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NETWORK A national newsletter on substance misuse management in primary care network NETWORK 37 OCTOBER 2014 Addiction to medicines: special edition

shows how specialist projects can provide bespoke support to those with benzodiazepine dependency. Pauline Forrester also gives an outline of a specialist primary care project working with dependency on opioid pain medicines on page 14. As with other dependency-related problems, support for recovery can also be accessed via local mutual aid support groups.

We are pleased to publish this special edition of Network newsletter on addiction to medicines (ATM).

ATM is gaining

increasing attention both in the news and in national policy, and yet there remains a level of uncertainty within the field about how to tackle the issues posed by misuse of over-the-counter (OTC) and prescription only medications (POM). ATM and what to do about it often causes confusion due to a lack of prevalence figures, evidence and guidance, guidelines and advice: and where this does exist, it is not always fit for purpose.

ATM causes a range of issues for individuals, their families and communities. On page 10 an anonymous author brings home the problems that can be caused, and the ability of individuals to make changes; in this case with support from primary care. However, patchy service provision for ATM can lead to problems. Some areas provide bespoke services, including primary care based, voluntary sector and peer lead services and in other areas local drug and alcohol teams usually provide support. An article by Melanie Davis from the Camden REST project on page 12

In this issue

George Ryan discusses the pharmacological management of pain, identifying potential risks to the development of addiction to medicines and how to manage problems when they arise. Page 2

Martyn Hull takes us through the complex issues involved in benzodiazepine prescribing. Page 5

Steve Taylor gives an overview of policy issues regarding addiction to medicines and places primary care at the heart of identifying patients with problems and emphasises the importance of localism in providing strong care pathways for this group. Page 7

Misuse of pregabalin and gabapentin is a growing concern and we are pleased to provide a summary of an advice document prior to its imminent publication. Page 8

This powerful personal account describes the problems addiction to prescription medicines can cause and the great strength individuals have in overcoming dependency. It also highlights the important role of GPs in not only preventing but also supporting people to overcome addiction to medicines. Page 10

Misuse of over-the-counter medication is often a hidden problem that can create dilemmas for practitioners when identified. Kevin Ratcliffe describes the issues involved and suggests that there may be more skills and knowledge amongst professional than we might think. Page 11

Melanie Davis puts the case for specialist services for people with addiction to benzodiazepines and the importance of tailoring each intervention to an individual’s needs. Page 12

Pauline Forrester provides an overview of a specialist primary care project to support people with problems with opioid pain medication. Page 14

Steve Brinksman is Dr Fixit to a GP who asks for support working with a patient who has developed a problem with over-the-counter medication. Page 15

See the latest course and events on page 16. We hope you enjoy this edition. Editor


Despite the fact that many services are developing to provide support for ATM, in some areas there remain no commissioned services for those experiencing problems with ATM, leaving people with few places to turn to for help. In this era of localism it is important that we ensure that the treatment response in our local areas is fit for purpose and where gaps exist we should be raising this with commissioners. On page 7 Steve Taylor from Public Health England Alcohol, Drugs and Tobacco division provides an outline on policy regarding ATM to support discussions with those in strategic positions.

The increasingly problematic misuse of gabapentin and pregabalin is a topic that frequently crops up on the SMMGP forums as practitioners seek advice and support from other clinicians. We are excited to provide a preview of a paper from an expert group convened to address this issue, on page 8.

We also cover other clinical issues in this special edition. George Ryan discusses the pharmacological management of pain on page 2, Kevin Ratcliffe outlines ways of working with misuse of over-the- counter medications on page 11 and Martyn Hull provides advice on prescribing benzodiazepines on page 5.

We hope this special edition of Network newsletter will support practitioners, individuals, their families, and communities in addressing problems with ATM.

Kate Halliday Editor


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