Medical Council Warns Doctors to Reduce Over-Prescribing of Benzodiazepines

Medical Council Warns Doctors to Reduce Over-Prescribing of Benzodiazepines, Z-drugs and Pregabalin or face Potential Investigation

Thursday, 19th September 2019: The Medical Council has today issued advice to all doctors prescribing benzodiazepines, z-drugs and Pregabalin to follow best practice guidelines and to only prescribe benzodiazepines or similar drugs when absolutely required.

The Medical Council, with its dual role of protecting patients and supporting doctors, takes a very serious view of over-prescribing of benzodiazepines, z-drugs and Pregabalin and is actively working with the HSE, the Department of Health, the Pharmaceutical Society of Ireland and the medical profession to take action on this issue on a national level.

If necessary, in order to protect the public, the Medical Council will take disciplinary action against medical practitioners in relation to the over-prescribing of benzodiazepines, z-drugs and Pregabalin.

Benzodiazepines are a group of medicines that can be prescribed for short periods to help with sleeping problems, or to help with episodes of severe anxiety. They are not for long-term use and can be dangerous when a patient develops an overreliance or a dependency on these drugs.

The President of the Medical Council, Dr Rita Doyle, said: “The impact of inappropriate prescribing of benzodiazepines, z-drugs, Pregabalin and other controlled drugs is having a significant impact on patient safety and wellbeing. While benzodiazepines may have a role in the treatment of a patient on a time-limited basis, caution and strict monitoring are required when they are prescribed. Patients who become dependent upon benzodiazepines should be referred to the appropriate drug treatment services and provided with appropriate supports.”

“As a Council, we acknowledge and appreciate the challenges faced by practitioners, the difficulties some practices are experiencing in terms of benzodiazepine and z-drug usage, and the demands from some patients for this and similar types of medication.”

“If a doctor is facing challenges in prescribing these medications, I would strongly encourage them, as a matter of priority, to engage with the HSE Addiction Services for support and guidance. The Medical Council supports doctors who follow recognised professional guidelines in line with professional practice and supports examples of good practice, particularly in difficult circumstances.”

“Any doctor whose level of prescribing is above the normal range, and who is not working in an exceptional area of practice, and who does not make any effort to refer their patients to support or reduce their high-prescribing levels may require formal investigation by the Medical Council.”

“However, it is vitally important that any patient who is taking benzodiazepines or z-drugs does not stop taking them without advice and guidance from their doctor.”

“Doctors have a very clear ethical responsibility with regard to the safe prescribing of these types of drugs as set out in the Medical Council’s Guide to Professional Conduct and Ethics for Registered Medical Practitioners.”

“By working in collaboration with the HSE, the Department of Health, the profession and other key stakeholders, the Medical Council and our partners are addressing a key patient safety issue and ensuring that doctors have the supports they need to protect patient safety,” concluded Dr Doyle.

The Medical Council’s Guide to Professional Conduct and Ethics for Registered Medical Practitioners clearly sets out the responsibilities of doctors in section 42.7:

“You must be aware of the dangers of drug dependency when prescribing benzodiazepines, opiates and other drugs with addictive potential. You should refer patients with drug dependencies to the appropriate drug treatment services and supports unless you have appropriate training, facilities and support yourself. You should not undertake treatment of opiate dependency unless you have been approved under the Methadone Treatment Protocol. You should safeguard patients with drug dependencies by taking reasonable steps to make sure that they are not inappropriately obtaining drugs from multiple sources. You can do this, for example, by liaising with drug treatment services, other doctors and pharmacists.”

When prescribing a controlled drug for a patient a doctor must:

• Provide a valid prescription which meets the requirements of the legislation
• Be satisfied as to the identity of the person for whose treatment the prescription is to be issued
• Follow relevant national and international prescribing guidelines
• Within reason, be available to confirm or discuss any matters related to the prescription and the patient
• Ensure the safe-keeping of prescription pads to reduce the risk of theft and forgery
• Facilitate appropriate withdrawal of controlled drugs and follow-up and refer as necessary

Doctors must also take additional care when considering prescribing benzodiazepines for patients in “at risk” groups or those with additional care requirements.

Examples include:

• Patients with drug dependency issues
• Patients receiving addiction treatment services
• Patients under the management of multiple doctors
• Patient population who attend pain clinics
• Patients transitioning from one place of care to another
• Patients in residential care settings
• Patients at risk of developing sleep disordered breathing
• Prisoners
• Patients with mental health issues
• Homeless patients
• Patients with additional care requirements
• Patients with poor health literacy or patients who don’t have English as their first language
• Paediatric patients
• Older people
• Pregnant/breast feeding women
• Patients with physical/intellectual disabilities
• Patients suffering from chronic illnesses
• Patients receiving palliative care

ENDS