John Perrott's Meeting with the Royal
College of General Practitioners
(Agenda)
Lancaster, March 28, 2011
Read Report of Meeting with the Royal College of General Practitioners.
Proposed agenda for discussion on involuntary tranquilliser addiction with Dr Harris, Head SMU, RCGP, Simon Ashmore, Head of Communications RCGP and John Perrott, Lancaster, Monday 28th March 2011.
The following outcomes relate to benzodiazepines and 'z' drugs.
Non-pharmacological routes are to be considered the primary treatment for patients with mental health problems such as anxiety, depression and insomnia and that if benzodiazepines are prescribed that they are for the correct indications, which many have not been in the past.
Patients should be fully informed of the dangers of addiction and side effects prior to prescribing them.
The BNF 2-4 week guidelines to be strictly adhered to with new patients and the first two weeks are to be considered as treatment and the final two weeks as the tapered withdrawal period.
GPs to be made aware that in the past polypharmacy prescribing has damaged patients further. This has been caused by misdiagnosis of ADRs and withdrawal symptoms caused by benzos. Withdrawal symptoms have been misdiagnosed as re-emergence of original problems or development of new ones.
During and after benzodiazepine withdrawal up to 200 withdrawal symptoms can persist for a long time (up to 2 years after complete withdrawal) and some have persisted for long enough as to represent permanent damage i.e. 5 years plus.
Additional psychotropic medication like SSRIs should therefore only be prescribed in exceptional circumstances as symptoms in the first year following complete withdrawal will more than likely be caused by benzodiazepine withdrawal. Also, SSRIs have their own problems with ADRs and withdrawal symptoms and often compound the problem.
Withdrawal can be frightening and prolonged and GPs need to employ trained counsellors to provide psychological support and withdrawal advice. They should work with their new Consortia to commission proper withdrawal services based on the Oldham model; the RCGP should lobby the Department of Health for funding. In addition to these services help-lines are required as many patients are unable to leave their homes due to the crippling effect of withdrawal symptoms. These services are currently supplied by a handful of voluntary and charitable organisations and individuals who are currently overwhelmed with calls from desperate patients; the current ones can be used as a basis to build on.
RCGP to commission a working party to design best practice for benzodiazepine withdrawal based on the Ashton Manual to include benzo withdrawal workers, ex-addicts and Professor Ashton (if she is available).
GPs to supply patients prescribed outside the guidelines with the Ashton Manual and inform them of their predicament offering them the choice of withdrawal and support; patients are not to be pressured into doing this.
To stop the practice of enforced and/or abrupt withdrawals by reduction/cessation of prescriptions. Withdrawal should be a choice made by the patient and the rate of withdrawal patient-centred as stated in the Ashton Manual. After switching to diazepam it is now currently accepted that the rate of withdrawal should be no greater than 10% of the current dose every 3-4 weeks. The last 5mg can be particularly difficult and flexibility with the rate of withdrawal and extra support may be necessary. Patients who have complained about their doctors in the past have been deregistered or ‘warned off’ complaining by their surgeries; this is not fair and incidents such as these should be investigated.
Patients should not be stigmatised as substance mis-users.
GPs found guilty of negligent prescribing or enforced/abrupt withdrawals should be disciplined.
RCGP to arrange a meeting with the Department of Health and the MHRA to allocate responsibility.
Contraindications - Fluoroquinolones should not be taken during benzodiazepine dependency or during withdrawal as they displace benzodiazepines from their receptor sites and have GABA antagonist effects. They have in the past caused major problems during dependency and withdrawal.
Ccs to all members of the All Party Parliamentary Group for Involuntary Tranquilliser Addiction, Anne Milton MP Minister for Public Health, Charities and voluntary organisations providing withdrawal advice and support, Department of Health, MHRA
Read Report of Meeting with the Royal College of General Practitioners.
Note to fellow victims in the UK: Complain directly to the Health Minister Anne Milton MP. Write, phone, fax or email her at the House of Commons, London SW1A 0AA · Telephone 020 7219 8392 · Fax 020 7219 5239 · Email anne.milton.mp@parliament.uk or anne@annemilton.com.
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