Some short term drugs are being overprescribed by doctors, the Medical Council have said.

A working group has published a report highlighting patient safety issues regarding the prescribing patterns of benzodiazepines, z-drugs and gabapentinoids in Ireland.

The report is calling for increased resources for Primary Care counselling supports and addiction services to reduce the number of people relying on these drugs long term.

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Key Recommendations of the Working Group:

1. Improved Service Delivery: Increase resources for Primary Care counselling supports and addiction services to reduce the number of people requiring prescriptions for benzodiazepines, z-drugs and gabapentinoids.
2. Education: Further educational initiatives should be developed for doctors, pharmacists, and the public to increase awareness of the risks associated with these drugs.
3. Advancing Transparency in Prescribing Practices: The Working Group proposes that a central repository for data, which would be accessible to prescribers, should be established.
4. Consideration given to including Pregablin and Gabapentin in the Controlled Drugs List: The Working Group supports the idea of consideration being given to including pregabalin and gabapentin on the controlled drugs list, as has been done in other countries, such as the UK.
5. Implementation of Recommendations of the Working Group: The successful implementation of these recommendations will require considerable stakeholder involvement across the Irish healthcare system to be effective.

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“The publication of this report and its recommendations is a result of over four years’ work involving multiple healthcare stakeholders in Ireland,” Chair of the Working Group and member of the Medical Council Dr Margaret O’Riordan said.

“It is an excellent example of utilising insights gained from a regulatory process, and working with partners to enhance public protection and patient safety.

“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, the overprescribing of benzodiazepines, z-drugs, and gabapentinoids is an issue that affects patient safety and has significant implications for public health.

“Our report highlights the importance of tailored approaches, the significance of services like pain clinics, mental health, and addiction services, as well as the necessity of medicines reconciliation and review in primary and secondary care settings and during care transitions.”

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Dr O’Riordan said that by exploring various practice settings such as hospitals, primary care and residential care, as well as dissecting patient cohorts, targeted solutions can be identified.

“It is important to acknowledge that addressing these issues demands a significant time commitment, especially in General Practice,” she said.

“Limited access to counselling and addiction services further strains both patients and health professionals' efforts to address these needs.

“Doctors have a very clear ethical responsibility regarding the safe prescribing of these drugs, as set out in the Medical Council’s Guide to Professional Conduct and Ethics for Registered Medical Practitioners.

“If any prescriber is facing challenges in prescribing these medications, we would strongly encourage them to engage with the HSE Addiction Services for support and guidance.”

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Dr O’Riordan concluded that this working group was established following an increase in serious complaints relating to the overprescribing of benzodiazepines and the publication of this report.

She said the report’s recommendations are an excellent example of utilising insights gained from a regulatory process to work with partners to enhance public protection and patient safety.

“The HSE and HSE Addiction Services welcome the publication of this report,” HSE Addiction Services National Clinical Lead Professor Eamon Keenan said.

“We see first-hand the impact the inappropriate use of these medicines can have on public health.

“From a treatment perspective, benzodiazepines were the fourth most common drug causing presentations to Addiction services in 2023, accounting for 1,477 cases.”

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Prof Keenan said these drugs are also implicated in drug related deaths as recorded on the National Drug Related Deaths Index (NDRDI).

“Over the years 2012 to 2021, there has been a 45% in the number of deaths where benzodiazepines have been implicated and deaths where pregabalin has been implicated have risen from 14 in 2013 to 83 in 2021,” he said.

“The recommendation in relation to resourcing services is timely and HSE Addiction Services looks forward to working with stakeholders to implement all recommendations set out in the report.”

The Working Group included representatives from:

• The Medical Council
• Health Services Executive (HSE) (Addiction Services, Primary Care, Primary Care Reimbursement Service (PCRS), Medicine Management Programme (MMP), Nurse and Midwife Medicinal Product Prescribing)
• Department of Health (DoH) (Medicines, Controlled Drugs & Pharmacy Legislation Unit, National Patient Safety Office & Mental Health Unit)
• The Pharmaceutical Society of Ireland (PSI)
• Irish College of General Practitioners (ICGP)
• Nursing and Midwifery Board of Ireland (NMBI)
• Health Products Regulatory Authority (HPRA)
• College of Psychiatrists of Ireland (CPI)

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