Back in June 2022, the College of Medicine launched the Beyond Pills Campaign – calling for urgent Government intervention on over-prescribing in the NHS.
The Campaign was established in the wake of the Government’s National Overprescribing Review, published in September 2021. This found that an estimated 10% of drugs (110 million items) dispensed in primary care were inappropriate, unnecessary and could do harm, including causing premature death.
In December 2023, the Beyond Pills All Party Parliamentary Group (APPG) launched, in which the Beyond Pills Campaign joined forces with the former APPG for Prescribed Drug Dependence.
Now, in November 2024, the Beyond Pills APPG was re-constituted with four members and 20 officers. The Chair is Dr Simon Opher, Labour MP for Stroud, a GP and pioneer of social prescribing. Lord Crisp, former head of the NHS, and former Chair Danny Kruger MP continue as Co Chairs. Sadik Al-Hassan, Labour MP for North Somerset, will be the fourth Officer.
The Secretariat remains the same: Dr Anne Guy (Coordinator), Dr James Davies, Luke Montagu, Dr Bogdan Chiva Giurca, and Sarah Stacey. The Secretariat functions under the umbrella of the Beyond Pills Alliance whose founder members are the Council for Evidence-based Prescribing UK (CEPUK) and the College of Medicine.
The Beyond Pills APPG has the following Mission and Objectives:
MISSION: To move UK healthcare beyond an over-reliance on pills by combining social prescribing, lifestyle medicine, psychosocial interventions and safe deprescribing. As well as reducing unnecessary and inappropriate prescribing, this integrated approach will improve outcomes and reduce health inequalities.
OBJECTIVES:
1). In line with UN and WHO guidance, to campaign for de-medicalised and community centred responses to emotional distress to improve outcomes and reduce health inequalities caused by over-medicalisation and unnecessary prescribing
2). To promote the funding and local delivery of integrated services to prevent and reduce dependence on prescribed drugs
3). To communicate to policymakers the latest evidence of the harms associated with an over-reliance on medicines, supported by appropriate research and analysis.
4). To lobby for the funding and delivery of a national, prescribed drug withdrawal helpline and website
5). To promote relevant changes to undergraduate and postgraduate training, and to CPD for relevant health professionals.
Focusing on antidepressant overprescribing
The initial focus of the Beyond Pills APPG is to address the rise in antidepressant prescribing. Over the last decade, antidepressant prescriptions have almost doubled in England, rising from 47.3 million in 2011 to 85.6 million in 2022/23.
Over 8.6 million adults in England are now prescribed antidepressants annually (nearly 20% – that’s one in five – adults over 18), 11 with prescriptions set to rise over the next decade.
On 5th December 2023, the British Medical Journal published an open letter, authored and signed by members of the APPG and others, calling for the Government to address the issue and giving specific recommendations. These reflect the latest WHO guidelines, which for the first time demote antidepressants from a first line treatment for depression to a subsidiary treatment behind social and psychological provision.
The letter emphasises the lack of evidence for efficacy in all but the most severely depressed patients. However, rates of prescribing to patients with mild and moderate depression remain high.
- One study showed 69% of diagnosed depression in older people was of mild severity (i)
- Another that 26.4% of those taking antidepressants reported mild depressive symptoms (ii)
- A UK study showed that 58% of people taking antidepressants longer term (for two years and more) failed to meet criteria for any psychiatric diagnosis (iii)
The letter also reflects the debilitating and sometimes life-changing side effects of antidepressants, as well as other potentially dependence forming drugs. These occur both when taking the drugs and notably when people try to withdraw from them.
A Public Health England review in 2019 showed that patients were not being warned of the risks of these medicines, that their withdrawal symptoms were not being acknowledged by doctors and that they did not – and still do not – have access to proper support for safe withdrawal.
The 2019 PHE review made several key recommendations, including the provision of withdrawal support services, alongside a national 24-hour helpline and website. These services are essential to help people taper off the drugs slowly and safely.