Short Life Working Group on Prescription Medicine Dependence and Withdrawal: consultation analysis

1. Executive summary

In response to a petition submitted to the Scottish Parliament and work undertaken by Public Health England (PHE) to review dependence and withdrawal associated with some prescribed medicines, the Scottish Government established a short life working group (SLWG). The group was asked to look at the scale of the issues in Scotland and the recommendations from the PHE report in the Scottish context, and with consideration of Scottish data. Membership of the SLWG included medical, pharmacy and nursing representation from the professions as well as professional bodies, patients with lived experience, patient organisations, SIGN, Public Health Scotland and academia.

The group sought to identify the scale, distribution and underlying contributors to prescription drug dependence and what might be done to address this in Scotland.

The review covered adults (aged 18 and over) and 5 classes of medicines:

• Benzodiazepines (mostly prescribed for anxiety and/or insomnia)
• Z-drugs (sleeping tablets with effects similar to benzodiazepines)
• Gabapentin and pregabalin (together called gabapentinoids and used to treat epilepsy, neuropathic pain and, in the case of pregabalin, anxiety disorders)
• Opioids for chronic non-cancer pain
• Antidepressants (for depression, anxiety disorders and neuropathic pain).

Draft recommendations were provided to the Cabinet Secretary for Health and Sport who has approved their publication by way of public consultation. The consultation paper discussed each of the PHE recommendations in turn, described the current landscape in Scotland, work that had been undertaken during the life of the SLWG and recommendations for further work agreed by the group and patient representatives. The analysis of the results of this consultation form the basis of this report.

A quantitative analysis was conducted on two of the questions within the consultation. These questions asked:

1. Whether the individual agreed with the specific recommendation, and

2. The degree to which they agreed with the recommendation.

Respondents were also provided with a free comment box within which they could express any particular comments they may have in regards to the recommendation or any other topic of interest or concern. A qualitative analysis of the responses to this open ended comments looked for themes, insights and opinions on the respondents views of the consultation recommendations.

1.1 Level and strength of agreement with the recommendations within the consultation:

There was a high level of agreement for the recommendations – 34 respondents (87%) agreed with Recommendations 1, 3, 4 and 5, and 33 respondents agreed with (85%) recommendation 2.

1.2 General themes that emerged throughout the consultation:

Although stakeholder responses were characterised by a wide range of topics and opinions in regards to their comments on the individual recommendations, there were certain themes that emerged across responses. These were topics or views that had a continuous thread throughout the various comments, even if within individual recommendation sections there were too few references to identify an emergent theme.

These topics included:

Value of data

• The value of Data and research, and the particular areas of interest respondents highlighted for further attention and focus.
• The need to consider not only how evidence and data are generated by also how that knowledge is implemented into practice through a process of knowledge mobilisation. Respondents highlighted some current issues with this process for existing data, and the need to alleviate the issue if future work is to be fruitful.

Need for culture change

• The need for change in work culture/dynamics within the healthcare system. Respondents made reference to the need for greater communication within and between actors in the healthcare system, as well as improved communication and decision making between patients and practitioners.
• Respondents also commented on the topic of patient experience and patient empowerment. These comments focused on the need to centre the patient experience in both data collection and research focus. In addition to the need for patients to be able to make informed decisions through a greater access to relevant information (particularly around the issue of withdrawal), as well as a more collaborative approach to the planning and decision making process of their individual health journey.

Accessibility of information

• Respondents discussed the need for suitable messaging with regards to guidance/information. Many respondents commented on the need to consider the accessibility of the guidance/data/information that the recommendations would make available. Accessibility in this context often referred to the ability of patients to have the means (either the physical IT resources, or the technical capacity to use said resources) to navigate to the required digital information and to ensure that alternatives were available in order to compensate for any potential disadvantages people may have in accessing this information.

Better use of resources

• A few respondents commented on the need to better utilise existing resources such as community pharmacies and community pharmacists in order to action the recommendations of the consultation paper.
• Many respondents commented on the issue of resourcing through the consultation. This typically revolved around discussion of the need for greater resources to be made available in order for the recommendations to be successfully implemented. Resourcing in this context could refer to issues such as additional staffing, additional funding, or additional time for people to parse the information available.

The final topics that emerged throughout the consultation were the positive comments and concerns respondents had with regards to the individual recommendations, as well as the consultation as a whole.

In addition, the comments to each individual recommendation were analysed and grouped into emergent themes for each specific recommendation. These themes were often recommendation specific, however due to the nature of the subject matter, themes were often interrelated (e.g. guidance development and adherence), and therefore should be considered within the broader context of the discussion around the recommendation in particular and the consultation as a whole.