Short Life Working Group on Prescription Medicine Dependence and Withdrawal recommendations: Scottish Government response

Conclusions

Scottish Government and members of the Short Life Working Group are grateful for the time that all respondents took to contribute to the consultation and welcome the input towards finalising the recommendations.

There is a strong view that respondents want to see the recommendations implemented and embedded in practice. To that end, we will add an additional recommendation focused on implementing a framework for delivery of the recommendations. We will do this through the development of an implementation programme as a formal project. Development of the programme has already started and we will publish this shortly. We have also made some amendments to the recommendations as a result of the feedback received during the consultation and have listed the final recommendations in table 3 (the amendments are shown in bold).

Final Recommendations

Table 3: Final SLWG Scottish Recommendations

PHE Recommendation:

Recommendation 1 – "Increasing the availability and use of data on the prescribing of medicines that can cause dependence or withdrawal to support greater transparency and accountability and help ensure practice is consistent and in line with guidance."

SLWG Scottish Recommendations:

In line with National Statistics protocol, composition, and publication of statistics by Public Health Scotland will continue to be reviewed with consideration to user need. This will mean that clinical professionals and researchers can use the breadth of data and data indicators to improve patient care and treatment by evaluating interventions, measuring long-term outcomes in clinical trials, assessing the safety of new medical interventions and supporting the understanding of patterns of health and illness across the whole population. The suite of indicators and reports will be developed within STU to support front line practitioners identify patients that need review of their treatment. The data will be relevant, regularly updated and comparable across and within locals

PHE Recommendation:

Recommendation 2 – "Enhanced clinical guidance and the likelihood that it will be followed."

SLWG Scottish Recommendations:

A high priority recommendation of the SLWG is to take the antidepressant and gabapentinoid guides to conclusion, this will involve establishing expert groups, including patient representatives, and building upon the scoping document.

SLWG are also recommending that Quality Prescribing Guides are developed for the remaining classes of drugs covered by the SLWG, Z-drugs, and benzodiazepines.

The clinicians involved in the development of the Quality Prescribing Guides will use their networks to help ensure that the guides are used in practice and we will take their advice on what additional steps need to be taken to aid implementation of each guide.

Quality prescribing guides will be evidence based, involve Experts by Experience in their development and be regularly updated.

PHE Recommendation:

Recommendation 3 – "Improving information for patients and carers on prescribed medicines and other treatments, and increasing informed choice and shared decision making between clinicians and patients."

SLWG Scottish Recommendations:

Work with NHS Inform and NHS 24 to develop on-line guides and resources to support patients suffering from withdrawal from the 5 classes of medication covered by the review. This will involve considering existing material produced for recreational drug use and put a team together to produce tailored guidance for each of the 5 classes of medication. The teams will include patient representation. Additional shared decision aids will be developed for the medicines covered by the SLWG and included within the polypharmacy app. Alternative formats will be available alongside any online resources in order to maximise the reach of the information.

PHE Recommendation:

Recommendation 4 - "Improving the support available from the healthcare system for patients experiencing dependence on, or withdrawal from prescribed medicines."

SLWG Scottish Recommendations:

The SLWG agree that an out-of-hours helpline is required to help patients suffering from dependence and withdrawal from prescribed medicines as it is often out-of-hours when symptoms are most acute. Further scoping work should be undertaken on how the existing service provision can be boosted to take this requirement on board, this would include training for those staff who answer calls on behalf of the service. We have established an NHS24 synergies sub-group that will take this forward jointly with recommendation 3.

PHE Recommendation:

Recommendation 5 – "Further research on the prevention and treatment of dependence on, and withdrawal from, prescribed medicines."

SLWG Scottish Recommendations:

The Public Health England group came up with some proposals for further research. The SLWG considered these in a Scottish context and added some additional project proposals. It is hoped that some of these proposals will be adopted by academia and while Scottish Government will not commission these directly, we will consult with the Chief Scientist's Office on how these can best be promoted to relevant academic and other bodies.

PHE Recommendation:

Recommendation 6

SLWG Scottish Recommendations:

Establish an implementation framework that will deliver on the recommendations of the SLWG.