The methodologies used by the NHS Business Services Authority (NHSBSA) for calculating these statistics have changed since January 2021. Therefore, the below tables include data for each of the last five financial years to address the additional two-year datasets requested as well as reflect the new methodologies used.

The following table shows the number of unique patients who were prescribed benzodiazepines including clonazepam in each financial year 2018/2019 to 2022/2023:

The following table shows the number of unique patients who were prescribed Z-Drugs in each financial year from 2018/2019 to 2021/2022:

The following table shows the number of unique patients who were prescribed an antidepressant in each financial year from 2018/2019 to 2022/2023:

The following table shows the number of unique patients who were prescribed opioids from financial year 2018/2019 to 2021/2022:

Note: Our reply to the previous question predated the official statistics used here, and used a different classification of opioids using the standard classification used in the NHSBSA Data Warehouse. Comparable data is shown in the final column of the above table; this counts patients without including any prescriptions for compound analgesics such as co-codamol and co-dydramol.

All figures included above are correct as of 5 September 2023 and could be subject to revision once audited reports are published.

Zopiclone is available in 3.75 milligram and 7.5 milligram tablet preparations. We are aware that some suppliers of these preparations are experiencing disruption to supply. However, alternative suppliers of zopiclone tablets remain in stock and supplies remain available for patients.

The following table shows the number of items that were prescribed in England for benzodiazepines including clonazepam, z-drugs, antidepressants and opioids in the latest two full years of available data.

Source:

NHS Business Service Authority Information Services ePACT2 system.

The following table shows the number of unique patients that were prescribed for benzodiazepines including clonazepam, z-drugs, antidepressants and opioids on a National Health Service prescription and dispensed in the community in England in each of the last three calendar years. Data up to and including October 2020 is the latest available data.

Source:

NHS Business Services Authority Information Services ePACT2 system.

The following table shows the number of prescription items prescribed in England in the last year for benzodiazepines, z drugs and antidepressants.

Information on hospital admissions and deaths in hospital settings only related to benzodiazepines and antidepressants is shown in the following tables. We are unable to provide data for Z drugs in the format requested. It should be noted that this is not a count of people, as an individual may have more than one admission in any given period.

The following table shows a count of finished admission episodes (FAEs) in 2019/20 with primary diagnosis of benzodiazepines and antidepressants and a count of FAEs in 2019/20 with any diagnosis of benzodiazepines and antidepressants. Activity in English National Service hospitals and English NHS commissioned activity in the independent sector.

The following table shows a count of finished discharge episodes in 2019/20 with primary diagnosis of benzodiazepines and antidepressants who passed away. Activity in English NHS hospitals and English NHS commissioned activity in the independent sector.

No recent comparative assessment has been made on the number of prescriptions for benzodiazepines, z drugs, and antidepressants.

We are publishing a new United Kingdom-wide cross-Government addiction strategy in 2020. We will be establishing clear ambitions for reducing drug deaths and including problem gambling for the first time. More detail on the strategy will be announced later this year.

The Department does not hold the information requested as the NHS Business Services Authority does not capture the duration for which a prescription is intended to be used.

In September 2019 Public Health England published an evidence review of medicines associated with dependence or withdrawal, including benzodiazepines and z drugs. The report is available at the following link:

https://www.gov.uk/government/publications/prescribed-medicines-review-report

Alongside ongoing improvements to medicines safety and the use of prescribed drugs, NHS England is reviewing the recommendations from this review and other evidence to develop a set of actions to reduce and treat prescription medicine dependency.

A national review of overprescribing in the National Health Service is being led by Chief Pharmaceutical Officer Dr Keith Ridge and will be published in 2020. This will focus on people who take multiple medicines to ensure patients are receiving the most appropriate treatment for their needs. The review will consider how to improve management of non-reviewed repeat prescriptions including prescriptions beyond guidelines, and the role of digital technologies in reducing overprescribing.

The Government is committed to growing the workforce by 6,000 more doctors in general practice and 6,000 more primary care professionals, including pharmacists. This is on top of the additional 20,000 primary care professionals NHS England are providing funding towards recruiting. Community pharmacists have a key role in monitoring the care and treatment of patients, and would be in a position to review a patient’s medication usage and prescriptions.

In September 2019 Public Health England published an evidence review of medicines associated with dependence or withdrawal, including benzodiazepines and z drugs. The report is available at the following link:

https://www.gov.uk/government/publications/prescribed-medicines-review-report

Alongside ongoing improvements to medicines safety and the use of prescribed drugs, NHS England is reviewing the recommendations from this review and other evidence to develop a set of actions to reduce and treat prescription medicine dependency.

A national review of overprescribing in the National Health Service is being led by Chief Pharmaceutical Officer Dr Keith Ridge and will be published in 2020. This will focus on people who take multiple medicines to ensure patients are receiving the most appropriate treatment for their needs. The review will consider how to improve management of non-reviewed repeat prescriptions including prescriptions beyond guidelines, and the role of digital technologies in reducing overprescribing.

The Government is committed to growing the workforce by 6,000 more doctors in general practice and 6,000 more primary care professionals, including pharmacists. This is on top of the additional 20,000 primary care professionals NHS England are providing funding towards recruiting. Community pharmacists have a key role in monitoring the care and treatment of patients, and would be in a position to review a patient’s medication usage and prescriptions.

In 2016-17, the Hospital Episode Statistics (HES) database showed the number of finished admission episodes with a primary or secondary diagnosis of benzodiazepines and antidepressants as follows:

Similar information on the number of admissions for Z drugs cannot be extracted from the HES database. The classification of admissions includes, but is not limited to, those relating to the use of Z drugs and therefore these instances cannot be isolated.

In 2016, the Office for National Statistics (ONS) published the following information for drug related deaths:

This information was published by the ONS on 2 August 2017 and is available online at:

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/deathsrelatedtodrugpoisoningenglandandwalesreferencetable

The cases highlighted in the Ombudsman’s report are deeply troubling. Everyone deserves good quality care, delivered with compassion, at the end of their lives.

In June 2014, the Leadership Alliance for the Care of Dying People, which included NHS England and the Department, published One Chance to Get it Right. This set out five priorities for the care of a dying person, the key principles that should underpin the care that all people at the end of life receive which the Ombudsman’s report endorsed as the right approach to achieving high quality, compassionate care for all dying people.

The priorities for care and the accompanying guidance for staff, care providers and commissioners, cover issues such as recognising dying, sensitive and timely communication, symptom control (including sedation), physical, psychological, social and spiritual support, care planning, nutrition and hydration and staff education and training. They also provide for a personalised approach aimed at delivering care in ways that meet individual needs and preferences.

Following One Chance to Get it Right, NHS England, the Care Quality Commission and other system partners have worked together to implement the priorities for care and taken forward specific actions to improve the way care is delivered and commissioned. Subsequently, in October 2014, NHS England set out in “Actions for End of Life Care 2014-16”, what it would do to improve end of life care.

NHS England is also working with key stakeholders on new ambitions for end of life care and this group now includes a representative from the Ombudsman. This will ensure that the lessons learned from the Ombudsman’s report are fed in to the National Health Service’s plans to improve end of life care.

The CPRD GOLD primary care database (former GPRD) includes information about all prescriptions issued in primary care for a subset of approximately 8% of the United Kingdom population. This database has previously been used to study prescribing of anxiolytic, hypnotic and psychotropic medication, commonly referred to as tranquilisers.

It would be possible to use the database to estimate the number of patients in the UK with a long-term dependency on prescription tranquilisers. However, as dependence will not be systematically identified by general practitioners, expert clinician advice would also be required to develop a definition. This could be based on frequency of prescribing and medication strength but could also include clinical codes for medical conditions including indications for these products, drug dependency and substance abuse, if recorded.

This work would represent a research project and as such, a scientific protocol would need to be submitted to the Medicines and Healthcare products Regulatory Agency’s Independent Scientific Advisory Committee for assessment and possible approval.

Even with such an approach, the rate of drug dependency in the population could only be estimated, and in order to assess whether this estimate was a true representation of the actual rate of drug dependency in this population, a validation study would be encouraged.

The Department is looking into the feasibility of commissioning further research on patterns of long-term prescription of dependency-forming medicines, including analyses of relevant prescribing data.

The Department has taken into account the All Party Parliamentary Group on Involuntary Tranquilliser Addiction’s survey in its deliberations in this policy area.

The Medicines and Healthcare products Regulatory Agency (MHRA) has not recently issued any new advice on the addiction potential or the safe withdrawal from benzodiazepines or “z drugs”.

Benzodiazepines and “z drugs” (zaleplon, zolpidem and zopiclone) are recognised to be associated with an addiction potential particularly when taken for longer than the recommended 2-4 weeks. Over the years action has been taken by the MHRA, the Department of Health and professional bodies to provide extensive warnings about the risks of dependence, limit prescribing and issue advice about gradual withdrawal.

The risk of dependence on a benzodiazepine (or zaleplon, zolpidem and zopiclone) can increase with higher doses and longer duration of use; therefore, the time it takes to completely stop the medicine varies and withdrawal programmes may sometimes need to be individually tailored.

Patients receive a patient information leaflet in their pack of benzodiazepine (or zaleplon, zolpidem and zopiclone). The leaflet includes information and advice about their medicine, which will support the vital discussions they have with their doctor and pharmacist about their treatment or stopping treatment.

Benzodiazepines and “z drugs” are considered acceptably safe and effective when used in accordance with the approved indications and for the recommended duration of use.

An online learning module for healthcare professionals on benzodiazepines was published on the MHRA’s website in March 2013. The module’s section on dependence and withdrawal gives general guidance on the principles of benzodiazepine withdrawal. The online learning module reflects the product information for these medicines.

Information on the number of prisoners who are prescribed a particular medicine or class of medicine is not collected centrally, nor are data held relating to prescription items dispensed in prisons.

NHS England commissions all pharmacy services in prisons in England. It is responsible for the quality of service and for ensuring that good practice guidelines are followed in relation to the prescribing, safe use and treatment following withdrawal of psychotropic drugs treatments, including benzodiapines and Z-drugs. Where healthcare professionals have concerns about prescribing decisions in relation to psychotropic drug treatment in prisons, they should record these as medication safety incidents and report them to the local medicines management committee for possible further investigation. NHS England commissioners also require healthcare providers to report these incidents in patient safety contract monitoring.

Prison pharmacy services currently follow guidelines set out in A Pharmacy Service for Prisoners, issued by the Department in 2003. NHS England is currently reviewing this guidance, and updated guidance will be published in due course. A copy of the current guidance has already been placed in the Library.

Detailed guidance on benzodiazepine detoxification for prisoners is included in Clinical Management of Drug Dependence in the Adult Prison Setting, published by the Department in 2006. A copy has already been placed in the Library. Clinicians are expected to follow this and other relevant guidance such as that published by the Royal College of General Practitioners’ Secure Environments Group on Safer Prescribing in Prisons.

The National Offender Management Service (NOMS) deploys a comprehensive range of measures to reduce the availability of drugs in prisons, including targeted searching, drug education, and other interventions. Prisoners are also subject to random and targeted mandatory drug tests, which include a test for the misuse of benzodiazepines. Prisoners found with prohibited items face swift and robust punishment. This can include having days added to their custody, being transferred to a different prison and losing privileges.

NOMS is not complacent about the potential misuse of prescription medication in prisons and prison governors work closely with health care providers to ensure that relevant information is shared and that medication is safely and appropriately administered.

The published National Partnership Agreement between NOMS, NHS England and Public Health England:

www.justice.gov.uk/downloads/about/noms/work-with-partners/national-partnership-agreement-commissioning-delivery-healthcare-prisons2013.pdf

has a commitment to review the level and choice of prescription medications within prisons and for the organisations to work together with professional bodies to promote changes in prescribing practice and tackle abuse of medications.

We are fully aware of the dangers of the misuse of prescription drugs such as tranquilisers, and law enforcement authorities have a robust range of powers available to deal with those who engage in the diversion and illicit trade of such drugs, particularly where those drugs are controlled under the Misuse of Drugs Act 1971. Police forces use these powers to tackle the trade of such substances in their area, and action is also being taken to tackle illicit online sales. For instance, the Medicines Healthcare and Regulatory Products Agency works closely with Internet Service Providers to close down websites that are illicitly selling prescription drugs to UK consumers. In June 2013, the Agency and Border Force collaborated on Operation Pangea, an annual international initiative which in the UK led to the seizure of 3.7 million doses of unlicensed medicine worth approximately £12.2 million.

As well as cracking down on the illicit supply of prescription drugs, we are taking steps to increase our understanding of the problem. This is why in September 2013 the Home Secretary asked the Advisory Council on the Misuse of Drugs to explore the potential for medical and social harms arising from the diversion and illicit supply of prescription drugs. I have asked that this work includes consideration of the prevalence of misuse, user demographics, and the most common drugs being misused. The Advisory Council is likely to report later in the year.