“Prescribers may want to move towards a ‘selective-use protocol’ based on individualised trial of medication and change depending on immediate and short-term response,5 rather than the indiscriminate current ‘offer to all with a diagnosis’ method of practice.”
Written by Prof. Richard Byng, this editorial has been published in the British Journal of General Practice. It relates to drugs prescribed for both physical pain relief and those prescribed for various forms of psychological/emotional distress.
The editorial begins:
“Awareness of prescribed opioid dependence is now reaching the general population along with concerns about levels of antidepressant prescribing and the potential for withdrawal symptoms. Gabapentinoids have become controlled drugs and Public Health England have published their report on prescribed drugs and dependence detailing extensive long-term prescribing.1 Family doctors will not have failed to notice both the increasing numbers of patients being prescribed multiple drugs for pain and distress, and the change in tone in consultations as we start to worry about their effects and wonder whether adding more, or another, or just switching drugs is the right action. What is the nature of the problem? What can we do instead?
The increase in gabapentinoids (pregabalin and gabapentin) prescribing in England has been dramatic between 2007 and 2017, from 2.1 to 13.2 million items per year.2 Total opioid prescriptions peaked in 2016, though more powerful agents continued to rise.2 In the last 10 years, we have seen a considerable rise in the antipsychotic quetiapine (doubling to 3.3 million items/year).2 And, the mammoth in the room, a continued decade on decade advancement in total antidepressant prescribing to 68 million items per year2 as ‘beyond guideline’ long-term prescriptions increase.1 Prescribing rates in some poor post-industrial and coastal areas boast average antidepressant scripting of 2 items per person per year.3 Figure 1 depicts the item rises together …”
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