§ Andrew GeorgeTo ask the Secretary of State for Health (1) how many patients(a) have been prescribed benzodiazepines and (b) were considered to be clinically dependent upon them during each year since 1971; [15588]
(2) what advice his Department issued with regard to the (a) daily dosage, (b) time limit of dosage, (c) possible 169W side-effects and (d) tendency to addiction of those prescribed benzodiazepines during the last 25 years; and what assessment he has made of such advice issued by medical advisory bodies; [15586]
(3) what recent assessment his Department has made of the impact on NHS patients of prescribing benzodiazepines; [15590]
(4) what assessment he has made of the impact of medical practice to prescribe benzodiazepines to some patients with a spectrum of mental health disorders in respect of (a) recovery from illness, (b) worsening of illness, (c) onset of known side-effects and (d) addiction to these drugs; [15587]
(5) how many (a) benzodiazepine doses have been administered and (b) prescriptions for benzodiazepines have been written for each year since 1971. [15591]
§ Ms BlearsThe numbers of prescriptions for benzodiazepines from 1980 to 2000 are listed in the tables. However the number of prescriptions cannot be used to determine the number of patients receiving benzodiazepines. Information is not available on the number of patients considered to be clinically dependent upon benzodiazepines.
Information on the daily dosage, time limit of dosage, possible side effects and tendency to addiction of benzodiazepines is present in the Summary of Product Characteristics, and the Patient Information Leaflet, which is produced by the manufacturer and approved by the Licensing Authority. The Committee of Safety of Medicines, and previously the Committee on the Review of Medicine have issued advice on all these aspects in relation to benzodiazepines use to healthcare professionals in the United Kingdom on a number of occasions in the drug safety bulletin "Current Problems in
170W Pharmacovigilance" and in the British Medical Journal. These publications are listed and copies will be placed in the Library.
Number of prescriptions dispensed in the community for benzodiazepines: 1980–2000—England Prescriptions (thousand) 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 Temazepam 1,014 1,709 2,431 2,896 3,378 5,133 5,802 6,242 6,129 5,946 5,985 Diazepam 7,300 6,604 5,812 5,147 4,449 4,374 4,217 4,071 3,622 3,331 3,147 Nitrazepam 7,362 6,910 6,596 5,912 5,368 5,001 4,657 4,383 3,850 3,523 3,188 Lorazepam 2,033 2,487 2,928 2,957 2,736 2,590 2,607 2,395 1,756 1,452 1,227 Chloridiazepoxide 1,834 1,694 1,516 1,294 1,112 1,007 893 816 697 604 548 Oxazepam 587 675 654 612 561 609 646 621 511 406 399 Lormelazepam — 32 163 346 442 122 160 191 194 169 163 Clonazepam 40 48 55 72 77 93 99 107 111 111 127 Loprazolam Mesylate — — — 2 50 19 71 125 127 144 160 Clobazam 275 330 381 378 396 109 42 39 48 59 53 Triazolam 402 795 855 782 906 1,200 1,468 1,576 1,635 1,530 1,513 Alprazolam — — — 127 261 63 — — — — — Bromazepam — — 9 76 151 32 — — — — — Clorazepate Dipotassium 945 930 971 971 1,016 216 — — — — — Flunitrazepam — — 7 86 188 54 — — — — — Flurazepam Hydrochloride 1,885 1,833 1,860 1,700 1,628 376 — — — — — Ketazolam 37 105 135 138 118 27 — — — — — Medazepam 198 176 159 140 108 25 — — — — — Prazepam — — 12 55 55 12 — — — — — Total 23,912 24,329 24,544 23,962 22,999 21,062 20,662 20,565 18,680 17,274 16,510 Annual change (percentage) — 1.7 0.9 -2.4 -4.0 -8.4 -1.9 -0.5 -9.2 -7.5 -4.4
- Current Problems in Pharmacovigilance 1978—thrombophlebitis associated with diazepam.
- British Medical Journal, 1980: 910–912. Systematic review of benzodiazepines.
- Current Problems in Pharmacovigilance 1981—Unexpected severe psychotic effects with Halcion.
- Current Problems in Pharmacovigilance 1985—Respiratory depression and hypotension with Midazolam (Hypnovel).
- Current Problems in Pharmacovigilance 1988—Benzodiazepines, dependence and withdrawal symptoms.
- Current Problems in Pharmacovigilance 1995—Side effects may impair driving.
- Current Problems in Pharmacovigilance 1997—Avoid benzodiazepines during pregnancy and lactation as they may cause side effects in the exposed babies.
- Mental Health Foundation 1994 "Guidelines for the Prevention and Treatment of Benzodiazepine Dependence".
- Department of Health 1999 "Drug misuse and dependence-guidelines on clinical management".
- British National Formulary 2001.
We are not aware of any audit of the impact of such advice.
No recent assessment has been made of the impact on national health service patients of prescribing any particular group of psychiatric drugs. Volume of benzodiazepine prescribing in the community is monitored and the measure has been included as a high level performance indicator.
No assessment has been made of the impact on medical practice of prescribing benzodiazepines, nor has any assessment been made of the impact of the information and advice provided on medical practice.
The number of prescriptions dispensed in the community for benzodiazepines in England since 1980 is given in the tables. Data prior to 1980 are not available. Information about drugs prescribed and dispensed in hospitals is not available. 171W
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Temazepam 6,428 6,914 6,651 6,345 6,063 5,540 5,252 5,043 4,878 4,697 Diazepam 3,254 3,225 3,220 3,288 3,411 3,600 3,798 3,989 4,108 4,293 Nitrazepam 3,186 3,074 2,902 2,721 2,582 2,539 2,426 2,333 2,210 2,095 Lorazepam 1,137 1,018 932 867 818 785 758 743 728 715 Chloridiazepoxide 542 503 467 449 438 428 423 414 402 384 Oxazepam 378 352 328 311 300 304 306 300 289 272 Lormelazepam 181 215 218 208 201 234 249 252 246 210 Clonazepam 137 144 152 160 168 181 196 213 231 253 Loprazolam Mesylate 195 239 230 219 213 221 215 211 200 191 Clobazam 66 67 67 68 70 74 74 82 85 93 Triazolam 1,123 — — — — — — — — — Alprazolam — — — — — — — — — — Bromazepam — — — — — — — — — — Clorazepate Dipotassium — — — — — — — — — — Flunitrazepam — — — — — — — — — — Flurazepam Hydrochloride — — — — — — — — — — Ketazolam — — — — — — — — — — Medazepam — — — — — — — — — — Prazepam — — — — — — — — — — Total 16,626 15,751 15,167 14,638 14,266 13,905 13,698 13,580 13,378 13,204 Annual change (percentage) — -5.3 -3.7 -3.5 -2.5 -2.5 -1.5 -0.9 -1.5 -1.3 Notes:
1. The prescription information was obtained from the Prescription Cost Analysis (PCA) system. Please note that the data up to 1990 are not strictly consistent with data from 1991 onwards. Figures for 1980–90 are based on fees and on a sample of 1 in 200 prescriptions dispensed by community pharmacists and appliance contractors only. Figures for 1991 onwards are based on items and cover all prescriptions dispensed by community pharmacists, appliance contractors dispensing doctors and prescriptions submitted by prescribing doctors for items personally administered. Also included are prescriptions written in Wales, Scotland, Northern Ireland and the Isle of Man but dispensed in England. The data do not cover drugs dispensed in hospital or private prescriptions.
2. Benzodiazepines are those drugs defined within the British National Formulary sections 4.1.1, "Hypnotics", 4.1.2. "Anxiolytics", and 4.8. "Antiepileptics".