Serious data gaps on prescribed drugs

Lack of private prescription data for benzodiazepines, z-drugs, and gabapentinoids is raised in a new document. Catherine Reilly reports

There is no method of obtaining timely access to a doctor’s private prescribing history when investigating complaints, the Medical Council has highlighted.

Gaining access to such records involves a “piecemeal trawl” of the geographic area and contacting each individual pharmacy for records.

“This can be very time-consuming, expensive and insufficient from a public protection point of view,” according to the report titled Examining the Overprescribing of Benzodiazepines, Z Drugs, and Gabapentinoids in Ireland. “To accurately quantify the issues of overprescribing of benzodiazepines, z-drugs, and gabapentinoids, we need to ensure that all prescribing (both public and private) of these drugs is recorded centrally.”

The report has been produced by a multiagency group led by the Medical Council. It makes recommendations that aim to reduce the inappropriate prescribing of these medicines and to support prescribers.

Recommendations include increased resources for primary care counselling and addiction services; appropriate resourcing for prescribers to support patients to reduce use of these drugs; further educational initiatives for doctors, pharmacists, and the public to increase awareness; and considering classifying pregabalin and gabapentin as controlled drugs (although the report says “reclassification alone may not be enough”). The report also advised that an implementation group should be convened, but as of press time, no such group was in place.

The working group recognised “positive downward trends” in some of the data regarding the prescribing of benzodiazepines and z-drugs. The report noted that socioeconomic factors such as poverty, unemployment, and lack of access to mental health services, can contribute to prescription rates. It also acknowledged that misuse of these drugs is sometimes down to illegal supply.

Visibility

The need to address the “lack of visibility” of private prescribing of the drugs is strongly emphasised in the report.

As previously reported in the Medical Independent (MI), concerns about the lack of private prescription data have been repeatedly expressed at working group meetings. In March 2021, meeting minutes noted that “legislative changes are required as the current situation just doesn’t make sense and… patient safety is at stake if this change doesn’t happen”.

In September 2022, during a discussion on a planned submission to the Department, the minutes noted: “The urgency and the appropriateness of the need for legislation, especially regarding the area of private prescribing, was emphasised.” At a meeting in November 2022, a Primary Care Reimbursement Service (PCRS) representative highlighted that a change in legislation would be needed to implement a central repository capturing all data. “The controlled drugs unit in the Department of Health highlighted that the current legislation does allow the Minister for Health to approve a software system for pharmacy, which could be step one in terms of a central repository.”

According to the report, the lack of visibility of private prescribing practices is “of major concern to the members of the working group”. Legislative change will be required to enable data collection for all prescriptions.

“The data collected from the PCRS is invaluable for identifying overprescribing trends in public prescribing, however, without access to private prescribing data trends, the picture is not complete. Access to full prescribing data of these drugs would allow for targeted interventions such as support for prescribers on reduction guidance and addiction specialists to advise patients, and in more extreme cases referral to the Medical Council to address patient safety concerns.”

The report proposed a central repository that would be accessible to different bodies. However, it acknowledged there were barriers to the establishment of such a database. “The current database for public prescribing data is not extendable to the private data collection and an equivalent system would require technological advances, along with the designation of an appropriate body to store and release this data. Furthermore, there are data protection issues which would need thorough consideration.”

It stated that developing a national prescribing solution for Ireland “would be a useful step”.

“The group supports the development of the National Shared Care Record programme, which will be another project that will provide greater visibility to health professionals on use of these medicines,” according to the report.

“The data protection obligations on a prescriber with respect to private patients to ensure they conform with data protection legislation are such that a significant volume of prescribing could not be factored into the working group’s investigations, which in turn affected the overall picture of overprescribing across the system.”

A Department of Health spokesperson told MI: “Currently data can only be obtained from public prescriptions. The e-prescribing initiative, when complete, will provide private data. The introduction of electronic prescribing and development of the national shared care record will provide all healthcare professionals, including prescribers and community pharmacists, with a more complete view of all prescribing and dispensing for each patient, resulting in benefits for the safe prescribing and dispensing of all medications and controlled drugs.”

The spokesperson also referred to “progress” in enhancing mental health and counselling supports. They referenced an additional €2 million in 2025 to improve access to the Counselling in Primary Care service.