Back on track: Lucy Fernandes has beaten her dependency
Lucy Fernandes, a 31-year-old who lives in London, is one of countless thousands of Britons who’ve become dependent on their prescription medicines through no fault of their own.
Lucy became trapped on three drugs prescribed to her for severe anxiety. She started taking them in 2009 after seeing a psychiatrist because she was breaking down under the pressure of doing a master’s in Renaissance art history.
‘Looking back, I realise now that I was too young to have taken on such a huge challenge,’ she says. ‘I’d begun the master’s straight after finishing university.’
She was prescribed the benzodiazepine tranquillisers diazepam (formerly known as Valium) and clonazepam, plus lamotrigine, an anti-convulsant drug that is used as a mood stabiliser.
But her body developed an increasing tolerance to the drugs and she needed greater doses. However, the longer she was taking the pills, the worse the side-effects became. ‘The mood stabiliser disrupted my sleep as it made me more alert at night, while the benzodiazepines made me withdrawn,’ she says.
‘I was just not myself. Things were fuzzy. It was hard for me to understand what was going on.’
At the end of 2014, the side-effects were so debilitating that Lucy decided to stop taking her medication. But the withdrawal only made her feel worse and she had to give up her job as a gallery shop assistant and move back home.
Meanwhile, the effects of withdrawing from the drugs worsened so that for months she didn’t sleep at all.
Lucy has since managed to overcome her dependency — thanks to one of the tiny handful of organisations that offer help to patients hooked on their prescription pills.
But the NHS has now said it will no longer fund that service, leaving others with nowhere to turn for help.
Like many Lucy became trapped on three drugs prescribed to her for severe anxiety (stock image)
The problem of prescription pill dependency is one that campaigners have long fought to have recognised, with growing concerns about patients left dependent on medication prescribed by their doctors — and then abandoned to their fate.
Concerns centre on drugs commonly prescribed for anxiety, depression, insomnia and pain.
They include benzodiazepines (such as diazepam and lorazepam); Z-drugs (such as zolpidem and zopiclone used for sleep problems), opioid painkillers (such as codeine and tramadol), and the gabapentinoids (GABA) for nerve pain.
Antidepressants, although not traditionally regarded as addictive, can also cause withdrawal problems for some patients. These pills can, and do, help some people — and many do not become dependent on them, while others do.
The NHS has now said it will no longer fund the service that helps patients get off prescription drugs, leaving others with nowhere to turn for help
Last year, a committee of concerned MPs, the All-Party Parliamentary Group on Prescribed Drug Dependence (APPG), warned that more than a million patients in England alone are taking dependency-forming drugs unnecessarily.
The overprescription of these drugs — and failure to provide help to patients to get off them — prompted calls from the APPG, along with the British Medical Association and other leading medical organisations and patient groups, for the Government to acknowledge the problem and set up a national helpline. The calls have been backed by the Mail.
And now it appears campaigners have been vindicated, with Steve Brine, the Public Health Minister, announcing last week that Public Health England will undertake an inquiry into the scale of the problem, including harm caused by dependency and withdrawal from tranquillisers, antidepressants and painkillers.
It is due to report in 2019 but what worries observers is whether this will come to anything — as for years ministers have been making grand statements, then doing nothing.
The problem of prescription pill dependency is one that campaigners have long fought to have recognised, with growing concerns about patients left dependent on medication prescribed by their doctors — and then abandoned to their fate
In 2013, Anna Soubry, then Public Health Minister, declared on BBC Radio 4 that the issue of prescribed-drug dependence ‘has not been sexy. The time has now come for us to put it up the agenda.’
Instead, it was parked in the long grass, where it had been left by David Cameron, who’d said in 2011: ‘Tranquilliser addiction is an extreme problem in our country . . . We must deal with the problem at source.’
Since then, tranquilliser prescriptions have spiralled. Back in 1994, David Blunkett, then Labour’s Shadow Secretary of State for Health, called benzodiazepine over-prescription ‘a national scandal’ and pledged to ensure justice for victims. When Labour won the 1997 election, it did no such thing.
And in 1993, the Tories had announced that GPs should be given local targets for reducing benzodiazepine prescriptions. Nothing came of this.
Concerns centre on drugs commonly prescribed for anxiety, depression, insomnia and pain
Announcing lengthy inquiries is a well-worn strategy for ‘kicking the can down the road’.Indeed, there is already a wealth of evidence to show the extent of the problem in Britain without yet another investigation.
The BMA reacted to the new announcement by urging prompt action. Dr Andrew Green, the GP Committee clinical and prescribing lead, welcomed the inquiry but also pointed out that it called for a national 24-hour helpline nearly two years ago.
‘A helpline could be set up relatively quickly,’ Dr Green said. ‘It would give individuals suffering with dependence to drugs like benzodiazepines vital, timely support and advice.’
Yet instead of promptly increasing support for these innocent victims, just as the review was announced, the NHS was quietly pulling the plug on one of the few such services that exists.
They include benzodiazepines (such as diazepam and lorazepam); Z-drugs (such as zolpidem and zopiclone used for sleep problems), opioid painkillers (such as codeine and tramadol), and the gabapentinoids (GABA) for nerve pain (stock image)
For 30 years, the REST (Recovery Experience Sleeping Tablets and Tranquillisers) service at the mental health charity Mind in Camden has helped people achieve the gruelling task of weaning themselves from benzodiazepines and other addictive prescription drugs. It is the only such service for London and one of only six in the whole country. Mind in Camden says standard clinics for people hooked on illegal substances are not suitable as they are geared to get clients off drugs as quickly as possible.
Yet experts say the only way to get off prescribed tranquillisers, painkillers and antidepressants without horrific side-effects is by cutting the dose slowly and carefully — known as tapering. This, says the charity, needs intense specialist support.
Lucy discovered REST on the internet at the end of 2014 and joined its patient support group, which meets weekly, with around eight to ten people.
She’s convinced this is the only thing that could have saved her: ‘You need the experience and wisdom of people who know how to come off these drugs.’
Last year, a committee of concerned MPs, the All-Party Parliamentary Group on Prescribed Drug Dependence (APPG), warned that more than a million patients in England alone are taking dependency-forming drugs unnecessarily
Previously her doctor had not taken her seriously, putting her symptoms down to anxiety.
‘He seemed to view all psychiatric drugs as fairly harmless in terms of side-effects and dependency,’ she explains.
With the help of REST, she started cutting her dose by 1mg a month. ‘It took me about 18 months to taper off,’ she says. ‘I was tired a lot of the time, but it was so much better than trying to go cold turkey.’
Today, 14 months on, she says her life is ‘back on track’. ‘I’m just starting a job, working to develop services in mental health, and I’m living independently.’
REST, which sees around 130 people at any one time, has successfully helped thousands. Each is supported for a year or more through the arduous process of weaning off their medications.
Antidepressants, although not traditionally regarded as addictive, can also cause withdrawal problems for some patients. These pills can, and do, help some people — and many do not become dependent on them, while others do (stock image)
Much of this is done through peer support from people like Lucy who have already escaped dependency on prescribed drugs.
But the local health authority, Camden Clinical Commissioning Group, says it will no longer pay REST’s annual £45,000 funding.
Instead, it plans to ‘improve’ services by telling patients dependent on prescription drugs to attend GP services and community centres.
The CCG has not answered our questions about how much money would be saved by the move, and whether the alternative services will be shared with people using illegal drugs.
But the move has been condemned by the APPG, which points out that REST costs only around £372 per client each year.
Paul Flynn MP, chair of the APPG, told us: ‘Closing the REST project is short-sighted, and will lead to unnecessary suffering and uncertainty for clients.’
Brian Dawn, chief executive of Mind in Camden says: ‘It is a false economy. Admissions to more expensive A&E, hospital, rehabilitation and other services will be the inevitable result.’
Bizarrely, only last week the NHS’s own National Institute for Health Research announced that it is to fund a clinical trial at Warwick University for treating people trapped on long-term strong painkillers — using the same group-therapy approach pioneered by Mind in Camden.
Observers fear this doesn’t bode well for the new inquiry: if it’s to have any effect, it will have to ensure the NHS takes a consistent approach to the problem.
One expert close to the inquiry, who wishes to remain anonymous, adds another concern: that ‘organisations with a vested interest in keeping things denied — such as people involved with drug companies — may sit on the inquiry group and try to bury the issue. We have seen this happen before,’ he told Good Health.
Meanwhile Barry Haslam, a retired accountant from Oldham, Lancs, who has long campaigned for prescribed drug-dependent victims following his own experience of ten years trapped on benzodiazepines, welcomes the review as a significant step.
‘But we have no idea yet about what issues it will cover,’ he said.
He runs Tranx, a withdrawal support service for people dependent on long-term prescriptions. It is England’s only NHS-funded facility — Haslam says patients need a network of such clinics across the country. But he fears that the review will fail to recommend this.
He adds: ‘From my 20 years in this area, I fear that there could be just another fudge.’
However, Oliver Letwin MP, the vice-chair of the APPG, remains cautiously optimistic. ‘We are hoping the inquiry will enable Public Health England to persuade itself, and the Department of Health and the NHS, that the need for national help for victims of prescription-drug addiction is well evidenced,’ he says.
‘The proof of the pudding is in the eating — but I am optimistic.’
WHEN DRUGS TO TREAT DEPRESSION CAN WRECK PATIENT’S LIVES
Weaning yourself off antidepressants can be as harrowing as getting off ben-zodiazepines, as an ever-growing number of Britons are discovering.
For years, it was thought these drugs don’t cause dependency, but some experts and patients disagree, and point to severe withdrawal problems.
Kerryan Hobbs: Battling for 15 years to give up
It is to Public Health England’s credit that its new review will include antidepressants.
Seven million GP prescriptions for antidepressants were written in England in 2016 — double that of a decade before.
Research published last year in the British Medical Journal says the main reason for this is a vast increase in the proportion of patients who are parked on the drugs long-term.
What this can mean for those affected is graphically illustrated by 43-year-old Kerryann Hobbs.
Kerryann, a single mother from Ilkeston, Derbyshire, became addicted to the prescribed antidepressant venlafaxine she was first given two decades ago.
For the past 15 years she’s been trying to stop taking it but the withdrawal symptoms she’s experienced — severe head pains, confusion and exhaustion — have made it impossible.
‘I have battled but have failed every time,’ she says.
She was prescribed the drug for anxiety and depression following the trauma of her parents’ divorce. ‘I was not warned of any possible side-effects,’ she says.
But after four years, the drug ceased working for Kerryann, leaving her with only the side-effects of dizziness and nausea.
‘I have been trying to wean myself off ever since by cutting the dose,’ she says. ‘I get down to the last bit of the tablet, but at that point my life crumbles, like I’ve suddenly gone cold turkey.
‘I lose all concept of where I am and what is happening. I get angry at the slightest thing. The pain in my head is horrendous if I even just nod.
‘I lose all interest in life and can’t get out of bed some days.’
According to the NHS Choices patient-advice website, venlafaxine ‘is safe to take for a long time. There don’t seem to be any lasting harmful effects from taking it for years’.
Furthermore, it says: ‘Withdrawal symptoms will be harmless and over in a few days.’
Yet expert reports in the Dutch psychology journal, Tijdschrift Voor Psychiatrie, spanning from 2002 to 2013, warn that withdrawal can cause severe delirium and mania, even when patients are trying to withdraw slowly by tapering their dose.
A further report by sleep-medicine specialists at New York’s Hofstra North Shore-LIJ School of Medicine published in the Journal of Clinical Sleep Medicine in 2013, highlighted another bizarre symptom of withdrawal — a rare type of narcolepsy called status cataplecticus, where people fall into a deep and unresponsive sleep for hours or even days.
And when investigators at the French National Institute of Health Research (INSERM) analysed nearly 2,500 online discussions about antidepressants, venlafaxine withdrawal was one of the most common subjects, they reported last October in the Journal of Medical Internet Research — Mental Health.
K erryann says three months ago she lost the specialist cake-baking business she’d built from a home-kitchen concern into a High Street shop because she ‘couldn’t put my all into it any longer’.
‘The drug had made me so poorly,’ she says. ‘I had so many plans for my life but my willpower and enthusiasm are demolished. In the past year, I have piled on six stone and lost my business.’
She is now trying again to wean herself off it but she’s been unable to find support from the NHS or voluntary organisations.
‘Doctors don’t recognise this as a problem,’ she says. ‘All I am told is to re-start the venlafaxine because my depression is back.’
Kerryann has now turned to Facebook forums for help.
‘There’s a lot of support from people who’ve had problems themselves,’ she says.
‘Most advise to taper off the drug incredibly slowly. I am hopeful that with their support I will get there.’