The rate of prescription of addictive drugs such as benzodiazepines is “significantly influenced” by societal factors such as poverty, unemployment and lack of mental health services, a report has found.
On Tuesday, the Irish Medical Council (IMC) published a report on the overprescription of benzodiazepines, “z drugs” – which are used to help with sleeping problems – and gabapentinoids in Ireland.
These drugs are medications commonly prescribed to alleviate symptoms associated with neurological and psychological conditions such as anxiety and insomnia.
The report, which was conducted by a working group with representatives from across the health sector, was in response to an increase in complaints about overprescribing.
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Between 2018 and 2022, there were 201 complaints made to the IMC about prescribing practices.
Of those, 32 or 15.9 per cent related to overprescribing. Of those 32, benzodiazepines, “z-drugs” and/or gabapentinoids were cited in 23 (71.9 per cent) of them.
Between January 2018 and December 2022, the council deemed it necessary to take immediate action in relation to 19 doctors as serious concerns were raised in respect of prescribing of these medications.
In these cases, the council met to consider whether to make an application to the High Court, the report said.
The working group said a “key issue” identified throughout its report was the lack of data around prescriptions. The number of prescriptions are only monitored for those under the general medical services (GMS) scheme, meaning those on a medical card or GP visit card.
“This is of major concern to the members of the working group and will need legislative change to enable data collection for all prescriptions,” the report said.
Prescribing of benzodiazepines and “z-drugs” have reduced slightly since 2018 from just over 2,450,000 public prescriptions to around 2,275,000 in 2022, the report said.
However, the prescribing of benzodiazepine medicines in those over 65 years of age, particularly in women, is higher than known international averages, it said.
“This is of concern as older individuals face additional risks with benzodiazepines due to increased sensitivity and slower metabolism,” the report said.
The researchers also said that gabapentinoids were not classified as a controlled drug under the Misuse of Drugs Regulations 2017.
However, the IMC report highlighted “abuse potential” with these drugs due to links to feelings of euphoria, sociability and calmness. It called for consideration to be given around classifying these as controlled.
One of the report’s key recommendations was to increase resources for primary care counselling supports and addiction services to reduce the number of people requiring these prescriptions.
In December 2023, the latest available month when the report was being written, 13,580 people were on a waiting list for an outpatient care in pain relief. Of those, 3,559 people had been waiting more than 12 months.
“Addressing these wider societal issues through proposed reforms, improved access to mental health services and better education for both healthcare providers and patients is essential to mitigate the inappropriate prescribing of these medications,” the report said.
Prof Eamon Keenan, national clinical lead of addiction services with HSE, said benzodiazepines were the fourth most-common drug causing presentations to addiction services in 2023, accounting for 1,477 cases.
“These drugs are also implicated in drug-related deaths as recorded on our National Drug-Related Deaths Index,” he said.
“Over the years 2012 to 2021, there has been a 45 per cent increase in the number of deaths where benzodiazepines have been implicated. And deaths where pregabalin has been implicated have risen from 14 in 2013 to 83 in 2021.”
Dr Margaret O’Riordan, chair of the working group and member of the IMC, said: “The overprescribing of benzodiazepines, z-drugs and gabapentinoids is an issue that affects patient safety and has significant implications for public health.”
