Doctors warned about prescribing sedatives

Overprescribing may lead to disciplinary action
  • Deborah Condon

Doctors have been warned that they will face disciplinary action if they are found to be overprescribing certain drugs, including benzodiazepines.

Benzodiazepines are sedatives that are often prescribed to encourage sleep or reduce stress and anxiety.

The Medical Council has issued advice to all doctors prescribing these drugs to follow best practice guidelines and only prescribe them when absolutely required.

The advice also relates to z-drugs, which are not benzodiazepines, but produce similar effects, and Pregabalin, which is used to manage a number of long-term conditions such as epilepsy, nerve pain and generalised anxiety disorder.

"The Medical Council, with its dual role of protecting patients and supporting doctors, takes a very serious view of over-prescribing of benzodiazepines, z-drugs and Pregabalin and is actively working with the HSE, the Department of Health, the Pharmaceutical Society of Ireland and the medical profession to take action on this issue on a national level.

"If necessary, in order to protect the public, the Medical Council will take disciplinary action against medical practitioners in relation to the over-prescribing of these drugs," the council said.

According to the president of the council, Dr Rita Doyle, the impact of inappropriate prescribing of these and other controlled drugs "is having a significant impact on patient safety and wellbeing".

"While benzodiazepines may have a role in the treatment of a patient on a time-limited basis, caution and strict monitoring are required when they are prescribed. Patients who become dependent upon benzodiazepines should be referred to the appropriate drug treatment services and provided with appropriate supports," she said.

She acknowledged that doctors face many challenges in relation to these drugs, including demands from some patients for these and similar types of medication.

"If a doctor is facing challenges in prescribing these medications, I would strongly encourage them, as a matter of priority, to engage with the HSE Addiction Services for support and guidance. The Medical Council supports doctors who follow recognised professional guidelines in line with professional practice, and supports examples of good practice, particularly in difficult circumstances."

"Any doctor whose level of prescribing is above the normal range, and who is not working in an exceptional area of practice, and who does not make any effort to refer their patients to support or reduce their high prescribing levels may require formal investigation by the Medical Council," Dr Doyle emphasised.

However, she also pointed out that it is essential that patients who are taking these drugs do not stop taking them without advice and guidance from their doctor.

"Doctors have a very clear ethical responsibility with regard to the safe prescribing of these types of drugs as set out in the Medical Council's Guide to Professional Conduct and Ethics for Registered Medical Practitioners.

"By working in collaboration with the HSE, the Department of Health, the profession and other key stakeholders, the Medical Council and our partners are addressing a key patient safety issue and ensuring that doctors have the supports they need to protect patient safety," Dr Doyle added.

Responding to this, the Irish Medical Organisation (IMO) said that GPs are "acutely aware" of the dangers and difficulties related to the prescribing of these drugs.

"These are important drugs which can play a critical role in the treatment of patients facing acute anxiety issues. However, GPs have to navigate an often difficult path between what a patient needs and what that patient may believe they need and this can lead to tension in the relationship between GPs and patients when a GP is not willing to prescribe these drugs.

"Every GP will be familiar with tense exchanges with patients who believe they should be prescribed such drugs and in some cases, that can escalate to threatening behaviour," explained GP and IMO president, Dr Padraig McGarry.

He noted that GPs are also sensitive to the dangers of overuse if a patient becomes more tolerant of a drug.

"From the outset, GPs will set out a plan as to how these drugs might be prescribed and used by the patient in question, and in any such plan, there should be discussion around alternatives and discussion about how long it is envisaged that the patient will use the drugs and so on," he said.

 


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