about the possibility of addiction and that side effects may occur on abrupt withdrawal of these medicines. The MHRA has statutory powers relating to marketing authorisations which in turn provide key risk management tools.
You will recall that at the meeting of the All Party Parliamentary Group in December 2009 we discussed public engagement with the review and I said that I would want to reflect on that as the review progressed. In the meantime, officials have been liaising closely with patients' groups including the Council for Involuntary Tranquilliser Addiction and Battle Against Tranquillisers. Thanks to the voices of these groups and the personal experience of the people I have met, we can be confident that the review will not lose sight of the individual patient's perspective. This will be important for the review in considering how awareness of the risks of long-term use of addictive medicines can be raised with the public and what sources of support are required for people facing problems through such dependence.
The British National Formulary (BNF) is the authoritative source of up-to-date information about the use of medicines and is relied upon by prescribers, pharmacists and other healthcare professionals. If you have concerns about the accuracy of information contained in the BNF then I would urge you to take these up with the Joint Formulary Committee at:
British National Formulary
Royal Pharmaceutical Society of Great Britain
I Lambeth High Street
I hope this letter clarifies the Department's position.
Terms of Reference for DH review of addiction to medicines
prevalence - to help to determine the extent and severity of the problem of dependence on prescribed and OTC drugs;
prevention - to assess the effectiveness of clinical governance in this field, including the provision of guidance for prescribers of benzodiazepines and other drugs;
provision of treatment services - to find out what services are available to support people needing treatment for dependence on these drugs; and
policy leadership for the area within the DH - how this might by improved and how communication between interested branches might be improved.
Annex A: Terms of Reference for NAC Evidence Review
to identify and collect all accessible Published information from the English and international literature;
to examine available data on the extents of Prescribing or provision/sale of these products and to document changes over time;
to identify methods for further exploration of the extent of dependence, the extent of misuse and extent of associated harm/Problems which constitute unmet healthcare need; and
to identify possible further work that can improve our understanding and increase our capacity to track and influence
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