Recommendations aimed at reducing the initiation and overprescribing of benzodiazepines, z-drugs, and gabapentinoids in Ireland, have been made by a multiagency Working Group established by the Medical Council, with representatives from the HSE and from across the health sector.
It said the recommendations were made in the interests of patient and doctor safety, and to support prescribers.
Key Recommendations of the Working Group:
- Improved Service Delivery: Increase resources for Primary Care counselling supports and addiction services to reduce the number of people requiring prescriptions for benzodiazepines, z-drugs and gabapentinoids. Additionally, provision of appropriate resourcing of all prescribers to support patients to reduce their consumption of these drugs.
- Education: Further educational initiatives should be developed for doctors, pharmacists, and the public to increase awareness of the risks associated with benzodiazepine, z-drug and gabapentinoid use. Training and awareness around overprescribing matters should be a focus of pre-registration education and training of all prescribers.
- Advancing Transparency in Prescribing Practices: The Working Group proposes that a central repository for data, which would be accessible to prescribers, should be established. The purpose of this is to enhance visibility of private prescribing of controlled drugs, to achieve greater accountability and improve prescribing practices, while ensuring data protection obligations are adhered to.
- Consideration given to including Pregablin and Gabapentin in the Controlled Drugs List: The Working Group supports the idea ofconsideration being given to including pregabalin and gabapentin on the controlled drugs list, as has been done in other countries, such as the UK. However, it acknowledges that this this alone may not be enough. Additional improved service delivery is also crucial to ensuring this reclassification has the desired impact on prescription rates and adverse impacts of these drugs.
- Implementation of Recommendations of the Working Group: The successful implementation of these recommendations will require considerable stakeholder involvement across the Irish healthcare system to be effective. The Working Group recommends the establishment of an implementation group to assess progress on the implementation of the recommendations within this Report.
Professor Eamon Keenan, National Clinical Lead, Addiction Services, HSE said, “The HSE and HSE Addiction Services welcome the publication of this report.
“We see first-hand the impact the inappropriate use of these medicines can have on public health. From a treatment perspective, benzodiazepines were the fourth most common drug causing presentations to Addiction services in 2023, accounting for 1,477 cases.
“These drugs are also implicated in drug related deaths as recorded on our National Drug Related Deaths Index (NDRDI). Over the years 2012 to 2021, there has been a 45% increase in the number of deaths where benzodiazepines have been implicated and deaths where pregabalin has been implicated have risen from 14 in 2013 to 83 in 2021.
“The recommendation in relation to resourcing services is timely and HSE Addiction Services looks forward to working with stakeholders to implement all recommendations set out in the report.”
The Working Group included representatives from the Medical Council, Health Services Executive (HSE) (Addiction Services, Primary Care, Primary Care Reimbursement Service (PCRS), Medicine Management Programme (MMP), Nurse and Midwife Medicinal Product Prescribing), Department of Health (DoH) (Medicines, Controlled Drugs & Pharmacy Legislation Unit, National Patient Safety Office & Mental Health Unit), the Pharmaceutical Society of Ireland (PSI), Irish College of General Practitioners (ICGP), Nursing and Midwifery Board of Ireland (NMBI), Health Products Regulatory Authority (HPRA), and College of Psychiatrists of Ireland (CPI).