Changing the conversation about health

Beyond Pills All Party Parliamentary Group (APPG) launches to stop over-prescribing

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 joins forces with the former APPG for Prescribed Drug Dependence.

The APPG’s former Chair, Danny Kruger MP, joined the new Beyond Pills APPG as Chair. He said of the union: ‘There is a natural synergy with our objectives and the APPG for Prescribed Drug Dependence is a great supporter of social prescribing, which we feel can make a valuable contribution to addressing this public and personal health crisis, both in terms of helping to prevent overprescribing and also to treating people who are suffering from the debilitating symptoms of dependence.’

The Beyond Pills Campaign became a founder member of the Beyond Pills Alliance (BPA), alongside the Council for Evidence-based Psychiatry (CEP-UK).

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.

VIDEO: Stevie Lewis is a member of LEAP (Lived and professional experience advisory panel) for Prescribed Drug Dependence. In the video above she speaks to people who have been affected by PDD 

NHS England has since published guidance to encourage health authorities to commission appropriate withdrawal services in their areas. But no new funding has been provided for these services and no helpline has been established. Additionally, existing charities that provide withdrawal support are having their funding removed as NHS Trusts rein in their spending.

There are support services available for such drug misuse/withdrawal, whereas there are no support services for a protracted withdrawal from a prescribed medication. In fact, quite the contrary, you are gaslighted by the very medical professionals who did this to you.’

RECOMMENDATIONS
The Beyond Pills APPG proposes five key public health recommendations to address the issue of antidepressant overprescribing:

1). Stopping the prescribing of antidepressants for new patients with mild conditions

2). Adhering to the 2022 NICE guidance on safe prescribing and withdrawal management including properly informed consent and regular review of harms and benefits 

3). Funding and delivering local withdrawal services integrated with social prescribing, lifestyle medicine & psychosocial interventions

4). Including the reduction of antidepressant prescribing as an indicator in the NHS Quality and Outcomes Framework (QOF)

5) Funding and delivering a national 24 hour prescribed drug withdrawal helpline and website 

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.

It is very important that people who want to stop taking antidepressants or other potentially dependence forming drugs do so in conjunction with a health professional who is informed about the process of safe withdrawal.

Advisors to the Beyond Pills APPG representing both patient groups and leading academics are working to make this information more widely available to health care professionals working across all sectors.

The NHS Specialist Pharmacy Service publishes material on safe deprescribing on their website: sps.nhs.uk/home/guidance/deprescribing

To read a Beyond Pills brief on antidepressant prescribing and deprescribing and the current situation regarding the lack of specialist withdrawal services, click here.

(i) Coupland, C., Dhiman, P., Morriss, R., Arthur, A., Barton, G., & Hippisley-Cox, J. (2011). Antidepressant use and risk of adverse outcomes in older people: Population based cohort study. BMJ (Online), 343(7819), 1–15. https://doi.org/10.1136/bmj.d4551

(ii) Shim, R. S., Baltrus, P., Ye, J., & Rust, G. (2011). Prevalence, treatment, and control of depressive symptoms in the United States: Results from the National Health and Nutrition Examination Survey (NHANES), 2005–2008. Journal of the American Board of Family Medicine, 24(1), 33–38. https://doi.org/10.3122/jabfm.2011.01.100121