The review showed that 11.5 million adults in England (26% of the adult population) received a prescription for benzodiazepines, Z-drugs, gabapentin/pregabalin, opioids for chronic non-cancer pain or antidepressants in 2017 to 2018.
Most patients who started a prescription in June 2015 were estimated to have received a prescription for 3 months or less. However, in March 2018, around half of people using each type of these drugs had been receiving a prescription continuously for at least 12 months.
More than 1.1 million patients prescribed opioids and 455,000 patients prescribed gabapentinoids had been receiving prescriptions for 12 months or more. Around 200,000 patients had been receiving Z-drugs and a similar number benzodiazepines for a year or more. More than 2 million patients had been prescribed antidepressants for a year or more as of March 2018.
The PHE report warns that long-term prescribing of these drugs can result in dependence or withdrawal problems.
Aside from antidepressants, the medications reviewed are all licensed and generally indicated for short-term treatment of acute conditions. Benzodiazepines should not usually be prescribed for longer than 2 to 4 weeks and long-term prescribing of opioids for chronic, non-cancer pain is not effective for most patients.
MIMS provides a quick-reference summary table to help prescribers withdrawing or switching patients' antidepressant treatment.
Between 2015 to 2016 and 2017 to 2018 the rate of prescribing for antidepressants increased from 15.8% of the adult population to 16.6% and for gabapentinoids from 2.9% to 3.3%, the report showed. There was a small decrease in prescribing rates for the other 3 medicine classes.
Rates of prescribing were higher for women (1.5 times those of men), and the rates generally increased with age.
Prescribing rates for opioid pain medicines and gabapentinoids had a strong association with deprivation, being higher in areas of greater deprivation. Antidepressant prescribing had a weaker association with deprivation. For benzodiazepines and Z-drugs, prescribing rates slightly decreased with higher deprivation. For all medicine classes the proportion of patients who had at least a year of prescriptions increased with higher deprivation.
RCGP chair Professor Helen Stokes-Lampard said: 'This report analyses prescribing data for medications that when prescribed appropriately can be effective and beneficial for many patients – and it shows that the vast majority of prescriptions issued are short term, and that we are seeing a decline in opioid prescriptions for chronic pain, both of which are encouraging trends.
'What it also indicates is the severe lack of alternatives to drug therapies for many conditions – and where effective alternatives are known and exist, inadequate and unequal access to them across the country.
'While the vast majority of prescriptions will be appropriate, if we are to reverse the prescribing trends outlined in this report, GPs need better access for our patients to alternative therapies in the community. We also need more high-quality research into alternatives to drug therapies in general – as well as around dependence and withdrawal - and for this to shape the clinical guidelines that GPs use to inform our practice.'