Prescription addiction: Leading Nottingham doctor says local GPs need more training

Dr Stephen Willott, a GP at The Windmill Practice, Sneinton.

Prescription painkillers are killing more people in the UK than cocaine, ecstasy and heroin, with an average of more than one death linked to either tramadol or codeine each day in 2015.

Notts TV yesterday revealed how a former Nottingham City Hospital midwife was fired and arrested after stealing NHS painkillers to feed her crippling addiction, instigated by a doctor’s prescription. 

In the second of a three-part investigation Jamie Barlow talks to a leading Nottingham doctor who explains why he’s leading new training for GPs on the increasing number of people becoming addicted to medication first given to them by doctors and pharmacists. 


A leading Nottingham doctor says local GPs urgently need more training to halt the rise in the number of people becoming addicted to prescription medication.

Dr Stephen Willott, a GP at The Windmill Practice, Sneinton, chairs a local medicines misuse group that meets regularly with GPs, pain specialists and addiction experts from around the city.

He says there has been “an escalation of both opioids and other drugs used for anxiety” prescribed by doctors – and patients can become addicted to these in just three days.

Opioids are a class of strong, addictive painkillers which include codeine, dihydrocodeine and tramadol.

His concerns come after Sarah Mann, a former midwife at Nottingham City Hospital, spoke out about how she became so addicted to common painkillers she ended up stealing them from the NHS and losing her job.

Sarah Mann used to be a midwife and nurse, but was hooked on tramadol: an extremely addictive opioid painkiller.

Her case is part of a wider problem which has been described by an all-party parliamentary group as a ‘public health disaster’ which has caused a level of addiction almost impossible to measure but which has led to a 666 per cent increase in the number of tramadol prescriptions in 13 years.

Dr Willott stresses GPs have to determine whether patients’ pain is physical or psychological and, if the pain is stress or distress-related, doctors who prescribe opioids “may be creating more of a problem than trying to solve it”.

He says some doctors have a tendency to “over-medicate” – in cases whereby GPs dispense prescriptions when they ought to offer advice, or refer patients for physiotherapy when they are in pain.

GPs across Notts are being given access to more training on how to cut the risks of addiction to prescription drugs.

The British Medical Association (BMA) issued guidance to GPs last October, warning them of the ease patients are becoming hooked on prescription drugs.

The BMA says antidepressant prescribing has more than doubled over the last decade, and more than 70 million prescriptions were dispensed in 2015 at a cost of more than £340 million.

That year there were also 16 million opioid prescriptions, costing more than £200 million, and 12 million benzodiazepine prescriptions – a class of anti-depressants – costing more than £5.5 million.

And Dr Willott says the local medicines misuse group has urgently implemented training modules, into formal GP learning time, to make health workers aware.

“Often it’s education that needs to be going to secondary care as well, to the doctors at casualty who are often much more junior than GPs,” he said.

“It’s tempting for all of us to reach for medication rather than taking the longer route of trying to explain why we don’t think medication is suitable.

“It’s a responsibility for all of us to try and tackle. But as a medical misuse group, we are doing things.

“We have issued a statement that goes to all of the GPs [in Nottingham] to warn them that some of pregabalin and gabapentin drugs can be addictive and are a bit like the new Valiums of this world.”

Both drugs are used to treat epilepsy, while pregabalin is used to mitigate anxiety and has pain relieving effects.

In 2015, pregabalin poisoning was linked to 90 deaths in England and Wales – a total which has rocketed from just four deaths in 2011.

Dr Willott says there are warning signs which can indicate a patient may have a problem: such as a person making frequent excuses about the loss of their prescription, in an attempt to get more medication.

Dr David Rhinds, an addiction psychiatrist at the NHS Nottinghamshire Healthcare Trust, says the problem of patients addicted to prescribed and over-the-counter medication is just the “tip of the iceberg”.

He says the most common form of addiction is patients addicted to “combination” medications available over-the-counter – such as Nurofen Plus, containing codeine and paracetamol.

Dr David Rhinds, addiction psychiatrist at the Nottinghamshire Healthcare Trust.

Patients become hooked on the codeine element because of its pain relieving effects, but taking too much paracetamol can prove fatal, causing liver toxicity and stomach ulcers.

Dr Rhinds admits some patients seek help because they take five or six times the NHS daily recommended amount of dihydrocodeine each day – an extremely strong opioid.

He adds an increasing trend is people abusing ‘z-drugs’, such as zolpidem, zopiclone and zaleplon: medication used to treat insomnia.

Other people, he says, develop dependencies to laxatives and herbal cough medicines.

Nurofen Plus, consisting of paracetamol and codeine.

Dr Rhinds believes GPs are prescribing drugs “too easily” and says doctors have little training in addiction psychiatry; that they are trained how to prescribe the correct drugs but not educated how to notice, and prevent, patients becoming addicted.

He argues the reason doctors routinely prescribe drugs is because GPs’ resources are stretched, and consultations with patients can only last around ten minutes – meaning they don’t have time to conduct a full assessment of whether patients are likely to become addicted.

Professor Helen Stokes-Lampard, chair of the Royal College of GPs, says doctors are trained to deal with patients of all ages with mental health problems, including addiction.

She says specialised, community addiction services are vital for the referrals of patients and there are currently not “sufficient services available” across the UK.

The Nottingham Recovery Network is a walk-in support service, based on Upper Parliament Street.

Professor Stokes-Lampard adds doctors regularly conduct reviews of patients’ prescribed medications and, when their conditions have been resolved, doctors will discuss with patients the possibility of coming off the drugs.

But she says a huge concern is that the drugs patients become addicted to are “far too easily available” to buy online, once patients’ prescriptions have come to an end.

“This is potentially very dangerous as there is no assurance of quality of the medication being taken and withdrawal requires careful management by healthcare professionals, which isn’t possible when access to the drugs is driven underground,” she adds.

“NHS England’s GP Forward View includes pledges for every GP practice to have access to a trained mental health therapist – this promise needs to be implemented urgently, if we are to deliver the best possible care to patients with mental health problems, including addiction.”

A Department of Health spokesman said people addicted to prescription drugs can access support via calling the NHS on 111, or by accessing the FRANK helpline, NHS Choices, or their GP.

Rosanna O’Connor, director of alcohol, drugs, tobacco at Public Health England, said: “If anyone is concerned they are becoming dependent they should seek help, speaking to a GP is a good first step.

“Public Health England supports local authorities to provide appropriate treatment services, in conjunction with the NHS, to address specific concerns about addiction to prescribed and over-the-counter medicines.

“It’s vital that all health professionals make every contact count with patients and are alert to possible signs of misuse and dependence, including to prescribed drugs.”

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