Prescribing benzodiazepines and other addictive drugs

Drug-related deaths in England and Wales reached their highest recorded level in 2015, according to Office for National Statistics data, which has led to concern about the availability of both legal and illegal drugs.

The number of deaths related to benzodiazepines remained high but relatively stable, with 366 deaths registered in 2015 compared to 372 the previous year. However, in nine out of 10 benzodiazepine deaths another more potent drug, such as heroin, is also mentioned.

The MDU has reviewed the last six years of advice and claims cases which centre on either opiate or benzodiazepine medication. Most cases relate to coroner's inquiries and inquests which would fit with the significant number of drug-related deaths identified nationally.

Many cases are of suspected suicide and, in keeping with the ONS figures, there may be more than one type of drug involved in the death.

Complaints

In 59 cases, complaints arose either from an allegation of a failure to prescribe the drug when requested, or that the drug was prescribed and the patient subsequently developed an addiction. It is not unusual for these complaints to come from a relative of the patient, rather than the patient themselves.

Such complaints may also include concern about the level of support provided to a patient to deal with their addiction. Other allegations were that clinical symptoms were mistakenly attributed to a patient's drug addiction, and that another condition was missed or a diagnosis delayed as a result.

Claims

Between 2010 and 2016 we settled 11 claims on behalf of members relating to benzodiazepines and other addictive drugs. Almost £750,000 was paid out in damages and legal costs for those settled claims. The highest amount paid in a settlement was around £400,000 but most cases were settled for less than £50,000.

In addition to claims, complaints and coroners files the MDU has also provided ethical advice on a diverse range of topics related to these addictive drugs. In particular this includes the disclosure of patient prescribing information to third parties, such as safeguarding teams, the police, the DVLA or the patient's employer.

MDU advice

The GMC's guidance Good practice in prescribing and managing medicines and devices indicates that you should only prescribe medicines if you have an adequate knowledge of the patient's health and you are satisfied that they serve the patient's needs.

If a patient asks for medication that you don't think will benefit them, you do not have to provide it. You should explain your reasons to the patient and any other available options, including seeking a second opinion.

The GMC also emphasises the importance of having systems in place to review medications, particularly if the medicines have common or serious side effects or if they are controlled drugs or another medicine that is commonly abused or misused.

We offer the following medico-legal advice when considering prescribing a potentially addictive medication:

  • Be aware of the relevant NICE guidance including CG113, CG115 and CG159 and also review the BNF's guidance on prescribing drugs likely to cause dependence.
  • If it is appropriate to prescribe a potentially addictive drug, clearly document the reason for the prescription, the alternatives considered, the duration of the treatment proposed and the side effects that have been explained to the patient.
  • Make sure adequate systems are in place to review the medication and that at each review the appropriateness of the medication is reconsidered in line with the GMC's guidance.
  • Be aware that patients who may appear to have drug seeking behaviour could have another underlying diagnosis. Make sure that you undertake a thorough history and examination and document this carefully in the medical records.

This guidance was correct at publication 24/10/2016. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

Nicola Lennard

by Dr Nicola Lennard BSc MBBS MRCGP

Nicola completed her post graduate training in general and vascular surgery before taking up post, initially as a senior medical officer, then Deputy Medical Director in the medical devices division of the MHRA. She joined the MDU as a medico-legal adviser in 2013 and completed her graduate diploma in law in 2014.

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Prescribing benzodiazepines and other addictive drugs

Drug-related deaths in England and Wales reached their highest recorded level in 2015, according to Office for National Statistics data, which has led to concern about the availability of both legal and illegal drugs.

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