Patients concerned about developing dependence or withdrawal symptoms from some prescribed drugs

Image of white pills. Credited to James Yarema on Unsplash
Image credited to James Yarema on Unsplash

General practice patients say that they are not sufficiently warned about the possibility of developing dependence or withdrawal symptoms from some prescribed drugs, according to a recent study.

Oxford Brookes University expert Dr Jennifer Seddon, a Senior Lecturer in Psychology, led a two-year study that explored how to improve the experience of patients who are prescribed drugs that carry risk of dependency or withdrawal. The study examined real life patient experiences of taking antidepressants, opioids, benzodiazepines, z-drugs and gabapentinoids.

Concerns highlighted by patients in the study included a lack of detailed information about the drugs when first prescribed, with some stating that they were not aware of the risks of dependency or withdrawal. Other concerns included not being given information about alternative treatments available, and patients described frustrations in accessing continuity of care due to booking systems not allowing them to see the same clinicians, and long waiting times.

Dr Seddon said: “Significant concerns have been raised by Public Health England and the British Medical Association regarding how medications with a risk of dependence or withdrawal are managed and how care is experienced by patients. This study not only highlights the main areas of concern from the perspective of patients and healthcare professionals, but also suggests ways to address these concerns to improve the patient experience of care. We hope that the results of this study will lead to change in the way these medications are managed within primary care, and will result in wider improvements to the patient experience.”

In response to patients’ concerns, the study found that ensuring patients receive detailed medication-related information at the point of prescription is key. This can be achieved by signposting patients to information, including risks, through automated text messages or signposting patients to relevant websites. Additionally, continuity of care should be prioritised for patients prescribed medications with a risk of dependence or withdrawal. One of the ways this could be achieved is by creating small teams of two to three clinicians working in partnership.

The study was funded by the National Institute for Health Research (NIHR), and published in the journal BMC Primary Care, with co-investigators Dr Sarah Wadd from the University of Bedfordshire, and Dr Sion Scott of the University of Leicester. 

The study involved five GP practices in Norfolk and Waveney, and included 20 patients and 15 healthcare professionals.

Dr Alice Shiner, a GP who took part in the study, said: "My practice has changed since taking part in the study.  Whilst previously I might have brought up the option of deprescribing drugs at a later date, I am now careful to always include this discussion at the time of initiating these medications.  Patients are therefore immediately aware of the option of stopping the medication as well as the intended short-term nature of the prescription, which may help them initiate a discussion around cessation at a later date.

“More generally, our practice also benefits hugely from having a great Clinical Pharmacist who has the time and knowledge to focus on deprescribing initiatives.  The practice has adopted policies to facilitate deprescribing which helps promote consistency amongst the clinicians."