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In the grip of a drugs crisis – Including Epilepsy Medications

In the grip of a drugs crisis – Including Epilepsy Medications

Thousands of people are addicted to a range of drugs originally licensed to treat epilepsy and nerve pain, a Devon doctor warns.
Drugs such as gabapentin and pregablin are being prescribed for conditions ranging from anxiety to all sorts of chronic pain, Richard Byng, professor in primary care research at Plymouth University and a General Practitioner (GP) in the city, said.

 

He is calling for pharmacists, doctors and patients’ groups to work together to reduce the number of prescriptions issued.Pictured:  Professor Richard Byng (Image: Keith Rossiter)

 
“There is a group of us who work with homeless in the city and have been seeing the problem coming for a few years,” he said.

 
“They come to us and ask for it, saying someone else has given them one and it was good.”

 
“The epilepsy treatment is almost incidental. The huge increase in their use is for pain, anxiety and stress.

 

“They give short-term relief for anxiety and neuropathic pain but then you get tolerance.

 
“They don’t cure anything, but they numb pain and distress for a bit. They work on nerve cells, but the nerves get used to them so you need a higher dose to have the same effect.

 
“People become addicted and go out of their way to get some.

 
“Patients and doctors love them because they’re an instant ‘cure’,” he said.

 
He warned that those who are homeless or also addicted to other substances were “the tip of the iceberg. The problem isn’t just a few people with really sad difficult lives.

 
Prof Byng said deaths had resulted from combining pregabalin and alcohol – a particular problem for those with past trauma seeking relief form psychological torment.

 
There are five main classes of “psychotropic” drugs that affect brain and nerves: anti-depressants; anti-psychotics; benzodiazepine (such as Librium and Valium) and zoplicone (a kind of sleeping pill); opioids such as codeine and morphine; and finally gabapentin and pregabalin.

 
“I see people on all five,” Prof Byng said.

 
“We are aware of this so we often don’t put them on repeats.

 
“As a GP, you are faced with a pile of drugs requests and half of them are for these five classes of drugs.”

 
The anti-psychotic drug quetiapine (marketed as Seroquel, among others) arrived about 20 years ago as an alternative without the severe muscle movement problems that accompanied earlier drugs.

 
“But what they can cause is diabetes and weight gain,” Prof Byng said. “They have also been shown not to be any better than the old drugs for reducing psychosis.

 
“The drugs companies have now gone off and got them licensed for other conditions, such as depression and bipolar disorder. While some people are helped by the medication, we doctors have started prescribing them for general agitation or mood instability.”

 

 

Many homeless people find relief in prescription drugs

“They give short-term relief for anxiety and neuropathic pain but then you get tolerance.

 
“They don’t cure anything, but they numb pain and distress for a bit. They work on nerve cells, but the nerves get used to them so you need a higher dose to have the same effect.  “People become addicted and go out of their way to get some.  Patients and doctors love them because they’re an instant ‘cure’,” he said.  He warned that those who are homeless or also addicted to other substances were “the tip of the iceberg. The problem isn’t just a few people with really sad difficult lives.

 

Prof Byng said deaths had resulted from combining pregabalin and alcohol – a particular problem for those with past trauma seeking relief form psychological torment.  There are five main classes of “psychotropic” drugs that affect brain and nerves: anti-depressants; anti-psychotics; benzodiazepine (such as Librium and Valium) and zoplicone (a kind of sleeping pill); opioids such as codeine and morphine; and finally gabapentin and pregabalin.  “I see people on all five,” Prof Byng said.  “We are aware of this so we often don’t put them on repeats.

 

“As a GP, you are faced with a pile of drugs requests and half of them are for these five classes of drugs.”  The anti-psychotic drug quetiapine (marketed as Seroquel, among others) arrived about 20 years ago as an alternative without the severe muscle movement problems that accompanied earlier drugs.  “But what they can cause is diabetes and weight gain,” Prof Byng said. “They have also been shown not to be any better than the old drugs for reducing psychosis.  “The drugs companies have now gone off and got them licensed for other conditions, such as depression and bipolar disorder. While some people are helped by the medication, we doctors have started prescribing them for general agitation or mood instability”.

Prescriptions for anti-depressants have doubled in 10 years

“We have to take responsibility for this, and I hope we can help patients to take some responsibility too.  “Anti-depressant use has been doubling every 10 years,” he said.  “We should prescribe these drugs a lot more judiciously. Certainly we need to stop them once the treatment period is over. This often does not happen. ”  Part of me would like to have none of these available – even the anti-psychotics for psychosis.  “There are no good trials of anti-depressant use of more than three years duration. We have no idea of the long-term effect.
“Yet it is common for people to take them for more than three years. We don’t have any good alternatives.  “Most people stop after six months, but about 20% continue taking them for a long time.  “Some people who take them feel ill in the first month and then never take them again.  “Some people don’t like taking any medication.”

 

But the two problem groups are those who may not feel any better, but feel anxious if they stop; and the group who do feel better on the drugs at the beginning and then worry about stopping.

 
“but because the brain gets used to the drugs people need to be careful when stopping and should discuss it with their doctor.’

 

Who is at risk?

Anyone who is susceptible can become addicted to the opioid or ‘gaba’ drugs, which work by interfering with the mechanism nerve cells use to send signals in the brain. But many homeless people and others have a troubled life history that makes them particularly vulnerable.

 
“They have a high intensity of pain and distress, mainly through a combination of trauma, abandonment and neglect in young life,” Prof Byng said.  “These can be alleviated by drugs in the short term. But some people are treating gabapentin and pregablin as a complement to illegal drugs.  “This is addictive behaviour. For some people either alcohol, internet acquired valium or pregabalin can take away intolerable agitation. They just need a hit twice a day and don’t mind what it is so long as it does the job.  “We GPs are just another source when you get to that level of pain and distress. Unfortunately some people sell their prescribed drugs on which makes matters worse.”  Breaking the habit can be just as difficult with these prescribed medications as it is with illegal drugs. “When you have got to the addictive stage, you need strategies to stabilise and slowly withdraw. Without the drugs or some other support, life can seem intolerable,” Prof Byng said.

 
Patients going after a quick fix need to be encouraged to find new solutions to their problems.

 
“For example, the evidence is that long-term use of opioids (such as codeine and morphine) doesn’t help pain effectively, even though they can help in the short term. Exercise on the other hand does help – but it might take six months, and at the start can feel very difficult. That’s why it’s easy to ask for a drug and easy for us doctors to prescribe.”  And he said GPs should start to be more honest with their patients about the evidence including long-term negative effects.  “We don’t know the long-term effects of being on anti-depressants, and we should be absolutely clear about that. At the moment most GPs don’t tell that to their patients.  “We also need GPs, pharmacists and patients’ groups to work together.”  He would also like to see an end to some automatic repeat prescriptions, so that patients have to go through a review process, perhaps with their pharmacist.

 

About the drugs

Gabapentin is an anti-epileptic medication, also called an anticonvulsant. Sold under the brand names Gralise, Horizant and Neurontin, it affects chemicals and nerves in the body that are involved in the cause of seizures and some types of pain.  Gabapentin is licenced to treat nerve pain, and can be effective in some people.  Gabapentin was designed by chemists at Parke-Davis, now a subsidiary of the pharmaceutical company Pfizer.  Pregabalin (brand names Lyrica, Alzain, Lecaent and Rewisca) also affects chemicals in the brain that send pain signals across the nervous system.  It is also used to treat pain caused by nerve damage in people with diabetes, herpes zoster, or sciatica.

 

Depressing UK statistics – Problem Worldwide

 
There were more than 64 million anti-depressant prescriptions in the UK in 2016, according to the database company Exasol.  On average, there were 1.5 prescriptions for anti-depressants per head of population in Plymouth in 2016, and 0.86 in the Isles of Scilly.  Across the whole of Cornwall, the figure was almost as bad as Plymouth, at 1.49.  Devon’s worst was Torbay (1.43); the best was the South Hams (1.09).  A map produced by Exasol shows anti-depressant use particularly prevalent in more deprived parts of the Westcountry, such as Plymouth, South East Cornwall and West Cornwall.

 

Depression rates are known to be higher in deprived areas, where people struggle with unemployment and poverty.  But London, which also has high levels of socio-economic deprivation, has some of the lowest areas for prescriptions.  Prof Richard Byng said two factors were driving the runaway use of anti-depressants: an increase in the number of people being prescribed the drugs for the first time; and people staying on the drugs for longer.

 

Source: DevonLive.com

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