Patient safety concerns in trying to check complaints about doctors who over-prescribe benzodiazepines and other habit-forming medications

An expert group set up to look at over-prescribing of drugs said serious patient safety concerns arose with difficulties in getting access to the prescribing history of doctors who were subject to complaints.

Minutes of group meetings said complaints about doctors required a “piecemeal trawl” of individual pharmacy records which could be time-consuming, expensive, and insufficient.

Concerns were also raised over how difficult it was to get solid data on the extent of private prescribing of benzodiazepines, and other addictive drugs, including sleeping tablets.

One meeting was told: “It was reiterated that it is very difficult to get a clear picture of private prescribing without a centralised record and the urgency of resolving the issue was flagged.”

It said a campaign needed to be undertaken to get prescription of certain addictive drugs in Ireland at least back to international averages and to “reign in the outliers”.

The meeting also heard that a lot of people come out of hospital on “sleeper” tablets they had never been on before admission.­­

Challenges in helping patients who had been on benzodiazepine drugs for years, especially the elderly, were raised.

It said it might be a better approach to start with patients who had been on the medications “for months, rather than years”.

“Two of the aims of the group are encouraging doctors not to initiate these medications and also reducing the number of chronic users,” a meeting heard.

The minutes also flagged how use of “chronic pain medication” could lead to addiction with particular issues with opiates, over the counter codeine medications, and the drug pregabalin.

A meeting was told that there was a serious issue in the UK and Eastern Europe with illicit fentanyl – a powerful opiate – that needed to be monitored.

The easy availability of over the counter codeine medications was highlighted with a “pattern of young women (age 15-34) purchasing high levels of these drugs”.

It was suggested that this could be due to period pain but the meeting heard that despite restrictions on buying codeine medications, it was easy for people to simply travel from “one pharmacist to another” to get around them.

A meeting also heard how the power of the pharmaceutical industry in Ireland was “huge”.

Minutes of that meeting said: “It was agreed that we need visibility on what is coming into the country.”

It said while doctors knew certain drugs could be addictive, patients did not, and that perhaps packaging should more explicitly state the risk of dependency.

The minutes said: “It was agreed that it can be much easier to prescribe pain relief than not to, as not doing so is more time consuming and requires spending longer with the patient and sometimes providing alternatives.”

Another meeting heard about the “aggressive promotion” by drug companies of certain drugs for pain after an operation.

It was told that opioids were given “far too easily” and that better access to pain clinics would be a better development for patients.

The minutes said: “There was a discussion around the importance of educating patients regarding the risk of addiction to opioids, and concern that Ireland could go down the same route as the US regarding opioid addiction.”

In a statement, the Irish Medical Council – who released the records – said they had been part of the overprescribing group since 2019.

The group’s chair, Dr Margaret O’Riordan, said “[We have] been working with the HSE, the Department of Health, the Pharmaceutical Society of Ireland and the medical profession over the past number of years to consider the issue of overprescribing, and particularly overprescribing of benzodiazepines and z-drugs [sleeping tablets], in this country.

“The Medical Council recognises the challenges medical practitioners face in regard to the prescribing of such drugs, and by joining with our stakeholders, aim to reduce initiation and overprescribing of these drugs in the interest of patients, and to support prescribers in adherence with guidelines.”