Psychoactive Substances Bill [HL] — House of Lords, 2015-06-09
Topic: Health
John Montagu (Crossbench, Unknown): My Lords, this has been a good-humoured while serious debate. Drug addiction, whether legal or illegal, remains a severe test of the ability of all of us concerned—doctors, psychiatrists, parents, police and lawmakers—to offer sensible advice and durable solutions. We can go on saying that the law must be reviewed and the Misuse of Drugs Act revised. We are now discussing a radical change: a blanket ban on new psychoactive substances. However, the results will always vary because of definitions and because of the effects of drugs on individuals. We are all different human beings and our metabolisms react in different ways The Minister mentioned the cat and mouse game. The noble Baroness, Lady Browning, said it was playing catch-up. The law may easily be intervening on the wrong people all the time. So I begin, not for the first time, in sympathy with the Minister who has to steer through these difficult problems and answer this debate. I also welcome the noble Baroness, Lady Chisholm, to the Front Bench on this issue for the first time I link this discussion directly to the related problem of prescribed drug addiction, which the noble Lord, Lord Patel, kindly mentioned in his contribution and which the Home Affairs Select Committee linked it with in its report 18 months ago. Here I declare an interest because, as some colleagues will remember from the Health Bill and before, a member of my family has for several years been severely affected by withdrawal from prescribed medicine. Incidentally, patients in this category must not be stigmatised because most are following doctors’ orders and doctors can get it very wrong. Some doctors deny that the prescribed drug has caused the problem at all. Patients are then left to cope with withdrawal on their own My points are very simple. First, addiction to medicines is every bit as serious an issue as legal highs and controlled drugs. The negative effects of legally prescribed medicines can be devastating and they potentially affect many more people than controlled drugs given the vast number of prescriptions issued every year. Of course, the same point was rightly made about alcohol Secondly, while huge resources are rightly devoted to criminality, virtually nothing is spent on prescribed drug addiction because it appears that no harm is caused to society; it is society that is causing the harm. Yet a mere handful of charities are coping with increasing numbers of desperate people who become dependent and cannot easily withdraw. Despite the—I am afraid—feeble efforts of the Department of Health and a few exceptions among primary care trusts, the devolved NHS and three successive health Ministers have virtually ignored the problem, having shown a lot of enthusiasm to begin with I refer to a fact-sheet produced by the Council for Evidence-Based Psychiatry for a meeting of APPGITA, the All-Party Parliamentary Group on Involuntary Tranquilliser Addiction, founded by the late and respected Jim Dobbin, of both of which organisations I am a member. The noble Lord, Lord Patel, mentioned some of these points. In England alone last year, there were over 80 million prescriptions for psychiatric drugs. Almost 10 million people in the UK, or around 15% of the population, are taking tranquillisers, antidepressants or other psychiatric medications at any given time, all of which have the potential to create addiction or dependence. Some 57 million prescriptions were issued for antidepressants in 2014 in England, which is a rise of over 500% since 1992; 11% of women and 6% of men are taking them regularly The prevalence of depression has not risen since 2003, but prescription numbers are increasing because more patients are taking antidepressants for longer. Over 1 million people are long-term users of tranquillisers, including sleeping pills, despite clear guidance that they should be used for no more that four weeks. Tranquillisers, antidepressants, antipsychotics and other psychiatric drugs can all be helpful in the short term, but long-term use—as with cocaine, cannabis or alcohol—is associated with serious harm. Furthermore, a large number of patients suffer debilitating symptoms for years following withdrawal from prescribed drugs, while some are left with symptoms that may persist indefinitely The government response to the Select Committee report, published last May, draws attention to various half-hearted attempts by the Department of Health to deal with the problem of prescribed drugs. However, it welcomes, as I do, the initiative by the Board of Science of the British Medical Association, which is at last undertaking a long-awaited report on involuntary dependence on prescribed medicine. This report, when it comes in October or soon after, will undoubtedly have enormous influence on the Government’s attitude to this whole issue. But it will be too late for some of the withdrawal charities. One of them, CITA in Liverpool, had to close recently because of a lack of funding, following changes in the NHS. There are only a handful of these charities. Another closed last year in Cardiff for similar reasons, and the saintly counsellor who ran it now finds herself unable to find alternative employment because the negative effects of prescribed drugs are just not a priority for the local clinical commissioning group Patients depend on a frail voluntary service. There are fewer than 10 charities groups that provide support to individuals trying to withdraw from benzodiazepines. They are currently located in Belfast, Bradford, Bristol, Camden—only in Camden, in the whole of London—Cardiff, Liverpool—at least there was one in Liverpool—Manchester, north Wales and Oldham. Only three of these support individuals withdrawing from antidepressants and none specialises in withdrawal from other psychiatric drugs The Government have a particular duty to provide appropriate services for people who have been harmed by medicines supplied through the NHS, yet they are clearly failing to do so. Guidelines need to be updated to reduce overprescribing, and support services need to be introduced across the country to help affected patients withdraw slowly and safely. Doctors need to be properly trained to recognise these harms and to provide appropriate support. More research is needed to investigate the harms associated with long-term use Finally, there is the acute problem of the misuse of both NPS and prescribed drugs in prisons. The noble Lord, Lord Rosser, mentioned this earlier. I know that this is already in the sights of the Ministry of Justice. Her Majesty’s Inspectorate of Prisons has drawn attention to it and the Centre for Social Justice highlights it in its most recent report on drugs in prison. Once again, this shows the grey area between lawful prescription and criminality and the constant risk that, while some culprits may be caught, the innocent victims will usually be forgotten.