Warning on over-prescribing benzodiazepines, Z-drugs and pregabalin

As first revealed recently in the Medical Independent (MI), the Medical Council has issued a statement on over prescription of benzodiazepines, z-drugs and pregabalin, with the regulator set to place greater focus on this issue in the coming months.

The Council said today that it takes “a very serious view” of over-prescribing of benzodiazepines, z-drugs and pregabalin and is actively working with the HSE, Department of Health, Pharmaceutical Society of Ireland and the medical profession to take action on this issue at a national level.

“If necessary, in order to protect the public, the Medical Council will take disciplinary action against medical practitioners in relation to the over-prescribing of benzodiazepines, z-drugs and pregabalin,” stated the regulator.

President of the Medical Council Dr Rita Doyle commented: “The impact of inappropriate prescribing of benzodiazepines, z-drugs, pregabalin and other controlled drugs is having a significant impact on patient safety and wellbeing.

“While benzodiazepines may have a role in the treatment of a patient on a time-limited basis, caution and strict monitoring are required when they are prescribed. Patients who become dependent upon benzodiazepines should be referred to the appropriate drug treatment services and provided with appropriate supports.”

She continued: “As a Council, we acknowledge and appreciate the challenges faced by practitioners, the difficulties some practices are experiencing in terms of benzodiazepine and z-drug usage, and the demands from some patients for this and similar types of medication.

“If a doctor is facing challenges in prescribing these medications, I would strongly encourage them, as a matter of priority, to engage with the HSE Addiction Services for support and guidance. The Medical Council supports doctors who follow recognised professional guidelines in line with professional practice and supports examples of good practice, particularly in difficult circumstances.

“Any doctor whose level of prescribing is above the normal range, and who is not working in an exceptional area of practice, and who does not make any effort to refer their patients to support or reduce their high-prescribing levels may require formal investigation by the Medical Council.

“However, it is vitally important that any patient who is taking benzodiazepines or z-drugs does not stop taking them without advice and guidance from their doctor.”

Dr Doyle said doctors had a clear ethical responsibility with regard to the safe prescribing of these drugs, as set out in the Council’s Guide to Professional Conduct and Ethics for Registered Medical Practitioners.”

“By working in collaboration with the HSE, the Department of Health, the profession and other key stakeholders, the Medical Council and our partners are addressing a key patient safety issue and ensuring that doctors have the supports they need to protect patient safety,” concluded Dr Doyle.

The Medical Council’s Guide to Professional Conduct and Ethics for Registered Medical Practitioners states that doctors must be aware of the dangers of drug dependency when prescribing benzodiazepines, opiates and other drugs with addictive potential.

“You should refer patients with drug dependencies to the appropriate drug treatment services and supports unless you have appropriate training, facilities and support yourself,” according to the guide.

“You should not undertake treatment of opiate dependency unless you have been approved under the methadone treatment protocol. You should safeguard patients with drug dependencies by taking reasonable steps to make sure that they are not inappropriately obtaining drugs from multiple sources. You can do this, for example, by liaising with drug treatment services, other doctors and pharmacists.”

Responding to today’s statement from the Medical Council, GP Dr Padraig McGarry, President of the IMO, said the comments were welcome and would generate an important debate on the issue. 

  “These are important drugs which can play a critical role in the treatment of patients facing acute anxiety issues,” said Dr McGarry.  “However, GPs have to navigate an often difficult path between what a patient needs and what that patient may believe they need and this can lead to tension in the relationship between GPs and patients when a GP is not willing to prescribe these drugs.  Every GP will be familiar with tense exchanges with patients who believe they should be prescribed such drugs and in some cases that can escalate to threatening behaviour.” 

According to Dr McGarry, GPs often have to address the reality that alternative treatments for conditions such as anxiety may take a number of weeks to access during which time the patient’s condition is worsening. In such circumstances, a prescription of a sedative may be warranted as an initial intervention.