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

Delivery of Recommendations

Delivery of the recommendations will involve a coordinated approach across related Scottish Government policy areas and colleagues in NHS Scotland. Relevant policy areas include: chronic pain, mental health and Drug Related Deaths. We have provided a short update from each.

Chronic Pain

Chronic pain is defined as pain which has persisted beyond normal tissue healing time.^[1] It is estimated that 1 in 5 people in Europe experience ongoing chronic pain, with 1 in 20 people in Scotland experiencing severe, disabling chronic pain.^[2] Chronic pain is a condition which is individual to the patient and any therapeutic management plan needs to place the individual at the centre.

Prescribing for chronic pain in Scotland increased by 66% over the ten years from 2006.^[3] Commonly prescribed drugs include classes of medicines covered by the work of the SLWG, including opioids and gabapentinoids. Many people with chronic pain may also be prescribed medicines associated with dependence including benzodiazepine, z-drugs and sedating agents. Therefore the recommendations of the SLWG will be used to complement and inform improved prescribing and support for people with chronic pain. In order to support prescribers and people with chronic pain alike in identifying the most appropriate management plan, the Scottish Government has supported the development of clinical and prescribing guidance. This includes SIGN 136 – Management of Chronic Pain and its companion document, Quality Prescribing for Chronic Pain – A Guide for Improvement 2018-2021. There is some evidence to suggest the introduction of these resources has influenced prescribing of pain-related medicines in recent years. REF: Assessing the impact of SIGN 136 on opioid prescribing rates in Scotland: An interrupted time series analysis | medRxiv]

Improving services and support for people with chronic pain in Scotland remains a priority for the Scottish Government. In September 2020 the Government published a Framework for Recovery of NHS Pain Management Services to support the rapid and safe remobilisation of specialist pain management services in Scotland which were paused during the initial wave of the COVID-19 pandemic. The Scottish Government intends to carry out consultation on a draft Framework for Pain Services in 2021 which intends to improve access to patient-centred care, and will support the implementation of the SLWG recommendations.

Mental Health

People experiencing mental ill health should expect high quality care, which can include the prescription of medication if they need it. The prescription of any medication is a clinical decision made in discussion with the patient, and within the context of their recovery. Prescriptions should be reviewed regularly to achieve the best possible health outcomes, and on-going support should be provided to patients who are prescribed medicines. Additional help and support is available as alternatives to prescribing drugs such as psychological therapies; talking therapies and digital support services.

We have committed to delivering a tailored programme of work to help individual NHS Boards respond effectively to the anticipated increase in demand for mental health services in the months ahead. We have also committed to building on innovations and new service designs that have emerged, such as the establishment of Mental Health Assessment Centres and the expansion of digital services and online therapies, where they best meet patient needs.

Protecting good mental health in Scotland is central to our long-term response to the coronavirus pandemic and - as set out in our Mental Health Transition and Recovery Plan - a key part of this is to ensure the continuity and the quality of mental health services, enhancing access where demand is high. We see reducing stigma as critical, which includes challenging any stigma around care and treatment for mental ill-health

Drug-Related Deaths

Within the recent increases being reported annually in drug-related deaths in Scotland there has been a pattern of rises in deaths where many of the contributors to prescription drug dependence have been implicated. As part of the National Mission to tackle the harms and deaths caused by drugs in Scotland, the Scottish Government is focusing attention on the use of and role of benzodiazepines which can lead to drug death in particular. The Drug Deaths Taskforce has lead on developing an approach to tackle the harms caused by these drugs and has made separate recommendations on actions to support people who have developed problematic use. A key focus now will be on providing good information to people in need of support, and on introducing a wider range of treatment options.