Dr Pardeep Grewal MBBS, MSc, MRCPsych: Consultant Psychiatrist
While doctors do not purposely prescribe drugs that can cause addiction, it is easy to overlook a number of factors, often outside of the doctor’s control, that can result in a patient becoming dependent on certain drugs. In this article Dr Pardeep Grewal, a Consultant Psychiatrist who is an expert in substance abuse, provides his top tips on how to reduce the risk of prescription drug addiction.
This article on prescription drug addiction is written by Dr Pardeep Grewal from Harley Street Psychiatry, a practice that offers effective medical diagnosis and treatment of mental health problems and substance misuse disorders (eg drugs and alcohol).
It was Hippocrates who recognised the potentially harmful effects of a doctor’s actions. Primum non nocere (first, do no harm) is etched in the minds of Western-trained doctors. The vast majority of senior doctors are wise, prudent and safe in their prescribing. However, it is also accepted that doctors are responsible for an astonishing number of deaths through inadvertent adverse side effects or complications caused by treatment, as well as through negligence. Fortunately, doctors can now be trained to avoid creating addicted patients, particularly when it comes to certain types of sedatives, pain killers and anti-depressants.
Doctors can inadvertently create drug addiction in patients
The idea that doctors make patients addicted to prescribed drugs might, at first, seem absurd. However, it may be that harm occurs without a doctor realising it. An example of this is when a patient is prescribed a generous supply of sedatives to be taken as required for an unstipulated period. No wonder, then, that the patient returns requesting that same "special blue tablet” that makes all their worries go away.
While addicted Harley Street patients are not typical drugs users, they do share some of the characteristics of more hardened addicts. They often seek medication from a number of different sources, buying drugs from the Internet and sometimes even off the street.
How to reduce the risk of prescription drug addiction
Here are some ‘top tips’ on how to reduce the risk of addiction:
Be cautious with benzodiazepines
Of course, it may not be possible to avoid prescribing benzodiazepines altogether as they are certainly useful in treating a number of disorders. But be cautious when using them. Even a short course (a little as two weeks) can cause a craving, and some people are more prone to becoming dependent on them than others.
Avoid the ingestion of too many drugs at the same time
This might sound obvious, but it easy to obtain addictive medicines from multiple sources. A vast number of over-the-counter preparations contain sedatives, for example as Nurofen Plus and cough syrups.
Try a drug holiday or use the minimum effective dose
A break from sedatives is often a good idea. It will help reduce the size of the dose and increase the efficacy of the medicine. If it is not possible to take a break, try the minimum effective dose.
Beware of sleeping pills that quickly cause dependence
Unlike antihistamines and herbal remedies, the sleeping pills zopiclone and other ‘z-drugs’ can cause dependence even at low-dose. A patient, who was using between 30 and 40 zopiclone tablets a day gathered from a number of different Harley Street clinics, suffered horrendous withdrawal symptoms. It was only through a slow reduction in medication and the use of behavioural techniques that she was able to get her sleep patterns back to normal.
Double-scripting is the phenomena of obtaining more than one prescription for the same medication, usually from different doctors. There are few safeguards to prevent this in the NHS or in private healthcare.
The best way to reduce the risk is to keep in contact with the patient’s GP and let them know you are prescribing a particular drug. The GP then becomes the key safety system preventing or reducing the risk of double-scripting. If the patient does not have a GP, then demand they register with one before prescribing a drug that may cause dependence.
Be vigilant and think ‘double-scripting’ whenever you see a new patient who is requesting potentially addictive medication. Ask yourself, “How do I know they are not also prescribed this from a different doctor?” Trust your instincts, as these so often tend to be right.
Beware of ‘diversion’
Diversion is the term used for the selling or exchange of prescribed medication by patients. It is well documented in substance misuse services, where controlled drugs are sold outside the department or exchanged for street drugs. It also occurs in private healthcare settings and might include patients sharing their tablets with family members (including those overseas), or stock-piling medication for later use.
Keep an eye on the ‘to be taken as required’ medication chart
The answer here is simple: review the ‘to be taken as required’ list of medications frequently, and at least weekly. Nurses like the ward quiet and safe, and find it all too easy to dispense sedatives to achieve this.
For patients in hospital for more than two weeks, opiate analgesia prescribed for pain relief can easily pose a difficulty after discharge. The situation is compounded when they receive additional supplies to take home. Slowly reduce doses at the earliest opportunity to reduce the need for these drugs after discharge
So, there we have it; an addiction psychiatrist’s guide to helping tackle a problem which effects the entire profession. And all without mentioning the misuse of prescribed medication by doctors. That, of course, is a different matter altogether.
Dr Pardeep Grewal BSc., MBBS, MSc., MRCPsych is a Consultant Psychiatrist at a London teaching hospital. He has extensive experience of treating drug and alcohol problems within both the NHS and private sector. He is listed on the General Medical Council's (GMC) Specialist Register as an expert in Substance Misuse and is a leader in his field. He is a member of several professional institutions including the Royal College of Psychiatrists, the British Medical Association and the Medical Protection Society.