The shameful cost of pills patients should never have been given

£500m… the shameful cost of pills patients should never have been given: As damning new research shows the NHS wastes a fortune on medication every year, a devastating investigation into a scandal wrecking so many lives

  • Emma Hames, from Cardiff, had to quit teaching due to a prescription medicine
  • The drug, bromazepam, eased her anxiety but left her exhausted and lethargic
  • When she tried to stop taking it, she experienced insomnia and other issues
  • Half of those using benzodiazepines for four weeks suffer withdrawal symptoms

Emma Hames is angry and it’s easy to understand why. Rather than enjoying health and happiness at the age of 33, her life is blighted by extreme fatigue, jelly-legged weakness, headaches, insomnia, muscle pain and brain fog.

Her heart can race so fast it ‘feels like a washing machine on spin cycle’ and she often lacks the strength to even walk to the shops.

Emma, who lives in Cardiff, has been largely housebound for four years and had to give up her job as a primary school teacher.

And it’s all due to a prescription medication, commonly dispensed on the NHS, which was supposed to improve her wellbeing.

The drug is bromazepam, which belongs to a class of medicines called benzodiazepines. She was put on a daily dose in 2012 after a brief bout of anxiety and while it initially helped, within a few months it was clear that improvement had come at a high cost.

‘My anxiety eased but the drug made me feel exhausted and lethargic,’ says Emma.

But worse was to come when she tried to stop taking it — with insomnia, heart palpitations, aches and pains, poor concentration and constant trembling.

‘It felt like severe flu and the worst hangover you can imagine at the same time — all the time,’ she says. ‘It was sheer torture.’

Emma, who lives in Cardiff, has been largely housebound for four years and had to give up her job as a primary school teacher, because of the prescription drug bromazepam

If Emma’s story sounds familiar that’s because it’s nearly a decade since Good Health first highlighted concerns that tens of thousands of Britons suffer crippling side-effects from benzodiazepines prescribed by doctors. The drugs are also addictive, and coming off them causes even worse symptoms.

Studies show 50 per cent of those using benzodiazepines for just four weeks suffer withdrawal symptoms, such as anxiety, dizziness, concentration problems, nightmares and weakness. And 100 per cent of those on them for six months or more experience such symptoms.

Similar evidence of drug dependency has emerged for other pills — antidepressants, painkilling opioids (eg codeine, tramadol and oxycodone) and gabapentinoids (including gabapentin and pregabalin), plus sleeping pills known as Z-drugs (zolpidem and zopiclone). This led to a Daily Mail campaign to save prescription pill victims.

Addictive drugs over prescribed

A 2019 report by Public Health England followed, which warned that ‘hundreds of thousands’ were dependent on them.

It called for face-to-face support for patients and better training for doctors on the risks of drug dependency, plus a 24-hour helpline with experts advising callers on how to reduce their medication. Currently, those affected get little or no help about how to quit.

Yet there is still no helpline and the drugs are still being prescribed in eye-watering quantities — with nearly 17 million people a year in England alone getting a prescription, according to NHS figures.

Now, new research seen by Good Health reveals the terrible cost of the drug-dependency crisis not only on the individual, but also on NHS finances. Damning figures show that in England alone, nearly £570 million-worth of the drugs are given annually to patients who should not be on them in the first place. The cost of the needlessly prescribed pills could pay the wages of an extra 10,000 GPs or 20,000 nurses.

The research, carried out by the Council for Evidence-based Psychiatry (CEP) was based on data for all the prescriptions for antidepressants, opioids, gabapentinoids, benzodiazepines and Z-drugs written in England from 2015 to 2018.

Based on National Institute for Health and Care Excellence (NICE) prescribing guidance, and looking at each patient’s diagnosis, the researchers determined who actually qualified for the drugs.

Their calculations included the price of the medicines, the average consultation cost (about £33) of seeing a GP and dispensing fees — the amount paid to GPs or pharmacists for issuing the drugs.

The results, reviewed by independent health economists, are published today in the journal Addictive Behaviours.

They show that the NHS in England alone spends between £490 million and £568 million annually on dependency-forming pills for patients who should not be given them — because their symptoms are not severe enough, or they have not exhausted safer options, such as counselling or less toxic drugs, or who were left on the drugs longer than needed (eg, over four weeks for benzodiazepines, or 12 weeks for opioids).

Over the three years they analysed, the researchers found the total bill came to a £1.7 billion and that unnecessary prescribing was happening on a massive scale.

‘For benzodiazepines, we found up to 72 per cent of prescriptions were unnecessary, for Z-drugs up to 76 per cent, opioids up to 53 per cent, gabapentinoids 12.6 per cent and antidepressants 13.5 per cent,’ they said in the paper.

Opioids accounted for the most financial waste — about £288 million a year — followed by £158 million a year for gabapentinoids.

It’s even likely the total amount of money lost in Britain’s prescription drug crisis is far higher than the study, warned the researchers (from Roehampton University, Greenwich University and University College London).

‘Our estimates are conservative . . . they don’t take into account the impact on productivity [from patients being unable to work], disability payments, lost tax revenue and absenteeism.’

The team was taken aback by the findings. ‘It was much higher than preliminary research suggested — we were surprised at the figures,’ says Dr James Davies, a reader in medical anthropology and mental health at Roehampton University.

‘Money is being wasted at a time when the health service is strapped for cash. The NHS is not taking this problem seriously and many doctors don’t appreciate the extent to which withdrawal from these medicines is a problem.’

Risks spotted 40 years ago 

Concerns over prescription-drug dependency are not new. The Committee on Safety of Medicines — a government body set up after the thalidomide scandal of the 1950s — warned back in 1980 that patients given benzodiazepines for anxiety and sleep problems were at risk of becoming dependent on them if they stayed on them for longer than four weeks.

It urged GPs to limit the drugs’ use, scrap repeat prescriptions and help patients come off the pills gradually — tapering to smaller doses — to avoid acute withdrawal symptoms.

Dr Davies says: ‘Yet, here we are, 40 years later and roughly half of those NHS patients prescribed benzodiazepines have been on them for more than two years.

‘It’s the easiest thing in the world to prescribe a drug but it can be very difficult to get some people off them.’

Meanwhile, Britain’s opioid crisis is starting to mirror that seen in the U.S., where overdoses have claimed more than 500,000 lives since the late-1990s.

Research published a year ago in the journal PLoS Medicine, by experts at Manchester University, found codeine use in the UK had risen five-fold in the previous decade. Prescriptions for opioids tramadol and oxycodone rose too. Latest data show deaths from codeine overdose rose to 212 in England in 2020 (from 156 in 2017); in the past decade codeine poisoning deaths have doubled.

Experts fear increased demand for over-the-counter codeine formulations may be largely to blame, sparking calls for a ban on their direct sale to the public.

Worryingly, the Manchester study showed one in seven first-time users of the painkillers became long-term users, even though it is known to lead to addiction.

Last year, the Medicines and Regulatory Healthcare products Agency — which vets drug safety — introduced stronger labelling for opioid medicines, warning patients they could get addicted and experience unpleasant withdrawal symptoms if they stopped taking it suddenly. The body also says drugs such as tramadol and oxycodone should be limited beyond cancer patients.

No support to come off medication

Meanwhile, under new NICE guidelines published in April patients with chronic pain should not be put on gabapentionoids, benzodiazepines, and opioids. If any already taking them this should be reviewed.

Emma Hames’s problems began when she was prescribed bromazepam for panic attacks brought on by intermittent breathing problems. These were caused by a viral infection that reduced her lung capacity to 60 per cent.

While this improved, the panic attacks continued, and a GP prescribed bromazepam.

‘There was no mention of how long I should stay on it, or that there was a risk of long-term damage,’ she says.

‘Initially, the drug helped ease my anxiety but it also made me very drowsy and lethargic — like someone had turned the lights down inside me. And the longer I was on it, the worse this got.’

The guidelines are that it should be taken for a maximum of around a month. Yet she was on it for four years with her GP routinely issuing repeat prescriptions without ever calling her in for a review.

‘After a few months, I quit the drug as I didn’t want to be on powerful medication for years,’ says Emma.

‘But I got terrible withdrawal symptoms. When I told the GP, he blamed the symptoms on a relapse of my mental health and actually increased the bromazepam dose.’

Emma’s symptoms worsened. When she moved in 2016 and saw a new GP, he said she should try to come off the drug slowly but he couldn’t help as ‘there was no NHS service to guide people addicted to these drugs’. Against her GP’s advice, Emma decided to go ‘cold turkey’.

‘I thought it would be pretty rough for a few weeks or months but then the worst would be over and I’d finally be free of it,’ she says. ‘But it has been awful. Even now — nearly five years later — I’m still suffering withdrawal effects.

‘One morning I woke to my heart racing at 180 beats per minute. It should be between 60 and 100.

‘At one point I was calling an ambulance about once a week because of the palpitations.’

It wasn’t until 2019, when yet another ambulance was called for her cardiac problems, that Emma discovered her symptoms were almost certainly due to the after-effects of the drug she’d stopped taking three years earlier.

‘The paramedic recognised the symptoms of protracted benzodiazepine withdrawal — I’d never heard of it before,’ she says.

‘Hellish’ effects of withdrawal

Other victims of benzodiazepine dependency tell similar stories. A woman, who didn’t wish to be identified, told Good Health her husband was put on lorazepam for pain after his appendix was removed in 1988.

Each time he tried to quit, the after-effects were overwhelming; weakness, circulation problems, swollen feet, numb hands and pins and needles.

Although he is now off them, his wife says his life ‘has been ruined by a drug that doctors are still handing out when there were warnings about it 40 years ago’.

Thousands of patients on antidepressants are thought to have suffered similarly.

A 2019 study found 56 per cent of those trying to quit antidepressants had withdrawal symptoms.

The NHS website states these include restlessness, insomnia, sweating, stomach pain, irritability, confusion and ‘feeling as if there is an electric shock in your head’.

One patient who also wished to remain anonymous, told Good Health he was so desperate for help with the withdrawal symptoms he approached a service for those using illicit ‘street’ drugs.

‘I was told they could only help if I was still abusing the drugs, but not if I’d stopped taking them,’ he says. ‘I’m gradually reducing the dose but it’s been hell.’

‘I wish i’d never been put on them’

Dr Mark Horowitz knows the feeling. As well as being a trainee psychiatrist at University College London, with a PhD in the neurobiology of depression, he’s been on antidepressants for more than 15 years. For the past four, he’s been tapering his dose — reducing it one tiny fraction at a time. ‘I was 21 and a student in Australia when a doctor put me on escitalopram for low moods. But it was a 30-second consultation without extensive checks. I wish I had never been put on them.

‘They’ve not been useful and if I had known at the time [about the risk of dependency] I would never have taken them.’

Dr Horowitz is now on two types of antidepressant and a sleeping pill, zopiclone. But even with his expertise, he is finding quitting the drugs gruelling.

‘It’s been much harder than I had ever imagined. NICE guidelines say [withdrawal takes] four weeks — I’m four years in and it may be five by the time I get there.

‘I reduce my dose by a small percentage every few weeks by using a liquid version of the drugs my GP prescribes. But many people can’t do that as some GPs won’t prescribe liquid forms of the medicines as they can cost a lot.’

Tapering antidepressants means reducing the dose by half-a-milligram a time — down to a lowest dose of 0.5mg. Yet the smallest available on the NHS are 10mg.

Experts say desperate Britons are buying ‘tapering strips’, plastic sleeves full of tablets in ever-decreasing doses from foreign websites — even though the MHRA has warned ‘self-medicating’ like this is potentially risky.

‘It’s heartbreaking because NHS doctors should be in a position to give these people the support they need to come off the drugs,’ says Dr Horowitz.

‘There is a huge amount of help for those on street drugs such as heroin, or alcohol, but no equivalent for those hooked on prescription drugs.’

Studies show 50 per cent of those using benzodiazepines for just four weeks suffer withdrawal symptoms, such as anxiety, dizziness, concentration problems, nightmares and weakness. And 100 per cent of those on them for six months or more experience such symptoms (stock picture)

NHS making people addicts

Joanna Moncrieff, a professor of critical and social psychiatry at University College London and a consultant psychiatrist at North-East London NHS Foundation Trust, said: ‘People are getting hooked on drugs like benzos and the only service they can go to is one for heroin addicts.

‘That’s quite upsetting for respectable middle-aged women, which most of them are. We [the NHS] are prescribing lots of drugs that are harmful, get people hooked and are hard to quit. And we are doing that on a vast scale.’

Stephen Buckley, head of information at the mental health charity MIND, says antidepressants ‘are really helpful for hundreds of thousands of people’ yet, it’s vital patients are told they come with a risk of ‘significant side-effects’.

‘Many GPs mistakenly think two to four weeks is ample to quit antidepressants. That’s undercooking it for most people — we would say it takes months, or even years.’

The Royal College of Psychiatrists agrees that antidepressant withdrawal can take months. Its patient leaflet Stopping Antidepressants offers advice on tapering, and urges patients to stop the reduction if they experience any ‘uncomfortable’ symptoms — before trying again with smaller dose reductions.

But critics argue the crisis needs far tougher action than just giving guidance for patients tackling dependency alone. ‘If the NHS was taking this seriously, it would be providing tapering services itself, such as liquid medications or smaller pill sizes,’ says Dr Davies.

Still no sign of a helpline

The CEP is calling for a 24-hour helpline to be set up as soon as possible, and an NHS smartphone app that can guide people through the tapering process. Face-to-face counselling is also needed for the most severely affected, it says.

‘A relatively small investment, say £20 million a year, in a helpline would be a great start and it’s a lot less than the £568 million a year currently being spent unnecessarily on the drugs,’ says Dr Davies.

The call for a helpline is backed by the Royal College of Psychiatrists and the British Medical Association.

The Department of Health and Social Care told Good Health that ministers are finally backing plans for a helpline and better support for patients dependent on prescription pills.

A spokesman said: ‘We are working closely with NHS England to take these proposals forward and implement them.’

Emma came off benzodiazepines almost five years ago, but has only recently been able to return to favourite pastimes, such as swimming.

She’s working on a film and podcast highlighting the plight of those dependent on the medicines.

‘I lost everything because of that drug, the ability to work, my income, my confidence and my independence,’ she says.

‘I’m trying to focus on coming out of this situation stronger but it’s hard not to be angry.’

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