NHS England has launched a new framework for pharmacists, prescribers and ICBs that aims to reduce inappropriate prescribing of five classes of medicine that might cause addiction, including antidepressants, opioids, gabapentinoids, benzodiazepines and sleeping pills.

It suggests that community pharmacists could help identify people who have been on these medicines for longer than a specified time, or who are self-medicating to deal with adverse affects of these medications. They can then review them or refer them to a general practice team.

The guidance also sets out to help clinical pharmacists and GPs to provide patients with a personalised review of their medicines, so that they can make a shared decision about whether to change the patients’ medication and explore other treatments.

It focuses on five classes of medicines that may be addictive: antidepressants, opioids, gabapentinoids, benzodiazepines and sleeping pills (z-drugs), all of which are prescribed ‘at levels higher than expected’ across most regions of England, with prescribing rates higher among women and in more deprived areas.

When staying on a potentially addictive medication is less clinically beneficial for the patient, the framework suggests steps that the healthcare provider could use to move them onto a different treatment.

This might be because the patient is no longer feeling the beneficial effects of the prescription, is continuing to take medication despite the underlying condition having resolved, there are more effective and safer evidence-based non-medicine alternatives available, the patient is experiencing withdrawal symptoms or needs to take other medicines to manage side effects, is developing harmful coping mechanisms or other conditions such as depression.

It also reminds NHS trusts that they can refer patients newly started on opioids and other medicines associated with dependence and withdrawal symptoms to the Discharge Medicines Service (DMS) or the New Medicines Service (NMS) in community pharmacy.

Over the past four years, pharmacists and GPs have helped cut opioid prescriptions in England by 450,000, according to the latest data.

The number of opioid painkillers prescribed has fallen by 8%, which is estimated to have prevented more than 2,100 incidents of patient harm and saved nearly 350 lives.

In 2019, a Public Health England review found that in 2017/18, one in four adults in England were prescribed benzodiazepines, sleeping pills, gabapentinoids, opioids for chronic non-cancer pain or antidepressants.

But since the review’s recommendations were implemented, the number of benzodiazepines prescribed in England has fallen by 170,000 (13.9%), while the number of sleeping pills prescribed in England fell by 95,000 (10.2%).

Since 2019/20, the number of antidepressants prescribed has increased by 8.4%, while the number of gabapentinoids prescribed has also increased. NHS England said that there is concern that this increase in use of gabapentinoids is in response to decreasing trends in opioid prescribing.

And figures from 2022 show that both the number of antidepressants prescribed and the number of patients taking the drugs in England has risen for six years in a row.

The new NHS plan will support primary care networks, integrated care boards, community health services and public health teams to help patients to manage their conditions without using potentially addictive drugs.

Professor Tony Avery OBE, national clinical director for prescribing at NHS England said: ‘The framework we are publishing today empowers local services to work with people to ensure they are being effectively supported when a medicine is no longer providing overall benefit’.

Professor Sir Stephen Powis, national medical director for NHS England said: ‘We know that patients who require prescriptions for potentially addictive drugs can become dependent and struggle with withdrawal, and this new action plan helps NHS services to continue positive work in this space having already slashed opioid prescriptions by almost half a million over the last four years.

‘The plan gives clear guidance to support patients who no longer need these drugs to provide them with routine medicine reviews and move them on to other, alternative therapies where appropriate, saving both lives and taxpayer money in the process.’

‘The plan gives clear guidance to support patients who no longer need these drugs to provide them with routine medicine reviews and move them on to other, alternative therapies where appropriate, saving both lives and taxpayer money in the process.’

The plan suggested that social prescribing could be offered instead of potentially addictive drugs.

Director for England at The Royal Pharmaceutical Society (RPS), James Davies, described the framework as a 'positive step forward', and called for all pharmacists to be able to refer patients to alternative treatments.

He said: 'The investment in innovative approaches to supporting patients is welcome and we would like all pharmacists to be able to refer people to such schemes.'

One case study referenced in the plan is ‘The Living Well with Pain Programme’ in Gloucestershire which supports patients living with long-term non-cancer pain to manage their mental health alongside the impact of pain.

It aims to reduce functional limitations caused by living with persistent pain, as well as to increase mental wellbeing and emotional resilience to live well alongside pain symptoms.

The programme was co-designed with patients living with pain, and includes approaches such as visual arts, music making, animation and physical movement.

Over the last four years, 83% of the patients who took part in the programme showed a significant improvement in their mental health and wellbeing.