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Survey of services John Perrott - APPGITA

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<strong>Survey</strong> <strong>of</strong> PCTs in England recording provision <strong>of</strong> <strong>services</strong> for involuntary<br />

tranquilliser addiction by <strong>John</strong> <strong>Perrott</strong>, 1 June 2012<br />

Background note: Ministers in the Department <strong>of</strong> Health have asserted that there are<br />

<strong>services</strong> for involuntary tranquilliser addiction (ITA) in most areas in England.<br />

According to the author <strong>of</strong> this survey, and to members <strong>of</strong> the All Party Parliamentary<br />

Group on Involuntary Tranquilliser Addiction (<strong>APPGITA</strong>), this assertion is incorrect.<br />

The NTA review, by its own terms <strong>of</strong> reference, is a review on substance misuse.<br />

On Page 16 <strong>of</strong> the NTA review it states that “94% <strong>of</strong> those partnerships who<br />

responded positively to the questionnaire reported that there was local service<br />

provision in place for those that reported problems in relation to POM/OTC<br />

medicines.” The “partnerships” questioned by the NTA were defined in the review as<br />

DATs which are Drug and Alcohol Teams and these are <strong>services</strong> provided within<br />

PCTs.<br />

The <strong>Survey</strong><br />

This survey was conducted in April – May 2012 by <strong>John</strong> <strong>Perrott</strong>, an expert patient and<br />

a member <strong>of</strong> <strong>APPGITA</strong>. Contact details may be obtained from the Office <strong>of</strong> Jim<br />

Dobbin MP at the House <strong>of</strong> Commons email dobbinj@parliament.uk<br />

<strong>John</strong> <strong>Perrott</strong> conducted his survey by sending a questionnaire to 149 PCTs to verify<br />

this statement in the NTA review. The responses he received are as follows:<br />

83 PCTs NO SERVICES<br />

11 PCTs PARTIAL SERVICES (very limited provision)<br />

6 PCTs YES (provide <strong>services</strong> meeting most <strong>of</strong> <strong>John</strong> <strong>Perrott</strong>’s criteria listed below)<br />

19 PCTs ESCALATED TO FOI. RESPONSE STILL OUTSTANDING<br />

30 PCTs NO REPLY<br />

Methodology:<br />

Copy <strong>of</strong> email sent to 149 PCTs on 10 April 2012:<br />

“Dear Sir/Madam,<br />

Please can you tell me what <strong>services</strong> your PCT/CCG provides for patients who are<br />

dependent upon prescribed only benzodiazepine and z drug tranquillisers and sleeping<br />

tablets and who do not abuse these or other substances.<br />

Would you please include details <strong>of</strong> the availability <strong>of</strong> withdrawal advice and<br />

support?<br />

In my experience the Drugs and Alcohol Teams routinely do not treat involuntary<br />

tranquilliser addiction but only illicit addiction.<br />

The Department <strong>of</strong> Health have referred me to PALS.<br />

Kind Regards,<br />

<strong>John</strong> <strong>Perrott</strong>”<br />

If more information was required, the first email was followed up by a second email<br />

or by telephone and the following description <strong>of</strong> specialised withdrawal support was<br />

provided:


1. Conversion to a longer-acting benzodiazepine like diazepam.<br />

2. Provision <strong>of</strong> withdrawal schedules.<br />

3. Knowledge <strong>of</strong> the Ashton manual.<br />

4. Provision <strong>of</strong> appropriate psychological support.<br />

5. Provision <strong>of</strong> a help-line.<br />

6. Any other details <strong>of</strong> such referral processes.<br />

PCT Responses (alphabetical order)<br />

Each PCT response is preceded by <strong>John</strong> <strong>Perrott</strong>’s comments in red.<br />

A<br />

Ashton, Leigh and Wigan PCT YES Provided by CITA<br />

Our response is below:<br />

The PCT commissions an outside provider to place counselors in practices to<br />

provide one to one support to patients that are withdrawing from these drugs.<br />

The counselors are based in approximately a quarter <strong>of</strong> our practices at any<br />

one time. This is normally practices where there is a high level <strong>of</strong> prescribing<br />

<strong>of</strong> benzodiazepines and Z drugs. In addition, there is a referral service where<br />

practices that do not have their own allocated counselor can refer their patients.<br />

If you are not satisfied with the information you have been provided with, make<br />

a complaint or wish to request an internal review you should write to Pauline<br />

Brown, Information Governance Manager at the above address. This should be<br />

done within a reasonable period <strong>of</strong> time from receiving this response.<br />

If you are not satisfied with our review under the Freedom <strong>of</strong> Information Act, you<br />

may apply directly to the Information Commissioner for a decision. Generally,<br />

the Information Commissioner’s Office cannot make a decision unless you have<br />

exhausted our complaints procedure. The Information Commissioner can be<br />

contacted at:<br />

Locality Chairman: Alan Stephenson.<br />

The Information Commissioner’s Office, Wycliffe House, Water Lane,<br />

Wilmslow, Cheshire, SK9 5AF<br />

If you need any further assistance, please do not hesitate to contact me quoting<br />

the above reference number.<br />

Yours sincerely,<br />

Andrea Hughes<br />

Information Governance<br />

Barking and Dagenham PCT NO see Redbridge<br />

Barnet PCT NO – The only service in London is provided by the long established and experienced<br />

tranquilliser project at Camden MIND and this is for Camden and Islington residents only and also is a<br />

charity and not an in-house NHS service


Barnsley PCT NO – I rang PALS who could not direct me to anyone that could help.<br />

The DAT only deals with misuse.<br />

Thank you for your email.<br />

Please visit the link below for details <strong>of</strong> how to contact PALS.<br />

http://www.barnsleyhospital.nhs.uk/facilities/patient-advice-and-liaison<br />

-service-pals/<br />

Many thanks<br />

Enquiries team<br />

NHS Barnsley<br />

Bedfordshire PCT NO<br />

I am writing in response to your enquiry, I apologise for the delay in replying to you.<br />

My colleague in the Medicines Management team has advised that NHS Bedfordshire do not<br />

commission separate <strong>services</strong> for patients who have an addiction to prescription drugs.<br />

However, you should discuss with your GP the issues you have with dependence and advise<br />

him/her if you wish to stop taking these drugs. The GP should be able to start you on a<br />

gradual dose reduction to help you come <strong>of</strong>f these drugs. The local Shared Care service may<br />

be able to <strong>of</strong>fer support and advice to the GP on appropriate dose reductions.<br />

Please let me know if you require any further information.<br />

Regards<br />

Diane Sollars<br />

Public Liaison Officer<br />

Public Engagement and Communications<br />

NHS Bedfordshire<br />

Berkshire East PCT and Berkshire West PCT NO<br />

I have had a reply from the Pharmaceutical Manager at the PCT who has advised me that the<br />

recommended route for this is to discuss and gain the clinical support <strong>of</strong> your GP.<br />

Regards<br />

Mrs Terry Pascucci<br />

Patient Advice and Liaison Service Officer<br />

Patient Experience Team<br />

NHS Berkshire<br />

Berkshire West PCT NO - See Berkshire<br />

Bolton PCT NO, not at time <strong>of</strong> response<br />

Dear <strong>John</strong> at the moment people taking that prescribed drug is under review a new model is<br />

being developed and that will include support for a wider variety <strong>of</strong> clients<br />

The alcohol and drugs service based at wood street Bolton may be able to provide<br />

psychological support however the medical management for yourself will still come under<br />

your GP hope this has been a help to you<br />

Regards<br />

Val pals <strong>of</strong>ficer Lever Chambers


Bournemouth and Poole Teaching PCT also Dorset PARTIAL – I spoke to Mark Harris who<br />

showed great understanding <strong>of</strong> the problem and although they do not have a<br />

dedicated service they will work with GPs and would <strong>of</strong>fer reduction advice and<br />

psychological support and have one member <strong>of</strong> staff who has benzo addiction as a<br />

special interest.<br />

Dear Mr Perrot<br />

Thank you for your enquiry below. Please accept my apologies for the delay in responding.<br />

In instances where an individual is solely dependent upon prescribed benzodiazepines, in<br />

most cases a suitable reduction plan can be agreed with the prescriber. The prescriber may<br />

wish to make contact with the local specialist drug treatment agency for advice on a suitable<br />

management and reduction plan where required. Additional psychological support can also be<br />

obtained through drug & alcohol support <strong>services</strong>.<br />

Please feel free to contact me should you have any further queries in this regard.<br />

Best wishes<br />

Mark Harris<br />

Senior Commissioning Manager - Substance Misuse<br />

NHS Bournemouth, Poole & Dorset<br />

Discovery Court<br />

Canford House<br />

551-553 Wallisdown Rd<br />

Poole<br />

BH12 5AG<br />

Bradford and Airedale Teaching PCT PARTIAL – refer to Bridge Project, BUT this is only through<br />

part-funding <strong>of</strong> an outside/voluntary/charitable organisation, insufficient compared<br />

with the magnitude <strong>of</strong> the problem and not an in-house service provided by the NHS.<br />

Thank you for your recent email.<br />

I write to advise that I have made enquiries with my colleagues at the PCT and I have been<br />

informed that the PCT commission a benzodiazepine withdrawal service through the Bridge<br />

Project based at Salem Street in Bradford and this is for any adult residing in Bradford who<br />

requires help and support to reduce or cease their use <strong>of</strong> benzodiazepines<br />

The service the PCT <strong>of</strong>fers is mainly delivered from GP practices, although home visits may<br />

be available. Advice, information, guidance and counselling are provided on all aspects<br />

relating to benzodiazepine use and dependance. Working closely with the patient's GP, an<br />

individual programme is agreed to enable gradual reduction in benzodiazepine use in a highly<br />

supportive environment. The specialist worker educates clients in the use <strong>of</strong> anxiety<br />

management techniques and uses structured interventions including cognative behavioural<br />

therapy.<br />

I am waiting for further information to be sent to me regarding referral routes and I have also<br />

made enquiries with our Pharmacy Team to see if they have a pharmacy support group going<br />

into GP practices to review/assist reduction.<br />

I hope that information that I have so far provided above will prove useful and I will make<br />

contact with you again once I have further information. However if in the meantime you feel<br />

that I can be <strong>of</strong> any further assistance please do not hesitate to contact me.<br />

Regards<br />

Emma<br />

Brighton and Hove City PCT PARTIAL – I had a long discussion with Charlie Freeman<br />

who is a substance misuse nurse and works part-time as a specialist benzo reduction<br />

worker. He is very experienced and showed substantial understanding <strong>of</strong> the problem.<br />

He supports and provides education for GPs and provides brief interventions, has set


up a website and works closely with surgeries. However, he cannot provide extensive<br />

long-term support for sufferers <strong>of</strong> ITA as one person working part-time. He also said<br />

that benzo misprescribing in Brighton is a huge problem. Through Charlie’s efforts<br />

Brighton and Hove have many initiatives to try to tackle the problem.<br />

You are very welcome. I have forwarded your questions to Charlie Freeman who is the<br />

Charge Nurse for the Substance Misuse Service and specialises in working with GP practices<br />

around Benzo's.<br />

I hope this helps.<br />

Kind regards,<br />

Tanya<br />

Bristol PCT PARTIAL – refer to BAT which is part funded by South Gloucester/Bristol and also refer to the<br />

Bristol and District Tranqilliser Project part funded by Bristol PCT BUT this is only through part-<br />

funding <strong>of</strong> an outside/voluntary/charitable organisation and not an in-house service<br />

provided by the NHS.<br />

I am sorry that it has taken me longer than I had anticipated to come back to you with the<br />

information you had requested.<br />

I have been advised that as part <strong>of</strong> the partnerships <strong>of</strong> the local Drug Action Team, NHS<br />

North Somerset funds a local service called Battle Against Tranquillisers. I am advised this<br />

organisation is able to provide a service for anyone with any kind <strong>of</strong> tranquilliser addiction or<br />

dependency, regardless <strong>of</strong> how they have arrived at that position. You may find their website<br />

<strong>of</strong> interest: http://www.bataid.org/<br />

If you would like to discuss what <strong>services</strong> they <strong>of</strong>fer then I am sure they would be happy to<br />

respond directly to you about that.<br />

Again I am so sorry about the delay in coming back to you, but I do hope this information is<br />

helpful. if you have any further queries then please do feel free to contact me again.<br />

With many thanks and kind regards,<br />

Lucy<br />

Lucy Delaney<br />

PALS Officer (Monday-Thursday)<br />

NHS Bristol<br />

Buckinghamshire PCT same as Oxfordshire NO – Substance misuse only and harm minimisation<br />

Bury PCT NO<br />

Thank you for your email and apologies for the delay in response.<br />

There isn’t a specific service that deals with the cohort <strong>of</strong> people with<br />

dependence to prescribed medication. The patient would be referred to their<br />

GP for advice and support.<br />

If you require any further information please do not hesitate to contact me.<br />

Regards,<br />

Joanne Maclean<br />

PALS and PPI Support Officer<br />

T: 0800 328 3166<br />

NHS Bury


Calderdale PCT NO<br />

Freedom <strong>of</strong> Information Act 2000<br />

I am writing in respect <strong>of</strong> your recent enquiry for information held by NHS<br />

Calderdale under the provisions <strong>of</strong> the Freedom <strong>of</strong> Information Act 2000.<br />

You asked for the information relating to the patients who are dependent upon<br />

prescribed only benzodiazepine and z drug tranquillisers and sleeping tablets. In<br />

response to your request, please find details below.<br />

Please can you tell me what <strong>services</strong> your PCT/CCG provides for patients who<br />

are dependent upon prescribed only benzodiazepine and z drug tranquillisers and<br />

sleeping tablets and who do not abuse these or other substances.<br />

Would you please include details <strong>of</strong> the availability <strong>of</strong> withdrawal advice and<br />

support including:<br />

1. Conversion to a longer-acting benzodiazepine like diazepam.<br />

2. Provision <strong>of</strong> withdrawal schedules.<br />

3. Knowledge <strong>of</strong> the Ashton manual.<br />

4. Provision <strong>of</strong> appropriate psychological support.<br />

5. Provision <strong>of</strong> a help-line.<br />

6. Any details <strong>of</strong> such referral processes.<br />

We do not commission a benzodiazepine/tranquilliser service as such. The substance<br />

misuse service will manage people with this type <strong>of</strong> addiction if they are also addicted<br />

to street drugs but do not take referrals for this type <strong>of</strong> addiction only.<br />

The Medicines Management Team have run initiatives (benzodiazepine reduction<br />

clinics) with some GP practices to inform and encourage good management and to<br />

help patients withdraw from benzodiazepines. But day to day management will be<br />

down to the individual GP.<br />

Chair: Angela Monaghan<br />

Chief Executive: Mike Potts<br />

Clinical Commissioning Executive Chair: Dr Alan Brook<br />

There is no current guidance in place to support practices with benzodiazepine<br />

reduction but practices would be signposted to suitable UK guidelines and<br />

information sources as<br />

required.<br />

Yours sincerely<br />

Anna Lewandowska<br />

Information Governance Officer<br />

Camden PCT PARTIAL – patients have access to the Minor Tranquilliser Project at Camden MIND<br />

managed by Melanie Davis which has over 20 years experience but this is only through part-funding<br />

<strong>of</strong> an outside/voluntary/charitable organisation, insufficient compared with the magnitude<br />

<strong>of</strong> the problem and not an in-house service provided by the NHS.<br />

Central and Eastern Cheshire PCT NO Also see Wirral. This is substance misuse treatment<br />

and anyone who refers patients to “Talk to Frank” (misuse helpline) as a specialist<br />

helpline as the author <strong>of</strong> this response has done, does not understand ITA treatment.


FREEDOM OF INFORMATION ACT REQUEST<br />

Please find detailed below Central & Eastern Cheshire PCT’s response to your FOI<br />

request.<br />

You asked: Please can you tell me what <strong>services</strong> your PCT/CCG provides for patients<br />

who are dependent upon prescribed only benzodiazepine and z drug tranquillisers and<br />

sleeping tablets and who do not abuse these or other substances.<br />

The Drugs and Alcohol Team (DAT) commission a Health Trust to provide a<br />

substance misuse service and Shared Care scheme to dependent drug users which<br />

meets the need for identified-referred patients who are drug dependent. The DAT also<br />

commissions inpatient detoxification provision.There is a number <strong>of</strong> patients who are<br />

abusing prescription medicine but who are not in the drug treatment service or<br />

working outside <strong>of</strong> the Shared Care scheme. Wider <strong>services</strong> to provide support<br />

include IAPT <strong>services</strong>, reablement and pain management <strong>services</strong>.<br />

General Practice is encouraged and supported to prescribe hypnotics in line with<br />

NICE guidance. From time to time, practices will review patients prescribed<br />

hypnotics for longer than the recommended 2-4 weeks and <strong>of</strong>fer encouragement to<br />

reduce the use <strong>of</strong> hypnotics. This will include advice on good sleep hygiene and a<br />

programme <strong>of</strong> conversion to diazepam and reduction in dose if needed, together with<br />

the option <strong>of</strong> referral into more specialist <strong>services</strong>. Overall, the PCT prescribing <strong>of</strong><br />

hypnotics is below the national average.Would you please include details <strong>of</strong> the<br />

availability <strong>of</strong> withdrawal advice and support including:<br />

1. Conversion to a longer-acting benzodiazepine like diazepam.<br />

All contracts with commissioned providers stipulate the need to meet the aim to<br />

provide a range <strong>of</strong> interventions for individuals with drug misuse problems in line<br />

with the national 2007 Drug Misuse and Dependence UK Guidelines on Clinical<br />

Management and NICE 2007 Drug Misuse guidance.<br />

2. Provision <strong>of</strong> withdrawal schedules.<br />

As above - policies are held by commissioned providers on withdrawal schedules and<br />

conversion <strong>of</strong> prescription where assessment indicates in line with national guidance.<br />

3. Knowledge <strong>of</strong> the Ashton manual.<br />

There is knowledge <strong>of</strong> the Ashton manual but we do not refer to this in contracts as it<br />

is not in the above national guidance.<br />

4. Provision <strong>of</strong> appropriate psychological support.<br />

As above - in line with national guidance and stipulated in contracts. Psychological<br />

support available through drug <strong>services</strong>, mental health <strong>services</strong> and wellbeing<br />

activities.<br />

5. Provision <strong>of</strong> a help-line.<br />

No specific local help line for prescribed benzodiazepine, z drug tranquillisers or<br />

sleeping tablets only. Talk to Frank website available nationally.<br />

6. Any details <strong>of</strong> such referral processes. Referral pathway to the drug service from all<br />

universal and specialist <strong>services</strong>.<br />

In my experience the Drugs and Alcohol Teams routinely do not treat involuntary<br />

tranquilliser addiction but only illicit addiction. –<br />

Cheshire DAT have included in the 2012-13 Direction <strong>of</strong> Travel Strategy focus to this<br />

area <strong>of</strong> work.<br />

Some DATs do treat tranquilliser addiction and we realise we need to address this<br />

locally in line with the National Drug Strategy and emerging health pictures. We are<br />

aware that prescription medicine (POM) and Over the Counter (OTC) medicine can<br />

bring comfort to many people suffering from a wide range <strong>of</strong> ailments and the overall


use <strong>of</strong> prescription drugs has increased nationally. It is clear some people can develop<br />

problems with the use <strong>of</strong> certain medicines that have the potential for dependency<br />

and abuse. While historically, problems in relation to POM/OTC medicines have not<br />

been a major<br />

focus <strong>of</strong> drug treatment policy, national data does suggest that the use <strong>of</strong> these<br />

medicines are reported as problematic by a significant proportion <strong>of</strong> the drug<br />

treatment population. We also recognise that dependent drug users may <strong>of</strong>ten take<br />

POM/OTC medicines for quite different reasons than the rest <strong>of</strong> the population, for<br />

example, to enhance the effects <strong>of</strong> illegal drugs or to manage their after effects. It is<br />

clear that while some people might develop problems from the directed use <strong>of</strong> these<br />

medicines others can develop problems that stem from their non-directed use.<br />

We will focus on helping both involuntary and illicit addiction.<br />

I hope this sufficiently answers your enquiry but please do not hesitate to contact<br />

Gary Shenton, contact details at the top <strong>of</strong> the letter, should you require any further<br />

information.<br />

Yours sincerely<br />

Kathy Doran<br />

Chief Executive<br />

NHS Cheshire Warrington Wirral<br />

Pp Alex Dalgarno<br />

Cornwall and Isles Of Scilly PCT YES – discussed on phone with Trevint House and they do provide<br />

<strong>services</strong> and showed a good understanding <strong>of</strong> the needs <strong>of</strong> ITA sufferers. They have 3 <strong>of</strong>fices across the<br />

County, workers in GP’s surgeries, they understand people become housebound due to withdrawal<br />

symptoms and provide home visits and the GPs work with therapeutic volunteers.<br />

I have been sent this information from our Joint Commissioning Manager,Cornwall & Isles <strong>of</strong><br />

Scilly Drug & Alcohol Action Team (DAAT)<br />

Some GPs <strong>of</strong>fer supported reduction programmes and Add action do <strong>of</strong>fer support. Their<br />

Central <strong>of</strong>fice is:<br />

Trevint House<br />

Strangways Villas<br />

Truro, TR1 2PA<br />

01872 263001<br />

I don't know if you have discussed this with your GP?, but you might like to give Trevint<br />

House a ring to see if they are able to help.<br />

Best wishes<br />

Wendy PALS Team<br />

NHS Cornwall and Isles <strong>of</strong> Scilly<br />

County Durham PCT YES – I spoke with Katharine Humby and the Community Drugs Team works closely<br />

with Mind and also NECA in their 7 treatment <strong>services</strong><br />

Thank you for your email.<br />

It is difficult to comment or provide advice to you on the basis <strong>of</strong> the information provided.<br />

Can I suggest that you contact PALS on freephone 0800 195 7998 in order that we can<br />

discuss your query in more detail.


Alternatively if you would like to email me your contact telephone number, a member <strong>of</strong> the<br />

PALS team will be happy to phone you.<br />

I look forward to hearing from you.<br />

Best wishes.<br />

Katharine Humby<br />

Patient Advice and Liaison Service (PALS) Manager<br />

Coventry Teaching PCT also Warwickshire NO<br />

The PCT does not provide any <strong>services</strong> for patients who are dependent upon prescribed<br />

drugs. The GP, will <strong>of</strong> course, provide necessary treatment but I believe the CWPT provide<br />

the substance misuse <strong>services</strong>.<br />

Hope that’s ok<br />

Regards<br />

Harpal Bains<br />

Patient Advice & Information Assistant<br />

NHS Coventry<br />

Nursing Directorate<br />

Christchurch House<br />

Cumbria Teaching PCT NO – I have a letter from my previous surgery (Head Doctor – Cumbria) stating that<br />

there are no such <strong>services</strong> in Cumbria.<br />

NHS Cumbria does not deliver this service but if you would like to contact Cumbria<br />

Partnership Foundation Trust on 01228 602020 they will be able to help<br />

Thank you<br />

Shirley Forrest<br />

Executive Assistant/PALS<br />

NHS Cumbria<br />

Tenterfield<br />

Brigsteer Road<br />

KENDAL<br />

Cumbria. LA9 5EA<br />

Derby City PCT NO – These all deal with illicit use. I also contacted Phoenix Futures in Trafford and they<br />

deal with illicit use only.<br />

I am unsure if you live in the Derby City or Derbyshire County geographical area, and the<br />

response may differ slightly between the two areas. I have contacted the Derby City Lead<br />

Commissioner Mr. James Sutherland, /Substance Misuse - who has kindly provided the<br />

information below:<br />

‘Individuals with addictions to prescribed medications (in the Derby City area) are supported<br />

by City <strong>services</strong> i.e. Phoenix Futures, who are happy to support the patients registered /<br />

prescribing G.P. in the development <strong>of</strong> management and support plans - to assist in recovery<br />

from prescribed medications.<br />

The City’s Drug treatment <strong>services</strong> are primarily concerned with providing substitute<br />

medication for illicit drug use. The rationale for this in relation to prescribed medications is<br />

there may be ongoing / underlying clinical care and medical needs which may preclude<br />

treatment to be undertaken directly by drug treatment agencies, and as such a supportive<br />

partnership approach is favoured within the City.<br />

I hope this information is helpful to you, however if you are a Derbyshire patient – I would be<br />

more than happy to approach our Senior Commissioning Manager Mr. M. Burrows, -<br />

Derbyshire Drug and Alcohol Team (DAAT) - in order to request additional feedback, linked<br />

to the same enquiry for Derbyshire response


Please do not hesitate to contact me, should you require this additional feedback<br />

Kind regards<br />

Colleen March<br />

PALS Patient Advice & Liaison Service<br />

Please note, i have a new address:<br />

NHS Derby City<br />

Derbyshire County PCT NO – See Derby City<br />

I have forwarded the email you have sent onto the PALS team for the Derbyshire County &<br />

Derby City Cluster. They will be in touch with you soon.<br />

With kind regards<br />

Clair Shipley, High Peak Locality, North Derbyshire<br />

Doncaster PCT NO Substance misuse only<br />

Drug Interventions Programme<br />

The Drug Interventions Programme focuses on the illicit use <strong>of</strong> heroin and cocaine<br />

by people who have committed a 'trigger' <strong>of</strong>fence, so the scheme is very specific in<br />

terms <strong>of</strong> the clients to whom <strong>services</strong> are provided. In terms <strong>of</strong> other illicit drug use<br />

our staff would signpost clients or other members <strong>of</strong> the public to other <strong>services</strong>. In<br />

relation to the substances referred to in the query, we would most likely refer the<br />

individual to their GP.<br />

New Beginnings<br />

In regards to question 4, New Beginnings runs a CBT restructuring programme<br />

designed for people seeking support or help due to problematic addiction issues that<br />

is able to focus on some <strong>of</strong> the cognitive issues that would be experienced by people<br />

suffering from either assisted withdrawal or detoxification from such drugs. In regards<br />

to item 5 there is a website www.drughub.co.uk, which is a local site <strong>of</strong> information<br />

and support for Doncaster <strong>services</strong>.<br />

Substance Misuse Service – Doncaster (The Garage)<br />

If this is an iatrogenic problem then we would generally advise the service user to<br />

ask their GP to refer to the consultant psychiatrist for a consultation and advice on<br />

managed withdrawal by the GP within practice.<br />

Dorset PCT see Bournemouth and Poole Teaching PCT PARTIAL<br />

Dudley PCT see Walsall PCT No<br />

FREEDOM OF INFORMATION ACT 2000 – NHS Dudley PCT -<br />

InvoluntaryTranquilliser Addiction - Ref: FOI/000144<br />

Thank you for your email received on 14th May 2012.<br />

Your request for information as detailed below has now been considered.<br />

However unfortunately Dudley PCT do not provide or specifically commission


<strong>services</strong> for patients dependent on benzodiazepine or Z drugs but who do not abuse<br />

them.<br />

Eastern and Coastal Kent PCT NO - See Medway<br />

East Riding Of Yorkshire PCT NO<br />

Your Request for Information<br />

I am writing in response to your recent request that we received on 2 May 2012, in which you requested the<br />

following information under the Freedom <strong>of</strong> Information Act 2000.<br />

Information Requested: Please can you tell me what <strong>services</strong> your PCT/CCG provides for patients who are<br />

dependent upon prescribed only benzodiazepine and z drug tranquillisers and sleeping tablets and who do<br />

not abuse these or other substances.<br />

No <strong>services</strong> are currently provided by NHS East Riding <strong>of</strong> Yorkshire for patients who are<br />

dependent upon prescribed only benzodiazepine and z drug tranquillisers and sleeping<br />

tablets and who do not abuse these or other substances.<br />

NHS East Riding <strong>of</strong> Yorkshire is looking to develop a service for 2013/2014<br />

I trust this letter provides a full response to your request, but please do not hesitate to contact<br />

me should you need any further assistance. You can find out more information about NHS<br />

East Riding <strong>of</strong> Yorkshire by visiting our website at www.eastriding<strong>of</strong>yorkshire.nhs.uk.<br />

Yours sincerely<br />

Emma Parker<br />

Corporate Affairs Administration Manager<br />

Enfield PCT NO – The only service in London is provided by the long established and experienced<br />

tranquilliser project at Camden MIND and this is for Camden and Islington residents only and also is a<br />

charity and not an in-house NHS service<br />

Gateshead PCT NO – See South Tyneside<br />

Gloucestershire PCT NO<br />

Our Reference: Freedom <strong>of</strong> Information request No. 1366/1666, seeking information<br />

on Services for Involuntary Tranquilliser Addiction, which we received on 23.4.12.<br />

I am writing to confirm that the Trust has now finished its search for the information<br />

you requested, which was as follows:-<br />

ANSWER: Treatment for involuntary tranquiliser addiction is not something that is<br />

specifically commissioned in isolation by the PCT or DAAT.<br />

Occasionally we receive requests from GPs or other psychiatrists about tranquiliser<br />

dependence in people with no other addictions and we would suggest the use <strong>of</strong> the<br />

prodigy website http://www.prodigy.nhs.uk/. This has useful info about associated<br />

topics, e.g, insomnia and depression, and is a Heather Ashton product.<br />

We are not aware <strong>of</strong> any local helpline and long term psychological support would<br />

not be available in this trust unless there were co-existing mental health problems<br />

and/or other addictions. We do recommend the national help lines in our leaflet and<br />

suggest people obtain help from Independence Trust as appropriate.


If you are unhappy with the service you have received in relation to your request and<br />

wish<br />

to make a complaint or have a review <strong>of</strong> our decision, you should write to:-<br />

Service Experience Manager,<br />

2gether NHS Foundation Trust,<br />

Rikenel,<br />

Montpellier,<br />

GLOUCESTER. GL1 1LY<br />

Tel: 01452-891138<br />

e-mail: complaints.2gether@glos.nhs.uk<br />

Yours sincerely,<br />

Trish Bluett (Mrs.),<br />

Information Governance Officer.<br />

Greenwich Teaching PCT NO CRI is Crime Reduction Initiatives and substance misuse treatment<br />

Freedom <strong>of</strong> Information Act Request<br />

Thank you for your request under the Freedom <strong>of</strong> Information Act.<br />

In response I am pleased to provide the following information that has been set out in<br />

a<br />

similar format to your request.<br />

Please can you tell me what <strong>services</strong> your PCT/CCG provides for patients who are<br />

dependent upon prescribed only benzodiazepine and z drug tranquillisers and sleeping<br />

tablets and who do not abuse these or other substances?<br />

The Greenwich Medicines Management team support the GPs within our CCG<br />

with prescribing information and usage <strong>of</strong> these drugs. The GPs are supported to<br />

review individual patient’s medication and are they obtain support from CRi to<br />

help patient who want to reduce the usage <strong>of</strong> these medicines. For those patients<br />

who require additional support, the service is provided via the Drugs and Alcohol<br />

service run by CRi.<br />

Would you please include details <strong>of</strong> the availability <strong>of</strong> withdrawal advice and<br />

support?<br />

Please contact CRi for further information on the availability <strong>of</strong> withdrawal advice<br />

at the following address:<br />

821 Woolwich Road,<br />

Charlton,<br />

London SE7 8JL<br />

Halton and St Helens PCT NO See Sefton and Liverpool<br />

Hammersmith and Fulham PCT NO Also see Westminster<br />

I am writing from NHS North West London which administers Freedom <strong>of</strong> Information Act 2000<br />

(FOIA) requests on behalf <strong>of</strong> Westminster, Hammersmith & Fulham, Kensington & Chelsea,<br />

Brent, Harrow, Hounslow, Hillingdon and Ealing PCTs. This response is on behalf <strong>of</strong> INWL PCTs<br />

(Hammersmith and Fulham, Kensington and Chelsea, and Westminster)You requested the<br />

following:<br />

Please can you tell me what <strong>services</strong> your PCT/CCG provides for patients who are dependent<br />

upon prescribed only benzodiazepine and z drug tranquillisers and sleeping tablets and who do


not abuse these or other substances?Would you please include details <strong>of</strong> the availability <strong>of</strong><br />

withdrawal advice and support?<br />

In my experience the Drugs and Alcohol Teams routinely do not treat involuntary tranquilliser<br />

addiction but only illicit addiction.<br />

The response to your request is as follows:<br />

Practitioners within the INWL PCTs are advised to follow the advice in the British National<br />

Formulary (BNF) with regards to prescribing hypnotics, and that they should not be prescribed<br />

indiscriminately and that routine prescribing is undesirable. Where prolonged administration is<br />

unavoidable hypnotics should be discontinued as soon as feasible and the patient warned that<br />

sleep may be disturbed for a few days before normal rhythm is re-established; broken sleep with<br />

vivid dreams may persist or several weeks.<br />

There is no specialised service addressing the patients who are dependent upon prescribed only<br />

benzodiazepine and z drug tranquillisers and sleeping tablets and who do not abuse these or<br />

other<br />

substances within INWL PCT area. The Royal College <strong>of</strong> General Practitioners would <strong>of</strong>fer advice<br />

and support to GP’s progressing a withdrawal regime with their patient. There is also<br />

information<br />

and guidance available from National Institute for Clinical Excellence (NICE) and easily accessed<br />

via NHS North West London is a partnership <strong>of</strong> NHS Brent, NHS Ealing, NHS Hammersmith &<br />

Fulham, NHS Harrow, NHS Hillingdon, NHS Hounslow, NHS Kensington & Chelsea and NHS<br />

Westminster.<br />

You are correct in your assumption that the specialist drug and alcohol <strong>services</strong> within INWL<br />

PCT’s catchment does treat tranquiliser addiction when combined with illicit substance misuse<br />

but not stand alone tranquilliser addiction unless illicit. They are not commissioned to carry out<br />

this function and there is a recognition that the needs <strong>of</strong> the cohort you refer to are significantly<br />

different to those who are illicit substance misusers.<br />

Specialist <strong>services</strong> do <strong>of</strong>fer advice and guidance however would refer individuals back to primary<br />

care <strong>services</strong> for the management <strong>of</strong> their care which might include a withdrawal regime.<br />

Yours sincerely,<br />

Andrew Lall<br />

Freedom <strong>of</strong> Information Lead<br />

Hampshire PCT also Isle <strong>of</strong> Wight and Southampton NO<br />

Further to your e-mail <strong>of</strong> 10 April 2012, I have been informed by our Head <strong>of</strong> Medicines<br />

Management that some GP’s support benzodiazepines withdrawal, however, he is not<br />

aware <strong>of</strong> any other support. He has also commented that previously, we did <strong>of</strong>fer a service<br />

through one <strong>of</strong> our Medicines Management nurses; if GP’s needed such a service he has<br />

confirmed we could consider that as an option.<br />

Our Community Pharmacy Lead has reported that there is nothing that involves Community<br />

Pharmacy, only as you point out, for those addicted to benzodiazepines engaged at IDAS.<br />

I do hope this information helps.<br />

Yours sincerely<br />

Samantha <strong>John</strong>son<br />

Quality Facilitator<br />

SHIP (Southampton, Hampshire, Isle <strong>of</strong> Wight & Portsmouth PCT)<br />

Haringey Teaching PCT NO – The only service in London is provided by the long established and<br />

experienced tranquilliser project at Camden MIND and this is for Camden and Islington residents only and<br />

also is a charity and not an in-house NHS service


Harrow PCT NO – Have only dealt with codeine products<br />

I am writing from NHS North West London which administers Freedom <strong>of</strong><br />

Information Act 2000 (FOIA) requests on behalf <strong>of</strong> Westminster, Hammersmith &<br />

Fulham, Kensington & Chelsea, Brent, Harrow, Hounslow, Hillingdon and Ealing<br />

PCTs. This response in on behalf <strong>of</strong> NHS Harrow.<br />

You requested the following:<br />

Please can you tell me what <strong>services</strong> your PCT/CCG provides for patients who are<br />

dependent upon prescribed only benzodiazepine and z drug tranquillisers and sleeping<br />

tablets and who do not abuse these or other substances?<br />

Would you please include details <strong>of</strong> the availability <strong>of</strong> withdrawal advice and<br />

support?<br />

In my experience the Drugs and Alcohol Teams routinely do not treat involuntary<br />

tranquilliser addiction but only illicit addiction.<br />

The response to your request is as follows:<br />

The drug treatment provider (Compass Harrow) do not usually receive referrals for<br />

those who are addicted to other tranquilisers, however they have had to develop<br />

reduction regimes for clients who are referred on some codeine based pain killers. In<br />

this situation they would work in partnership with the prescriber to look at a reduction<br />

regime, usually the Prescriber would continue the prescribing with support and advice<br />

from a specialist doctor at Compass, and also receive Psychosocial interventions<br />

alongside this. They have done this with GP’s and also consultants who may have<br />

prescribed this medication after an operation or as on-going pain relief, this<br />

arrangement has worked really well.<br />

In regards to Benzodiazepines again the treatment provider would support the<br />

prescriber to reduce this medication and in some cases where the reason for the initial<br />

commencement is due to mental health we would support a referral to the CMHT and<br />

Liaise with them. They would normally only take over the prescribing in<br />

circumstances where the client is being prescribed an opiate substitute by us and this<br />

would always be on a reduction regime. All clients would be <strong>of</strong>fered Group work and<br />

one to one support alongside any other intervention or support for the Prescriber.<br />

If you require any further information please do not hesitate to contact me.<br />

Yours sincerely,<br />

Andrew Lall<br />

Freedom <strong>of</strong> Information Lead<br />

Havering PCT NO - see Redbridge<br />

Herefordshire PCT NO – I rang the DAT and they do not understand benzo withdrawal and their work lies in<br />

treating substance misuse <strong>of</strong> mainly opioids. They did not understand withdrawal symptoms or the<br />

reassurance and support required during withdrawal and would apply inappropriate psychosocial<br />

interventions used in substance misuse treatment. Benzo addicts would have to join illicit opioid users in any


group work. When I explained what <strong>services</strong> should consist <strong>of</strong> they agreed that they did not <strong>of</strong>fer <strong>services</strong><br />

and retracted their claim.<br />

I have checked with our Drug and Alcohol team who have confirmed that they care able to<br />

<strong>of</strong>fer full support to you.The route in would be to call the team on 01432 263 636 and make an<br />

appointment to see them.<br />

Do let me know if there is anything else that I can do.<br />

Kind regards,<br />

Mark O'Donnell<br />

Patient Advice and Liaison Service (PALS)<br />

Hertfordshire PCT NO – Had long discussion with Naomi from PALS.<br />

Thank you for your email and in response to your enquiry, it would be a patient's GP that<br />

would have the responsibilty to provide advice initially by providing a withdrawal treatment<br />

plan. The GP can discuss any aspects outside their expertise with other NHS medical<br />

pr<strong>of</strong>essionals including those based at the PCT.<br />

If you have a specific concern or want to discuss this, you can telephone me on 01707<br />

369704.<br />

Regards<br />

Naomi<br />

Naomi Davies<br />

Patient Experience Co-ordinator<br />

Quality and Patient Experience Team<br />

NHS Hertfordshire<br />

Hounslow PCT NO – Provider <strong>of</strong> response had no experience or understanding<br />

Dear Andrew,<br />

The response you sent me from Hammersmith and Fulham and Westminster<br />

PCTs were fine.<br />

However, I will need much more detail from Hounslow. I require the<br />

information for Jim Dobbin MP to inform the next meeting with Anne<br />

Milton MP Public Health Minister. Further details required are as<br />

follows:<br />

Details <strong>of</strong> the characteristics <strong>of</strong> a proper withdrawal service including:<br />

1. Conversion to a longer-acting benzodiazepine like diazepam.<br />

2. Provision <strong>of</strong> withdrawal schedules.<br />

3. Knowledge <strong>of</strong> the Ashton manual.<br />

4. Provision <strong>of</strong> appropriate psychological support throughout what may<br />

be a prolonged withdrawal and post withdrawal period <strong>of</strong> up to a year<br />

or more.<br />

5. Provision <strong>of</strong> a help-line.<br />

6. Any other referral details<br />

Who provided the reply and which organisation e.g. a DAT?<br />

The reply cites Hounslow and Surrey; does the response apply to the<br />

whole <strong>of</strong> Surrey PCT as well?<br />

What does a group programme consist <strong>of</strong>, which other self-help groups<br />

referred to? Are they NHS funded/National Treatment Pool<br />

funded/voluntary sector?<br />

Whoever wrote this asked what I mean by treat; I mean provision <strong>of</strong> 1.-5. above.<br />

The person providing this response also asked about the level <strong>of</strong><br />

addiction. I mean people who have, through no fault <strong>of</strong> their own,<br />

become addicted to tranquillisers, prescribed to them by their doctors<br />

beyond the 2-4 week guidelines, many for years and decades, and have<br />

taken them under their doctor’s guidance, and have not abused these


prescribed tranquillisers or other substances.<br />

If these people needed help, what would be <strong>of</strong>fered to them.<br />

I do need this information rather urgently now as my original request<br />

went out on 10 April 2012 so an early response would be appreciated.<br />

From FOI Please see below a response to your follow up query;<br />

I cannot answer all that as the service is new and all the pathways are not fully<br />

established .<br />

It did not ask for withdrawal regimes.<br />

What I answered is that in the first instance one would assess the pt at the request <strong>of</strong><br />

the gp and there maybe a huge variety in the pt referred that would require differing<br />

responses. If the pt was suitable they would enter the treatment system if not back to<br />

the gp. My initial response answered the question would we see them or not, the<br />

answer is yes for an assessment after that it is difficult to comment but I would not<br />

refuse to see them.<br />

Isle Of Wight NHS PCT also Hampshire and Southampton NO<br />

Further to your e-mail <strong>of</strong> 10 April 2012, I have been informed by our Head <strong>of</strong> Medicines<br />

Management that some GP’s support benzodiazepines withdrawal, however, he is not<br />

aware <strong>of</strong> any other support. He has also commented that previously, we did <strong>of</strong>fer a service<br />

through one <strong>of</strong> our Medicines Management nurses; if GP’s needed such a service he has<br />

confirmed we could consider that as an option.<br />

Our Community Pharmacy Lead has reported that there is nothing that involves Community<br />

Pharmacy, only as you point out, for those addicted to benzodiazepines engaged at IDAS.<br />

I do hope this information helps.<br />

Yours sincerely<br />

Samantha <strong>John</strong>son<br />

Quality Facilitator<br />

SHIP (Southampton, Hampshire, Isle <strong>of</strong> Wight & Portsmouth PCT)<br />

Islington PCT PARTIAL – patients have access to the Minor Tranquilliser Project at Camden MIND<br />

managed by Melanie Davis which has over 20 years experience but this is only through part-funding<br />

<strong>of</strong> an outside/voluntary/charitable organisation, insufficient compared with the magnitude<br />

<strong>of</strong> the problem and not an in-house service provided by the NHS.<br />

Kensington and Chelsea PCT NO see Hammersmith and Fulham<br />

Kirklees PCT NO – however they do have a good guidance.<br />

Freedom <strong>of</strong> Information Act 2000<br />

I am writing in respect <strong>of</strong> your recent enquiry for information held by the PCT under the<br />

provisions <strong>of</strong> the Freedom <strong>of</strong> Information Act 2000.<br />

You asked for information relating to involuntary tranquilizer addiction.<br />

In response to your request please find below the following response:<br />

There are no specifically commissioned <strong>services</strong> to manage the group <strong>of</strong> patients who are<br />

dependent on z drugs and benzodiazepines. It is expected that the patient’s registered<br />

general practitioner will manage these patients.


The PCT does provide guidance and advice to GPs looking after patients who wish to stop<br />

taking benzodiazepines. Kirklees has adopted the Calderdale guidelines for this purpose<br />

(attached). The PCT’s Medicines Management team has occasionally provided additional<br />

support to GP practices/patients where this has been requested.<br />

If you are unhappy with the outcome or service you have received in relation to your<br />

request and wish to make a complaint or request a review <strong>of</strong> our decision, you should<br />

contact me in the first instance and I will be happy to work through any issues you<br />

may have. Alternatively, you can write to the Head <strong>of</strong> Patient Safety and Risk at:<br />

Broad Lea House<br />

Bradley Business Park<br />

Dyson Wood Way<br />

Bradley<br />

Huddersfield<br />

HD2 1GZ<br />

Knowsley PCT YES – Showed a good understanding <strong>of</strong> the needs <strong>of</strong> ITA sufferers and <strong>services</strong> reflect<br />

this.<br />

Dear Mr <strong>Perrott</strong>,<br />

Hello, I am one <strong>of</strong> Knowsley Primary Care Mental Health Services Benzodiazepine Reduction<br />

Therapists. I have been asked to give you some information about our Benzodiazepine<br />

Reduction Programme. My colleague Don Charnock and I developed an evidence-based<br />

holistic reduction programme which has now been available within our primary care mental<br />

health service to patients with a Knowsley GP for 10 years. We work with people who wish to<br />

reduce from prescribed tranquillizers and sleeping tablets in an individualized and openended<br />

way.<br />

In answer to your specific queries:<br />

1. Conversion to a longer-acting benzodiazepine like diazepam – this is the usual method we<br />

follow, when appropriate, in accordance with the BNF (British National Formulary) guidelines<br />

for withdrawal from Benzodiazepines, and in liaison with a patients GP.<br />

2. Provision <strong>of</strong> withdrawal schedules – we work collaboratively to suit individual circumstance,<br />

supporting each step closely and taking account <strong>of</strong> psychological readiness, other stress, comorbid<br />

health conditions, etc. A schedule will be outlined at the beginning, but may be varied<br />

according to need. This will <strong>of</strong> course be within BNF recommendations and with the<br />

agreement <strong>of</strong> the GP.<br />

3. Knowledge <strong>of</strong> the Ashton manual – our programme was devised in line with this by a<br />

Benzodiazepine Reduction Therapist with many years previous experience at CITA (Council<br />

for Involuntary Tranquillizer Addiction).<br />

4. Provision <strong>of</strong> appropriate psychological support – our therapists are all qualified counsellors<br />

/ psychological therapists with many years experience supporting people to withdraw from<br />

prescribed medication. We support the patient as required whether the need is simply to<br />

support a stepped withdrawal, or more complex. We work with anxiety, sleep strategies, and<br />

supporting nutrition if required.<br />

5. Provision <strong>of</strong> a help-line – unfortunately we are not able to <strong>of</strong>fer this as Benzodiazepine<br />

Reduction is a small part <strong>of</strong> a general primary care mental health service. However, when a<br />

reduction is in progress a therapist usually provides a flexible level <strong>of</strong> support appropriate to<br />

the stage the patient is at, for example: initial weekly face to face sessions, option for<br />

alternate telephone support sessions, and telephone check-ins during difficult periods. As<br />

each therapist holds a mixed caseload they are not always contactable by phone when in<br />

clinic, but messages are taken and they call patients back as soon as they can.<br />

If you wish to have a copy <strong>of</strong> the Benzodiazepine Reduction Programme booklet for more<br />

information I will be happy to post one out to you. Please email me your postal address if you<br />

would like this.<br />

As advised, if you wish to be referred for assessment your (Knowsley) GP can do this via our<br />

usual referral process, marked FAO Benzo Reduction. You would be assessed over the<br />

telephone initially by a member <strong>of</strong> our screening team, (who are not all Benzodiazepine


Reduction Therapists) then you will be seen for in-depth assessment for the Programme by a<br />

specialist clinician.<br />

I hope that answers your queries, if there is anything else you wish to ask please feel free to<br />

do so.<br />

Yours Sincerely and best wishes,<br />

Elizabeth Turp (MBACP) BACP Accredited & UKRCP Registered Counsellor/Psychological<br />

Therapist / Benzodiazepine Reduction Therapist - Specialist Clinician<br />

Knowsley Primary Care Mental Health Service<br />

Lambeth PCT NO - Rang the Drug and Alcohol Service and they treat illicit use only.<br />

In response to the questions your asked in relation the availability <strong>of</strong> <strong>services</strong> that support<br />

people that are involuntarily addicted to tranquilliser, we would expect them to be supported<br />

by their GP in the first instance. If the client is does wish to continue seeing the GP then they<br />

can be referred to our specialist Drug and Alcohol Service that is delivered by the South<br />

London & Maudsley Mental Health Foundation Trust.<br />

Unfortunately we are not aware <strong>of</strong> any informational materials that have been produced that<br />

provide information on withdrawals or support.<br />

If you any further information related to treatment provision then our borough consultant<br />

Psychiatrist for addictions has kindly suggested that you can contact him, his email address is<br />

below.<br />

mike.kelleher@slam.nhs.uk<br />

Kind regards<br />

Kenneth Gregory<br />

Joint Commissioning Manager - Substance Misuse<br />

Social Inclusion<br />

Integrated Commissioning Directorate<br />

NHS Lambeth<br />

1 Lower Marsh,<br />

SE1 7NT<br />

Leeds PCT PARTIAL – This is substance misuse treatment NOT ITA however, some systems are in<br />

place<br />

We, at the Leeds Addiction Unit (LAU), have always been innovative in providing patient care<br />

and are leaders <strong>of</strong> quality service provision. I agree with you, I think it is imperative that we<br />

have 'properly' qualified staff dealing with addiction problems. AT the LAU, we have robust<br />

clinical governance policies as well as prescribing guideline developed locally. They<br />

incorporate all necessary information (including benzodiazepine conversion table) for<br />

prescribers and are easily available to all health pr<strong>of</strong>essional in the trust. There is a protocol<br />

for gradual reduction but we encourage prescribing clinicians to treat each individual<br />

separately and cater to their needs and requirements.<br />

We have, for a long time now, believed that psychosocial interventions are equally important<br />

(if not more) to address the complex problem <strong>of</strong> addictions. Nearly all our clinical staff are<br />

trained to deliver psychological therapies and all our patients are dealt with, in a motivational<br />

interviewing style and we engage them in social behavioural network therapy. Our clinical<br />

staff have a variable background which ranges from psychiatric nurses, midwives, general<br />

nurses, whilst we also have two senior clinical psychologist, one CBT therapist, three<br />

consultant psychiatrist and a junior psychiatry trainee doctor at the unit. Apart from the<br />

doctors, we also have Non Medical Prescribers (NMPs). The referral process to LAU is quite<br />

flexible and we take referrals from anyone and deal with all patients above 18 years <strong>of</strong> age<br />

(there is no upper age limit).<br />

I am quite interested in your campaign and from your website it appears that you have done a


lot work around this issue. Please do let me know if I can be <strong>of</strong> any assistance to you in this<br />

campaign.<br />

If you have any further queries, please feel free to contact me again.<br />

Kind regards,<br />

Dr Yasir Abbasi<br />

Consultant Psychiatrist in Addictions/ Leeds and York Partnership NHS Foundation Trust<br />

Honorary Senior Lecturer/ University <strong>of</strong> Leeds<br />

Clinical Lead for Dual Diagnosis/ Leeds Addiction Unit<br />

Leicestershire County and Rutland PCT PARTIAL – Spoke with Mike Haj from LCPT and they are aware <strong>of</strong><br />

the needs <strong>of</strong> ITA sufferers and provide reduction schedules, are aware <strong>of</strong> the Ashton manual and can<br />

provide a wide range <strong>of</strong> therapies including 1:1 for sleep, anxiety and depression including acupuncture. He<br />

said they would be overwhelmed if this cohort all required withdrawal support.<br />

Hi Caroline,<br />

Thank you for this information which leads me to another couple <strong>of</strong> questions please. Are these<br />

in-house therapists knowledgeable regarding benzodiazepine withdrawal, do they follow the<br />

Ashton manual? What psychological support do they provide?<br />

Would you please provide contact details for the outreach service.<br />

Thanks <strong>John</strong><br />

You will need to approach Leicestershire Partnership Trust (LPT) for the answer to your<br />

questions below, as they provide the service and employ the therapists. We are a<br />

commissioning organisation, and therefore would not have this level <strong>of</strong> detail about how<br />

particular clinical staff at LTP operate.<br />

The outreach service, Paget House, is also run by LPT, so it may be best to approach them<br />

for any guidance/policy details concerning this service. However, I have included further<br />

details below:<br />

Paget House<br />

2 West Street<br />

Leicester<br />

LE1 6XP<br />

Tel: 0116 225 6400<br />

I hope you are successful in getting the information you require from LPT.<br />

Kind regards<br />

Caroline<br />

Customer Services Officer<br />

Medical Directorate<br />

NHS Leicester, Leicestershire County & Rutland<br />

Lewisham PCT NO<br />

In response to your enquiry, please accept my apologies for the delay in responding to you<br />

sooner. Unfortunately, the commissioner/contact for Lewisham was on leave, however I<br />

trust that the information detailed below will help.<br />

Please note that Lewisham Drug and Alcohol Team (DAAT) do not commission specific<br />

interventions for the client group detailed below. However, the commissioned service Crime<br />

Reduction Initiative (CRI) - New Direction 0208 314 5566 will be able to support individuals<br />

with interventions/techniques that would be able to support their dependence and<br />

recovery.<br />

Please also note that the patient’s GP would be able to initiate a reduction programme with<br />

the client – GPs are able to refer to Lewisham’s funding panel for funding for


detoxification/rehabilitation if needed. There are also self-help groups such as Narcotics<br />

Anonymous etc, however the first point <strong>of</strong> call would be via the GP.<br />

Should you require further information, please let me know.<br />

Kind regards<br />

Jenny McFarlane<br />

Patient Advice & Liaison Service (PALS) & Complaints Officer<br />

NHS South East London Lewisham Business Support Unit<br />

Liverpool PCT No – they refer to the experienced and long established voluntary charity CITA which is not<br />

NHS funded and struggling to maintain a service due to a lack <strong>of</strong> funding.<br />

M<br />

Manchester PCT PARTIAL at time <strong>of</strong> response and new service cannot be evaluated until in place<br />

Please find attached a response to your email requesting information<br />

regarding <strong>services</strong> for patients who are dependent upon prescribed only<br />

benzodiazepine and z drug tranquillisers and sleeping tablets I am sorry that<br />

this information did not get to you in the first instance.<br />

I liaised with the Public Health regarding your enquiry and the response from<br />

them is that the short answer to your question is no. This is not currently<br />

commissioned. A number <strong>of</strong> our current providers however, including Greater<br />

Manchester West (GMW), Lifeline, and Addiction Dependency Solutions<br />

(ADS) will see people with these problems. GMW has reported that the<br />

numbers referred to them from GP's are small. From July 2012, 3 new<br />

providers will start to deliver (and the current <strong>services</strong> provided by those<br />

providers mentioned above will be de-commissioned.) The 3 new providers<br />

are being commissioned to work with adults who have problems with any drug<br />

including those mentioned.<br />

If you would like further information you can contact Marie Earle Programme<br />

Lead for drug treatment in Public Health Manchester who can be emailed<br />

at m.earle@manchester.gov.uk.<br />

Once again, please accept my apologies for any delay in you receiving this<br />

information.<br />

Regards<br />

Sue Curzon<br />

PALS & Complaints Lead Officer<br />

PALS & Complaints Team<br />

NHS Manchester<br />

Room 3, 1st Floor<br />

Higher Openshaw Primary Care Centre<br />

Ashton Old Road<br />

Openshaw<br />

Manchester<br />

M11 1JG<br />

Medway PCT NO – I rang Bobbie Walkem-Smith – there are no <strong>services</strong> in Kent or Medway<br />

Reference my previous email, I have received a further response from the<br />

Medicines Management Team - NHS Kent and Medway, as follows:


"There is no formal service but the staff at KCA will sometimes provide advice<br />

and support for these patients if the GP is prepared to provide the prescribing<br />

support. I suggest that the person talks to their GP and KCA about this."<br />

I hope this information is helpful.<br />

Kind regards<br />

Bobbie Walkem-Smith<br />

PALS Officer<br />

NHS Kent and Medway<br />

Middlesbrough PCT see Stockton-on Tees NO<br />

Milton Keynes PCT same as Buckinghamshire NO – Substance misuse only and harm minimisation<br />

Newcastle PCT NO<br />

Within Newcastle there is Bridge View Drug Treatment Service – this service does not<br />

provide <strong>services</strong> to patients who do not misuse prescribed only medication. The service is<br />

only available to patients that abuse prescribed only medication and other substances.<br />

I trust that this answers your request.<br />

If you are unhappy with the response you receive to a request for information made under<br />

the Freedom <strong>of</strong> Information Act 2000, you should contact us as soon as possible giving us<br />

reasons why you believe we have not satisfied the requirements <strong>of</strong> the act. The matter will<br />

then be considered by one <strong>of</strong> our executive directors who will respond in writing.<br />

You will receive a letter about the outcome <strong>of</strong> this review, inviting you to contact the<br />

Information Commissioner if you remain dissatisfied with our response.<br />

Yours sincerely<br />

Nicola Gannon<br />

Information Access/HQ Manager<br />

Norfolk PCT Yes – I had a long discussion with Denise Grimes Service Manager at TADS who<br />

demonstrated a good understanding <strong>of</strong> the needs <strong>of</strong> ITA sufferers and commitment to this cohort. TADS<br />

work closely with GPs, are aware that those with ITA may not wish to attend groups along with illicit users<br />

and do clinics at GPs surgeries; they ran a benzo reduction group in Gt Yarmouth and intend to repeat this in<br />

another area. Denise sounded very committed.<br />

I have now had a response from a colleague who has given this response:-<br />

‘the TADS service in Norfolk do work with people with prescribed addictions. This is<br />

usually via a shared arrangements with GP’s to provide specialist oversight <strong>of</strong> a<br />

reduction regime. The service would also <strong>of</strong>fer counselling for anxiety/ underlying<br />

mental health issues that may accompany the medication reduction’.<br />

I hope this is helps to answer the questions you have raised – I have attached a link<br />

to the TADS service for your information, if I can be <strong>of</strong> any further assistance in this<br />

or any other matter then please do let me know.<br />

Kind regards<br />

Susan Rixham<br />

PALS – NHS Norfolk and Waveney<br />

North East Essex NO<br />

In response, I am able to provide you with the following answers to your questions.


The PCT does not provide any such <strong>services</strong>.<br />

If the individual is not abusing prescription drugs but is dependent on the drugs being<br />

prescribed then responsibility would lie with the prescriber to deal with and provide a<br />

managed withdrawal and replacement.<br />

If you have any queries about this response, please contact us at the above<br />

address, quoting the reference number given.<br />

If you are unhappy with the service you have received in relation to your request and<br />

wish to make a complaint or request a review <strong>of</strong> our decision, please write to us<br />

at the above address.<br />

If you are not satisfied with the outcome <strong>of</strong> your complaint or querying <strong>of</strong> the<br />

information provided, you may apply directly to the Information Commissioner (IC) for<br />

a decision. Generally, the IC cannot make a decision until you have exhausted<br />

the PCT’s FOI complaints process. The Information Commissioner can be contacted<br />

at: The Information Commissioner's Office, Wycliffe House, Water Lane,<br />

Wilmslow, Cheshire SK9 5AF.<br />

Yours sincerely<br />

Liz Mason<br />

Freedom <strong>of</strong> Information Officer<br />

North Lincolnshire PCT PARTIAL – This is really an appendage to the misuse <strong>services</strong> and the<br />

response does not reflect the needs <strong>of</strong> ITA sufferers especially support and reassurance. As<br />

they say they have only dealt with one paracetamol and one pain killer case in the last year.<br />

In a scenario where a service user attends through our direct access service<br />

with OTC/prescription drug addiction they would undergo an assessment at Direct access and<br />

a referral would be made to our specialist treatment provider (Junction). No key working or<br />

care planning is undertaken at direct access, a referral is 'actioned' and an appointment<br />

<strong>of</strong>fered within 21 days <strong>of</strong> initial referral.<br />

Although there is a service provided, we have certainly not been inundated over the past<br />

year. most recently there have been two cases, one paracetamol and another with opiate<br />

based pain killers. Clients <strong>of</strong>fered care planning, key working and controlled reduction/<br />

community detox. The same service is <strong>of</strong>fered for Z drugs.<br />

Unsure what is being referred to as tranx, is this referred to under banner <strong>of</strong> z drugs?<br />

Hope this helps, in terms <strong>of</strong> the future demand for <strong>services</strong> we are aware <strong>of</strong> the need to meet<br />

this demand under our treatment model and the various partners involved in meeting this<br />

need. As stated there haven't been many clients presenting with a need over the previous 12<br />

months, which is apparently not a reflection <strong>of</strong> the problem. An area that needs more attention<br />

going forward as culture <strong>of</strong> substance misuse is changing.<br />

Substance Misuse Service – North Lincolnshire (The Junction)<br />

The Junction specialist service has supported cases <strong>of</strong> this nature, including providing<br />

advice and information, planned detoxification programmes, access to counselling/<br />

psychosocial interventions. There is no specific help line just the 9am - 5pm, service<br />

number 01724 85591 GP's can refer in writing.<br />

North Tyneside PCT NO – This is substance misuse treatment and the taper is too rapid<br />

The following information relates to Project Answer, a drug treatment service in North<br />

Tyneside.<br />

Details <strong>of</strong> the availability <strong>of</strong> withdrawal advice and support including:<br />

1 Conversion to a longer-acting benzodiazepine like diazepam.<br />

For z drugs we would simply reduce the dose but transfer to multiple dispense at<br />

the chemist.


2 Provision <strong>of</strong> withdrawal schedules.<br />

usually discussed and agreed with client provided there is always reasonable reduction (for example the<br />

reduction may be 5mg per 2 weeks on doses above 30mg, slowing to 5mg per month on daily doses below<br />

30mg or even 2mg per month for daily doses below 10mg.) we would also increase frequency <strong>of</strong> chemist<br />

dispense (to reduce the temptation to use extra and run out). Doses above 30mg are almost always daily<br />

pick-up at the chemist. We rarely give more than 7 days at a time. (all doses stated diazepam equivalents)<br />

3 Knowledge <strong>of</strong> the Ashton manual.<br />

Yes<br />

4 Provision <strong>of</strong> appropriate psychological support during what can be a prolonged withdrawal period.<br />

a) benzo support group every Wednesday afternoon<br />

b) CBT for any underlying anxiety and depression 1:1<br />

c) complimentary therapies for relaxation, sleep etc.<br />

d) appropriate anti-depressant prescribing where indicated<br />

5 Provision <strong>of</strong> a help-line<br />

No help-line from this service but there are a number <strong>of</strong> national tranquillisers<br />

support groups (web-based) they can get involved in.<br />

6 Any other details <strong>of</strong> referral processes.<br />

Referral = self, GP, any other health care pr<strong>of</strong>essional etc. We would then contact the GP to take over the<br />

script <strong>of</strong> benzodiazepine or z drugs.<br />

Bevan House<br />

1 Esh Plaza<br />

Sir Bobby Robson Way<br />

Great Park<br />

Newcastle upon Tyne<br />

NE13 9BA<br />

North Yorkshire and York PCT NO<br />

Our Senior Commissioning Manager has suggested that you speak to your GP. He has stated<br />

that it is possible to negotiate, in some instances, for a local drug treatment provider to treat<br />

patients as you described but with the knowledge <strong>of</strong> the GP as there are higher risks<br />

with benzodiazapines if not safely managed.<br />

Your GP can contact our Commissioning team if they experience any problems with obtaining<br />

help.<br />

I hope the above is useful,<br />

Many thanks,<br />

Dianne E Lowe,<br />

Patient Relations Officer,<br />

NHS North Yorkshire and York<br />

Northamptonshire Teaching PCT NO - but they do have withdrawal protocols. However, one step <strong>of</strong> their<br />

protocol misinterprets the BNF guidelines and states - Step 2: Reduce diazepam dose in fortnightly steps <strong>of</strong><br />

2mg or 2.5mg; if withdrawal symptoms occur, maintain this dose until symptoms improve. This is incorrect<br />

and would represent a dangerous abrupt withdrawal when down to lower doses.<br />

Thank you for contacting our service.<br />

I have taken advice from our Community Pharmacist, Sue Smith, who is happy to discuss this<br />

situation with you and can be contacted on 01604 651360.<br />

We do not have a specific commissioned service for situations such as you highlighted below<br />

however we work with GP's to support such situations. Sue has provided the attached<br />

information on benzodiazepine protocol which gives examples <strong>of</strong> the approach that could be<br />

taken.<br />

I hope this information is helpful<br />

Kind Regards<br />

Alison Berlie Complaints Dept<br />

Oldham PCT Yes – Oldham has an experienced service provided by ADS who liaise closely with the charity<br />

Oldham Tranx run by Barry and Sue Haslam.


Many thanks for your enquiry.<br />

I have been informed that the Addiction Dependency Solutions service (ADS) based<br />

on Greaves Street in Oldham, have qualified specialists that assist with<br />

benzodiazepine withdrawal advice and support. They do this via GP health centres<br />

and have satellite <strong>services</strong> at most Oldham GP practices. Clients can self refer and be<br />

seen on a 1:1 basis by contacting ADS on Tel: 0161 624 9595. I have been in contact<br />

with them today and was assured that they do treat involuntary tranquiliser addiction<br />

as well as illicit addiction.<br />

Hope this information is <strong>of</strong> use to you.<br />

Kind Regards<br />

Michele Warburton<br />

Patient Advice & Liaison Service (PALS)<br />

NHS Oldham<br />

Oxfordshire PCT NO – Substance misuse only and harm minimisation<br />

Further to my e-mail last week there is further addition al information from DAAT:<br />

• The BNF has clear guidance for managing the withdrawal <strong>of</strong> prescribed<br />

benzodiazepine use, which all GPs can access and use, and for z’s a similar reduction<br />

approach is usually taken<br />

• The DAAT commissioned Drug Services usually treat the illicit drug use; for licit<br />

prescribed addiction, they can <strong>of</strong>fer some support to the GP, or <strong>of</strong>fer an informal<br />

opportunity for individuals to discuss their drug/alcohol use in ‘Drop-In’ sessions.<br />

The Drop-In sessions are provided by Oxford Health (in partnership with The Oasis<br />

Partnership) across the county as part <strong>of</strong> the new Harm Minimisation Service, the ‘Drop-In’<br />

is not treatment, but can <strong>of</strong>fer brief interventions for the individual, patients can self –refer .<br />

For more information about the Drop –in contact Roy<br />

Walsh, Roy.Walsh@oxfordhealth.nhs.uk<br />

I hope this is helpful.<br />

Kind regards<br />

Akhbar<br />

Redbridge PCT also Barking and Dagenham, Havering and Waltham Forest NO – I<br />

rang RDAS and they only deal with illicit use<br />

We refer to a request you placed with our PALS team on 10 April. This<br />

request has been passed to me as it is deemed to be a Freedom <strong>of</strong><br />

Information request. We apologise for the delay this has caused in providing<br />

a response.<br />

I have obtained the information requested and am able to respond as follows<br />

concerning <strong>services</strong> for involuntary tranquiliser addiction.<br />

Drug treatment <strong>services</strong> in Redbridge provide advice and information for<br />

anyone dependent on drugs (illicit, licit or prescribed). Service users can also<br />

access 1:1 support, group work and aftercare. Redbridge Drug and Alcohol<br />

Service (RDAS) provide detoxification for opiate users (heroin and<br />

methadone).


Anyone requiring detoxification for non-opiate drugs such as tranquilisers<br />

would be referred to an (inpatient) detoxification service that specialises in<br />

detoxification for benzodiazepines, etc. This is due to the more intensive<br />

clinical supervision required for tranquiliser detoxification.<br />

To further assist you the contact details for the Redbridge Drug and Alcohol<br />

Service are as follows:<br />

Redbridge Drug and Alcohol Service (RDAS)<br />

Tel: 0300 555 1180<br />

3rd Floor, Ilford Chambers<br />

11 Chapel Road<br />

Ilford Chambers<br />

Ilford<br />

IG1 2DR<br />

rdas-ilford@nelft.nhs.uk<br />

We trust this information will prove to be <strong>of</strong> assistance to you.<br />

If you are dissatisfied with the handling <strong>of</strong> your request you have the right to<br />

ask for an internal review. Internal review requests should be submitted<br />

within two months <strong>of</strong> the date <strong>of</strong> receipt <strong>of</strong> the response <strong>of</strong> your original letter<br />

and should be addressed to:<br />

Sue Brown<br />

Freedom <strong>of</strong> Information Officer<br />

NHS outer north east London<br />

Redcar and Cleveland PCT NO see Stockton-on-Tees<br />

Rotherham PCT NO – Substance misuse<br />

Substance Misuse Service – Rotherham (Clearways)<br />

In secondary care we have a number <strong>of</strong> patients (approximately 40 at any one time<br />

out <strong>of</strong> around 450 individuals) who receive benzodiazepine prescriptions, always in<br />

the context <strong>of</strong> a methadone programme or treatment for alcohol dependency. These<br />

individuals usually have significant anxiety problems, <strong>of</strong>ten in the context <strong>of</strong> very<br />

poor physical health related to their substance misuse.<br />

At present there are just two individuals who are receiving nitrazepam<br />

prescriptions and three receiving temazepam from secondary care <strong>services</strong>: the rest<br />

are prescribed diazepam so that they can be supported in having their benzodiazepine<br />

medication more easily controlled, especially when reductions and discontinuation are<br />

appropriate and can be managed.<br />

It should be noted that, in the Rotherham service, the greater proportion <strong>of</strong><br />

treatment for drug and alcohol dependency problems is provided through individual<br />

patients’ GP/ primary care teams in a shared care model where the Trust provides the<br />

drug/ alcohol worker support to the practices.<br />

Within primary care individuals being treated for alcohol or drug, generally<br />

opiate, dependency that also have a benzodiazepine dependency should be switched<br />

to diazepam for the same supportive/clinical management reasons. The Shared<br />

Care prescribing Guidelines from NHS Rotherham support GPs on this and other


prescribing issues.<br />

Presumably within the primary care setting there will be individuals who are<br />

prescribed benzodiazepines by their GP and have long standing prescriptions and<br />

therefore presumably dependencies but do not "abuse" these drugs, i.e.: by buying<br />

illicit supplies in addition to their prescriptions. However, these individuals will be<br />

managed by their GPs and would not be seen by the Trust’s Shared Care workers<br />

or referred in to the secondary care <strong>services</strong>. Therefore, the Trust does not hold any<br />

information regarding this group and individual GPs would need to be approached by<br />

if detail regarding this patient group is required.<br />

Psychological support is integral to the provision <strong>of</strong> drug/ alcohol treatment<br />

for patients both in secondary and primary care drug and alcohol treatment.<br />

Many GP practices have primary care mental health workers based within<br />

their premises that can provide support and counselling to individuals but, again, this<br />

information would need to be requested from the GP practices.<br />

Referral in to the <strong>services</strong> is open with the majority <strong>of</strong> service users either<br />

self referring via the Single Point <strong>of</strong> Contact (SPOC) number or for those accessing<br />

Shared Care via their GPs. An additional significant route in to treatment is via the<br />

Criminal Justice System.<br />

There is no identified local help line for benzodiazepine dependant<br />

individuals, or for other drug or alcohol users.<br />

Salford PCT NO<br />

Thank you for your query. I have liaised with our Prescribing Team, our<br />

Mental Health Commissioning Team, and our GP with Special Interest in<br />

Mental Health, and I have the following information to feed back to you:<br />

Salford has no specialist <strong>services</strong> that are commissioned to<br />

specifically support people withdrawing from prescription meds (<br />

including opiates such as codeine and tramadol as well as Z drugs, BDZs) as<br />

their core business however, there is certainly support available via a number<br />

<strong>of</strong> routes.<br />

GPs are the first port <strong>of</strong> call - many <strong>of</strong> whom would be perfectly capable <strong>of</strong><br />

supervising a structured withdrawal programme from their<br />

medication. Community Drug Teams do not always get involved as they see<br />

their core business as illicit drug use. However, they will <strong>of</strong>ten assess in relation to<br />

complex/challenging cases and advise, without necessarily managing the patient but<br />

discharging back to GP with a tailored management plan.<br />

Sometimes it can be appropriate for primary care-based psychological<br />

therapy <strong>services</strong> to engage, particularly where the individual with the drug<br />

dependency hasn't previously accessed that type <strong>of</strong> intervention, and may<br />

have, for example, anxiety or depression-based problems. We know that our<br />

local therapy <strong>services</strong> (such as IAPT service) are certainly managing many<br />

patients who have co-existing dependency on prescription drugs.<br />

The GP is the main route into the additional specialist <strong>services</strong> cited above,<br />

and our Salford GPs are fully conversant with the referral criteria and<br />

processes.<br />

I hope this information answers your query.


Kind Regards<br />

Gina Magson<br />

Complaints & PALS Officer<br />

Customer Care Team<br />

NHS Salford<br />

Sandwell PCT NO – Swanswell deal with substance misuse<br />

Thank you for your enquiry.<br />

Drug and alcohol <strong>services</strong>, in Sandwell, are provided by an organisation called Swanswell. In<br />

the first instance, the patient would have to approach their GP. Each patient is treated on an<br />

individual basis. Swanswell may advise the GP on how to treat the patient or the GP may<br />

refer the patient to Swanswell as necessary.<br />

Please do not hesitate to contact PALS if you require further information.<br />

Regards<br />

Avery Faulkner<br />

(PALS Lead Officer)<br />

Sefton PCT No – they refer to the experienced and long established voluntary charity CITA which is not<br />

NHS funded and struggling to maintain a service due to a lack <strong>of</strong> funding.<br />

Good afternoon <strong>John</strong><br />

Your email <strong>of</strong> 10th April 2012 has been passed to me for response.<br />

I would hope that your GP would be signposting you to <strong>services</strong> which could be <strong>of</strong><br />

help to, however, if you are a Sefton patient, you could contact CITA (Council for<br />

Information on Tranquillisers, Antidepressants and Painkillers) who may be able to<br />

<strong>of</strong>fer you advice and support.<br />

Their website is as follows: http://www.citawithdrawal.org.uk/<br />

I hope this information is <strong>of</strong> some help to you.<br />

Kind regards<br />

Pauline Delamar<br />

Customer Access Team<br />

NHS Merseyside<br />

Shropshire County PCT NO - See Telford and Wrekin<br />

I received your enquiry from Soma Moulik on the 11 th April.<br />

My first response to you was on the 11 th April 2012 at 16:02, I then responded further on the<br />

same date at 16:34.<br />

The information is as follows:<br />

After speaking to our Medicines Management team for clarification, they advise patients to<br />

see their GP. If the GP feels it is clinically appropriate to do so, they will then refer the<br />

patient on to the appropriate which is the Substance Misuse Team.<br />

Alternatively you can contact the team direct on 01743 255740.<br />

I hope that this answers your enquiry<br />

Kind regards<br />

Sharon<br />

Sharon Smith<br />

Self Care Management/PALS Lead<br />

NHS Telford & Wrekin


South Gloucestershire PCT PARTIAL – refer to BAT part-funded charitable organisation not in-house<br />

NHS service.<br />

The South Gloucestershire Drug and Alcohol Action Team provides access to Battle Against<br />

Tranquiliser’s which is a charity based in Patchway. The single point <strong>of</strong> contact is 01454<br />

868750 and service users can access the treatment if they are using prescribed drugs illicitly<br />

or through involuntary addiction.<br />

If a person would like to ask some basic questions, there is a helpline 0844 8269317 or they<br />

can access the website at www.bataid.org<br />

When a service user calls the Single Point <strong>of</strong> Contact number, they go through an<br />

assessment process and are <strong>of</strong>fered a one to one meeting to ascertain need; however they<br />

do not have to go any further than telephone assistance if they do not want to. Treatment is<br />

free and they can access it for as long as they need.<br />

I hope this is useful to you, if you need any more information or would like to get in touch,<br />

please feel free to email/call me back.<br />

Sarah Jenkins<br />

PALS Manager<br />

Southampton City PCT also Hampshire and Isle <strong>of</strong> Wight NO<br />

Further to your e-mail <strong>of</strong> 10 April 2012, I have been informed by our Head <strong>of</strong> Medicines<br />

Management that some GP’s support benzodiazepines withdrawal, however, he is not<br />

aware <strong>of</strong> any other support. He has also commented that previously, we did <strong>of</strong>fer a service<br />

through one <strong>of</strong> our Medicines Management nurses; if GP’s needed such a service he has<br />

confirmed we could consider that as an option.<br />

Our Community Pharmacy Lead has reported that there is nothing that involves Community<br />

Pharmacy, only as you point out, for those addicted to benzodiazepines engaged at IDAS.<br />

I do hope this information helps.<br />

Yours sincerely<br />

Samantha <strong>John</strong>son<br />

Quality Facilitator<br />

SHIP (Southampton, Hampshire, Isle <strong>of</strong> Wight & Portsmouth PCT)<br />

South Tyneside PCT NO<br />

Please accept my apologies for the delay in responding to you.<br />

Following your e-mail to the Patient Advice and Liaison Service (PALS) on 10 April<br />

2012 I am now in a position to respond.<br />

I have liaised with the Head <strong>of</strong> Service for Substance Misuse, South Tyneside NHS<br />

Foundation Trust and the have provided the following response.<br />

“Thank you for your request for information about what <strong>services</strong> our PCT/CCG<br />

provides for patients who are dependent upon prescribed only benzodiazepine and z<br />

drug tranquillisers and sleeping tablets and who do not abuse these or other<br />

substances. South Tyneside NHS Foundation Trust provides treatment and care for<br />

people who misuse substances in two localities <strong>of</strong> Gateshead and South Tyneside.<br />

We do not provide <strong>services</strong> to patients with involuntary tranquilliser addiction.<br />

Patients who have these problems are treated through their General Practitioner in a<br />

primary care setting with support from practice pharmacists on withdrawal<br />

programmes. Other voluntary <strong>services</strong> in the locality may be involved depending on<br />

the individual needs <strong>of</strong> the patient.”<br />

If you have any queries with the information I have provided please do not hesitate to<br />

contact me.


Kindest regards,<br />

Gemma<br />

Gemma Evans<br />

Patient Advice and Liaison Officer<br />

Customer Services Department<br />

South Tyneside NHS Foundation Trust<br />

Yes, we cover Gateshead PCT, South Tyneside PCT and Sunderland TPCT.<br />

Regards,<br />

Gemma<br />

Southwark PCT NO<br />

I passed your enquire to Ms. Cuthbert, Clinical Advisor for Substance Misuse Commissioning,<br />

who replied that in Southwark we have some specialist GPs with experience in managing<br />

drug withdrawals/reductions but we do not have specific <strong>services</strong> for people who are<br />

dependent on prescribed only benzodiazepines and other sleeping tablets and tranquillisers.<br />

If you can let us know which GP practice you are registered with or where<br />

you live in Southwark, we may be able to assist you further.<br />

Best Regards,<br />

Antonio Labigalini<br />

PALS and Complaints Officer<br />

Southwark Business Support Unit<br />

South West Essex PCT NO<br />

In reply to your FOI request <strong>of</strong> 18 May we have pleasure in supplying you with the following<br />

information:<br />

Our drug addiction <strong>services</strong> do not facilitate a service for treating these patients but do<br />

provide support and guidance to GPs based on the "Drug misuse and dependence: UK<br />

guidelines on clinical management". However, the Charity 'Open Road' also support GPs<br />

with prescribing advice and withdrawal plans when required.<br />

We do not have any service level agreements for this particular service but we are working on<br />

a Benzodiazepine prescribing and withdrawal policy which will cover this.<br />

More information may be obtainable from one <strong>of</strong> the PCT's providers; SEPT ( South Essex<br />

Partnership Trust ).<br />

They can be contacted at: SEPT, Trust Head Office, The Lodge, The Chase, Wickford,<br />

Essex, SS11 7XX Tel: 0300 123 0808.<br />

They also have a useful website: www.sept.nhs.uk<br />

We thank you for your enquiry and hope this meets your requirements. Please do not<br />

hesitate to contact me if I can be <strong>of</strong> further assistance.<br />

Kind regards<br />

Janet Lawn<br />

Janet Lawn | Customer Services Team Leader | NHS South West Essex


Staffordshire PCT NO<br />

and North Staffordshire PCT NO and the letter from the Clinical secretary points out that despite the need<br />

and also their obvious understanding <strong>of</strong> the problem, there are no <strong>services</strong>.<br />

Apologies for the delay in responding to your email, however the email account that your<br />

correspondence had been forwarded to had been temporarily suspended during a IT transfer.<br />

I have liaised with the Head <strong>of</strong> Medicines Management over your query and he has advised<br />

that there is no specialised service to assist with the withdrawal <strong>of</strong> the prescribed<br />

medications. Discussing the withdrawal with the patients GP is the first step. All Gp's have<br />

guidance on the withdrawal <strong>of</strong> these types <strong>of</strong> medication and can assist in the process.<br />

If the issue is that this has already been discussed with the GP and the advice provided has<br />

not been helpful, then if the GP's contact details are provided we can discuss that with the GP<br />

practice directly, or our <strong>of</strong>fice can assist with locating a new GP for the patient to register with.<br />

I hope this has helped, however if you would like clarification or further assistance, please do<br />

not hesitate to contact our <strong>of</strong>fice.<br />

Kind regards<br />

Michelle Kiernan<br />

Complaints & Enquiries Officer<br />

Complaints & Enquiries Office<br />

NHS Staffordshire Commissioning Support Services<br />

Please accept my sincere apologies for the delay in my response, but I hope I now have the<br />

answers to your questions; please see the attached and the copy response below.<br />

Kind Regards,<br />

Cath Barratt<br />

Cath Barratt<br />

Admin Assistant<br />

NHS Staffordshire Commissioning Support Services<br />

St George's Chambers<br />

31 Merrial Street<br />

Newcastle<br />

Staffs<br />

ST5 2AE<br />

Tel: 0845 602 6772 Extn: 1529<br />

Fax: 01782 298228<br />

Dear Cath,<br />

In answer to Mr <strong>Perrott</strong>’s query below,<br />

He is correct in that the Drugs and Alcohol Teams routinely do not treat involuntary<br />

tranquilliser addiction, only illicit addiction.<br />

The PCT/CCG does not provide a specific service for these patients and it would be<br />

something they would need to discuss with their prescribing doctor who should have<br />

sufficient expertise to <strong>of</strong>fer a safe withdrawal programme within their own practice.<br />

There are unfortunately many patients in this predicament in the Stoke-on-Trent area,<br />

Stoke-on-Trent is the one <strong>of</strong> the highest prescribers <strong>of</strong> these type <strong>of</strong> drugs in the West<br />

Midlands.<br />

Benzodiazepine hypnotics should be used only if insomnia is severe, disabling or<br />

causing the patient extreme distress. The lowest dose that controls symptoms should<br />

be used, for a maximum <strong>of</strong> four weeks and intermittently, if possible. Due to the lack


<strong>of</strong> evidence <strong>of</strong> differences in the effects <strong>of</strong> zaleplon, zolpidem, zopiclone and the<br />

shorter-acting benzodiazepines, NICE recommends that doctors should prescribe the<br />

cheapest drug, taking into account the daily dose required and the cost for each dose.<br />

If treatment with one <strong>of</strong> these hypnotic medicines does not work, the doctor should<br />

not prescribe one <strong>of</strong> the others. Treatment should only be changed from one <strong>of</strong> these<br />

hypnotics to another if side-effects occur that are directly related to the medicine.<br />

NICE confirms that there is no compelling evidence <strong>of</strong> a clinically useful difference<br />

between zaleplon, zolpidem and zopiclone (the so called ‘Z drugs’) and shorter-acting<br />

benzodiazepine hypnotics from the point <strong>of</strong> view <strong>of</strong> their effectiveness, adverse<br />

effects, or potential for dependence or abuse. There is no evidence to suggest that if<br />

patients do not respond to one <strong>of</strong> these hypnotic drugs, they are likely to respond to<br />

another.<br />

Risks associated with long term use <strong>of</strong> hypnotic drugs have been well recognised for<br />

many years. Nevertheless, despite these national safety warnings and guidance,<br />

overall prescribing <strong>of</strong> hypnotics is not decreasing.<br />

As a result, this is one <strong>of</strong> the prescribing areas we are asking GPs to focus on in terms <strong>of</strong><br />

attempting to reduce inappropriate prescribing. (And has been a focus for a number <strong>of</strong> years<br />

now) please note, this focus is on the use <strong>of</strong> these drugs as sleeping tablets (hypnotics) and<br />

not for anxiety (anxiolytics), it is also recognised that only certain patients are suitable for<br />

withdrawal.<br />

Commonly, to aid the withdrawal process, patients are first transferred onto a longer acting<br />

tranquiliser (benzodiazepine) such as diazepam. This allows a more gradual reduction in drug<br />

concentration and can delay the emergence <strong>of</strong> withdrawal symptoms, allowing a smoother<br />

withdrawal process.<br />

I am currently working on adapting a rather lengthy document to aid GPs in benzo/Z drug<br />

withdrawal and once this has been developed we plan to distribute this to GPs.<br />

In terms <strong>of</strong> patient support, we have a number <strong>of</strong> patient information leaflets, but again<br />

these may need updating slightly, I have attached for information.<br />

In summary, if Mr <strong>Perrott</strong> is interested in withdrawing from his medication, he will need to<br />

speak to his prescribing GP (Should his GP require any additional support, this can be <strong>of</strong>fered<br />

from the Medicines Management team)<br />

In case Mr <strong>Perrott</strong> is interested, (although I must warn you it is a very large document), I<br />

have attached the Welsh Medicines Partnership document that I plan to adapt for our local<br />

GPs. He may find some general useful information regarding withdrawal, again, this is<br />

something I hope to put in a patient friendly version.<br />

I hope this helps, please do not hesitate to contact me if I can be any further assistance.<br />

Kind Regards,<br />

Stockport PCT NO – Misuse only, an ITA asked for help and was <strong>of</strong>fered a rapid withdrawal in rehab only.<br />

They have a reasonable guidance but this is for GPs and there is no specialist support or helpline or even<br />

referral to the charities.<br />

Further to my email below, please see response to each point from our Associate Director<br />

Medicines Management and Long Term Conditions:<br />

1. Conversion to a longer-acting benzodiazepine like diazepam.<br />

Practices have guidance available to them from the prescribing team<br />

http://stockportmanagedcare.co.uk/wp-content/uploads/2008/12/Guidance-onbenzodiazepines-and-z-drugs-Stockport.doc<br />

2. Provision <strong>of</strong> withdrawal schedules.<br />

This is defined within the guidance


3. Knowledge <strong>of</strong> the Ashton manual.<br />

The guidance issued is based on the information in this manual but as you will see is focused<br />

on the pr<strong>of</strong>essional rather than on the patient.<br />

4. Provision <strong>of</strong> appropriate psychological support throughout what is <strong>of</strong>ten a prolonged<br />

withdrawal and recovery period <strong>of</strong> up to a year or more.<br />

This is provided by the GP practice however if there concurrent mental health problems<br />

patients can be referred to the out IAPT/mental health <strong>services</strong> as appropriate. The<br />

Community drug team will only see people who also are using other illicit drugs.<br />

5. Provision <strong>of</strong> a help-line.<br />

There is no helpline in Stockport<br />

6. Any further details <strong>of</strong> such referral processes.<br />

I hope this information is useful.<br />

Yours sincerely<br />

Nazie Gerami<br />

PALS, Complaints & Claims Manager<br />

Corporate Service<br />

NHS Stockport<br />

Stockton-on-Tees Teaching PCT see Middlesborough and Redcar and Cleveland NO – I<br />

rang them and treatment is based on substance misuse and ITAs would be referred to<br />

Crime Reduction Initiative (CRI)<br />

The Drug and Alcohol Teams are provided by the local Councils not the Primary Care Trusts.<br />

The contact details are:<br />

Stockton - Tel 01642 528474<br />

The specialist GP practice for Stockton is The Birchtree practice, tel: 01642 633561<br />

The specialist GP practice for the Middlesbrough area is the Fulcrum practice, tel: 01642<br />

354550<br />

You would need to contact the practices and the Drug and Alcohol Teams to ask the<br />

questions you have.<br />

I hope this helps.<br />

Shirley Stephenson<br />

Patient Relations Officer<br />

NHS Tees<br />

Stoke On Trent PCT NO see Staffordshire<br />

Suffolk PCT NO – First number unobtainable, Suffolk Recovery Service is for Substance Misuse. Rang them<br />

and they have not heard <strong>of</strong> the Ashton manual.<br />

Thank you for your email regarding involuntary tranquiliser addiction. There are 2 options<br />

available to you. Firstly you could contact the Tranquilizer Withdrawal Support which is 24<br />

hour service on 01284 702550. Alternatively you can contact Suffolk Recovery Services on:<br />

0808 1783 285 to see if they are able to <strong>of</strong>fer advice and withdrawal support or signpost you<br />

to a more appropriate service. If you do not find these appropriate <strong>services</strong> I would suggest<br />

that you speak with your doctor for further help and advice.<br />

I hope this information is helpful, and if you have any further queries or concerns, please do<br />

not hesitate to contact us.<br />

Kind regards,<br />

Lucy Blake I PALS Officer I NHS Suffolk<br />

Sunderland Teaching PCT NO – See South Tyneside


Surrey PCT NO<br />

NHS Surrey does not currently commission such a service and this is a gap that has been identified.<br />

When undertaking routine inquiries on controlled drugs monitoring the lack <strong>of</strong> support for patients<br />

who have become addicted to prescription drugs has been noted. A survey <strong>of</strong> GP practices was<br />

carried out to gain an understanding <strong>of</strong> the potential number <strong>of</strong> patients who have become addicted<br />

to their prescribed meds. The feedback indicated that GP’s felt the level <strong>of</strong> patients addicted to<br />

Benzos and Z drugs was equivalent to that <strong>of</strong> opioid addiction.<br />

We understand that GPs are providing support to patients and extra support is available to GPs from<br />

the DAAT if the patient is willing to engage. The mental health trust, Surrey and Borders Partnership<br />

Trust has indicated that it routinely sees patients addicted to their medication. They are happy to<br />

have individual cases referred to them.<br />

Whether CCGs would look to commission a specialist service in the future, we don’t know.<br />

I hope this is <strong>of</strong> help.<br />

Regards<br />

Laura Dennett<br />

Public Engagement Manager<br />

Communications and Engagement Lead: Surrey Heath Clinical Commssioning Group<br />

Sutton and Merton PCT NO Cecilia will also deal with the FOI for Surrey, Richmond, Kingston and<br />

Wandsworth.<br />

Sutton and Merton do not commission any specific <strong>services</strong> for prescribed drug dependency; individuals<br />

concerned about such dependency should discuss the matter with the prescriber who is normally the<br />

General Practitioner<br />

Thank you for your request for information about Services for involuntary traquilliser addiction.<br />

Your request was received on 18/04/2012 00:00:00 and I am dealing with it under the terms<br />

<strong>of</strong> the Freedom <strong>of</strong> Information Act 2000.<br />

In some circumstances a fee may be payable and if that is the case, I will let you know. A fees<br />

notice will be issued to you and you will be required to pay before we will proceed to deal with<br />

your request.<br />

Any information we provide following your request under the Freedom <strong>of</strong> Information Act will<br />

not confer an automatic right for you to re-use that information, for example to publish it. If you<br />

wish to re-use the information that we provide and you do not specify this in your initial<br />

application for information then you must make a further request for its re-use as per The reuse<br />

<strong>of</strong> Public Sector Information Regulations 2005 www.opsi.gov.uk/psi-regulations/ this will<br />

not affect your initial information request.<br />

If you have any queries about this letter, please contact me. Please remember to quote<br />

the reference number: FOI12-157 in any future communications.<br />

Yours sincerely,<br />

Cecilia Tapping,<br />

Governance Manager<br />

and FOI Lead<br />

020 8251 0589<br />

Swindon PCT NO – not at time <strong>of</strong> response


Further to my email <strong>of</strong> the 12th April 2012, I would like to apologise for the delay in<br />

providing a response to your enquiry.<br />

NHS Swindon’s Head <strong>of</strong> Medicines Management had advised me to speak to the<br />

Assistant Director for Mental Health Commissioning. I have now received a response<br />

and in a position to feedback to you.<br />

As you have correctly stated in your email the statutory drug and alcohol <strong>services</strong> no<br />

longer provide <strong>services</strong> for involuntary tranquilliser addiction. However, there are<br />

currently plans to re-commission the drug and alcohol service in Swindon. This will<br />

include providing a service to support those patients who are either prescribed or<br />

purchase over-the-counter tranquilliser medication through detox. Patients will need<br />

to be referred by their own GP in order to access the drug and alcohol service for an<br />

assessment.<br />

There is also a national organisation www.benzo.org.uk for patients who may wish to<br />

self-manage their detox for involuntary tranquilliser addiction. It has been advised by<br />

the Inclusion Drug Service Manager that the Ashton Manual which is available online<br />

should be used as a reference guide.<br />

‘Battle Against Tranquillisers’ is a helpline that can provide information and advice<br />

for involuntary users <strong>of</strong> tranquillisers. They can be contacted on 0844 826931.<br />

I hope you find the above information useful.<br />

Kind Regards<br />

Melissa Probets<br />

PALS/Complaints Administrator<br />

NHS Swindon<br />

Tameside and Glossop PCT PARTIAL - This PCT employs an in-house benzo reduction worker to support<br />

withdrawal but compared to the magnitude <strong>of</strong> the problem this would be insufficient if all those in the PCT<br />

iatrogenically addicted needed support.<br />

Please find attached response letter to your recent FOI request.<br />

Regards<br />

Jackie Gordon<br />

Risk and Complaints<br />

Tameside and Glossop NHS<br />

Telford and Wrekin PCT No – I spoke to the service manager <strong>of</strong> Shropshire Drug and Alcohol team and they<br />

do not provide <strong>services</strong> for ITA sufferers. They only provide <strong>services</strong> for illicit use.<br />

Dear Mr <strong>Perrott</strong><br />

My understanding from my colleagues that the GP’s will refer patient’s to the Substance<br />

Misuse Team.<br />

There is a web site and below is the link to the page<br />

http://www.shropshire.nhs.uk/Care-and-Treatment/Out-<strong>of</strong>-Hospital-Services/Alcohol-and-<br />

Drug-Misuse/<br />

Alternatively you can contact the team direct on 01743 255740<br />

Kind regards<br />

Sharon<br />

Self Care Management/PALS Lead<br />

NHS Telford & Wrekin<br />

Trafford PCT NO - I rang Phoenix Futures and they treat illicit use


Further to your earlier email I am pleased to be able to respond to your enquiry more quickly than<br />

I originally anticipated. The contact details I have been given to provide you with are:<br />

If the patient is aged 11-25 they can contact Phoenix Futures, the number is: 0161 905 1013<br />

If the patient is aged over 25 they can contact the Trafford Drug Service, the number is: 0161<br />

786 8250.<br />

Having contacted Trafford Drugs Service to ask specifically about <strong>services</strong> for involuntary<br />

tranquiliser addiction, they explain that for prescribed medications a patient can contact them<br />

direct on the number given above and they will liaise with the patient’s GP to determine if and<br />

how they can assist. If they can’t help for any reason they will ensure a patient is re-directed<br />

appropriately.<br />

Jasmine Clarke<br />

Head <strong>of</strong> Customer Care and Experience<br />

NHS Trafford<br />

Wakefield District PCT No<br />

Thank you for your email. Having made enquiries I am not aware <strong>of</strong> any specific<br />

withdrawal <strong>services</strong> currently commissioned within the Wakefield District, it is my<br />

understanding that <strong>services</strong>/support would be available locally by your own GP/GP<br />

Practice, is this something your have already looked into?<br />

I have contacted Spectrum Community Health for guidance and it may be worth your<br />

contacting them directly on 01924 330500 to discuss your issue.<br />

I hope this information helps.<br />

Kind regards<br />

Sarah Deakin<br />

PALS Officer<br />

Patient Advice & Liaison Service<br />

NHS Wakefield District<br />

Walsall Teaching PCT see Dudley NO<br />

FREEDOM OF INFORMATION ACT 2000 – NHS Dudley PCT -<br />

InvoluntaryTranquilliser Addiction - Ref: FOI/000144<br />

Thank you for your email received on 14th May 2012.<br />

Your request for information as detailed below has now been considered.<br />

However unfortunately Dudley PCT do not provide or specifically commission<br />

<strong>services</strong> for patients dependent on benzodiazepine or Z drugs but who do not abuse<br />

them.<br />

Waltham Forest PCT NO - see Redbridge<br />

Warrington PCT NO – I rang Pathway to Recovery and although they provide a basic diazepam taper when<br />

I gave my own case as an example <strong>of</strong> converting from Ativan to diazepam, and then requiring specialist<br />

support throughout the withdrawal and post-withdrawal period, they do not provide a service at this level.<br />

Also, they did not seem to expect withdrawal symptoms which points to their dealing mainly with high dose<br />

benzo abuse; their main provision is for illicit crack cocaine and opioid use.<br />

I have now been able to obtain the information that you require.


Such <strong>services</strong> are commissioned by NHS Warrington from the Service called ‘Pathway to<br />

Recovery’, to which you can self present. This Service <strong>of</strong>fers one to one support via a<br />

keyworker, and will liaise with your GP.<br />

You can telephone or attend in person, but should attend in good time to have an assessment<br />

done, so it is best to attend a few hours before closing time. You should ask for the Duty<br />

Worker.<br />

Contact details:<br />

Pathway to Recovery<br />

14 Bold Street<br />

Warrington<br />

(Opposite the Museum Library)<br />

Telephone 01925 415 176<br />

Opening Times:<br />

Monday, Wednesday, Thursday and Friday 9.00 am to 5.00 pm<br />

Tuesday 9.00 am to 7.00 pm<br />

I do hope that this information is <strong>of</strong> assistance to you.<br />

With kind regards<br />

Marie Montgomery<br />

Patient Relations Manager<br />

NHS Warrington<br />

Warwickshire PCT NO – See Coventry<br />

Thank you for your enquiry. The response that I gave you on 3 May 2012 applies to Coventry<br />

PCT and Warwickshire PCT. Both PCT's make up the Arden Cluster.<br />

Kind regards,<br />

Gerald Dadley<br />

Freedom <strong>of</strong> Information Officer<br />

Western Cheshire PCT NO Also see Wirral. This is substance misuse treatment and anyone<br />

who refers patients to “Talk to Frank” (misuse helpline) as a specialist helpline as the<br />

author <strong>of</strong> this response has done, does not understand ITA treatment.<br />

Please find attached NHS Western Cheshire’s response to your request for information received on 23rd<br />

May 2012 regarding Services for involuntary tranquiliser addiction:<br />

You asked:<br />

1) Please can you tell me what <strong>services</strong> your PCT/CCG provides for patients who are dependent upon<br />

prescribed only benzodiazepine and z drug tranquillisers and sleeping tablets and who do not abuse these or<br />

other substances. The DAT commission a Health Trust to provide a substance misuse service and Shared<br />

Care scheme to dependent drug users which meets the need for identifiedreferred patients who are drug<br />

dependent. The DAT also commissions inpatient detoxification provision. There is a number <strong>of</strong> patients who<br />

are abusing prescription medicine but who are not in the drug treatment service or working outside <strong>of</strong> the<br />

Shared Care scheme. Wider <strong>services</strong> to provide support include IAPT <strong>services</strong>, reablement and pain<br />

management <strong>services</strong>.<br />

2) Would you please include details <strong>of</strong> the availability <strong>of</strong> withdrawal advice and support including:<br />

1. Conversion to a longer-acting benzodiazepine like diazepam. - All contracts with commissioned<br />

providers stipulate the need to meet the aim to provide a range <strong>of</strong> interventions for individuals<br />

with drug misuse problems in line with the national 2007 Drug Misuse and Dependence UK<br />

Guidelines on Clinical Management and NICE 2007 Drug Misuse guidance.<br />

2. Provision <strong>of</strong> withdrawal schedules. - As above - policies are held by commissioned providers<br />

on withdrawal schedules and conversion <strong>of</strong> prescription where assessment indicates in line<br />

with national guidance.<br />

3. Knowledge <strong>of</strong> the Ashton manual. - There is knowledge <strong>of</strong> the Ashton manual but we do not<br />

refer to this in contracts as it is not in the above national guidance.<br />

4. Provision <strong>of</strong> appropriate psychological support. As above - in line with national guidance and<br />

stipulated in contracts. Psychological support available through drug <strong>services</strong>, mental health<br />

<strong>services</strong> and wellbeing activities.<br />

5. Provision <strong>of</strong> a help-line. - No specific local help line for prescribed benzodiazepine, z drug<br />

tranquillisers or sleeping tablets only. Talk to Frank website available nationally.<br />

6. Any details <strong>of</strong> such referral processes. Referral pathway to the drug service from all universal<br />

and specialist <strong>services</strong>.<br />

3) In my experience the Drugs and Alcohol Teams routinely do not treat involuntary tranquilliser


addiction but only illicit addiction. - Cheshire DAT have included in the 2012-13 Direction <strong>of</strong> Travel<br />

Strategy focus to this area <strong>of</strong> work. Some DATs do treat tranquilliser addiction and we realise<br />

we need to address this locally in line with the National Drug Strategy and emerging health<br />

pictures. We are aware that prescription medicine (POM) and Over the Counter (OTC) medicine<br />

can bring comfort to many people suffering from a wide range <strong>of</strong> ailments and the overall use<br />

<strong>of</strong> prescription drugs has increased nationally. It is clear some people can develop problems<br />

with the use <strong>of</strong> certain medicines that have the potential for dependency and abuse. While<br />

historically, problems in relation to POM/OTC medicines have not been a major focus <strong>of</strong> drug<br />

treatment policy, national data does suggest that the use <strong>of</strong> these medicines are reported as<br />

problematic by a significant proportion <strong>of</strong> the drug treatment population. We also recognise<br />

that dependent drug users may <strong>of</strong>ten take POM/OTC medicines for quite different reasons than<br />

the rest <strong>of</strong> the population, for example, to enhance the effects <strong>of</strong> illegal drugs or to manage<br />

their after effects. It is clear that while some people might develop problems from the directed<br />

use <strong>of</strong> these medicines others can develop problems that stem from their non-directed use.<br />

We will focus on helping both involuntary and illicit addiction.<br />

I hope this sufficiently answers your enquiry but please do not hesitate to contact Laura Wentworth,<br />

Governance Office on 01244 385041 or e-mail foi@wcheshirepct.nhs.uk, should you require any further<br />

information.<br />

As part <strong>of</strong> our commitment to improving our <strong>services</strong>, I would be grateful if you would take the time to tell<br />

us how we dealt with your request for information by completing a short customer satisfaction survey. The<br />

survey is completely anonymous and should take no more than a couple <strong>of</strong> minutes to complete.<br />

The survey can be found on our public website via the following link Freedom <strong>of</strong> Information customer<br />

satisfaction survey<br />

Yours sincerely<br />

Kathy Doran<br />

Chief Executive<br />

NHS Cheshire, Warrington and Wirral<br />

West Essex PCT NO – See North East Essex<br />

Further to your enquiry I have now received information which I believe answers your first two<br />

questions. However we do not have the information to be able to answer your other queries<br />

as these fall with our provider <strong>services</strong>. Our provider service for mental health is North Essex<br />

Partnership NHS Foundation Trust and you can contact their PALS team direct on 01245<br />

546433 or email pals@nepft.nhs.uk .<br />

Please do not hesitate to contact us with any further queries.<br />

Kind regards.<br />

Karen Weatherill<br />

PALS Officer<br />

NHS West Essex<br />

West Kent PCT NO – See Medway<br />

Westminster PCT NO<br />

The response to your request is as follows:<br />

Practitioners within the INWL PCTs are advised to follow the advice in the British<br />

National Formulary (BNF) with regards to prescribing hypnotics, and that they should<br />

not be prescribed indiscriminately and that routine prescribing is undesirable. Where<br />

prolonged administration is unavoidable hypnotics should be discontinued as soon as


feasible and the patient warned that sleep may be disturbed for a few days before<br />

normal rhythm is re-established; broken sleep with vivid dreams may persist or<br />

several weeks.<br />

There is no specialised service addressing the patients who are dependent upon<br />

prescribed only benzodiazepine and z drug tranquillisers and sleeping tablets and who<br />

do not abuse these or other substances within INWL PCT area. The Royal College <strong>of</strong><br />

General Practitioners would <strong>of</strong>fer advice and support to GP’s progressing a<br />

withdrawal regime with their patient. There is also information and guidance available<br />

from National Institute for Clinical Excellence (NICE) and easily accessed via the<br />

internet.<br />

You are correct in your assumption that the specialist drug and alcohol <strong>services</strong> within<br />

INWL PCT’s catchment does treat tranquiliser addiction when combined with illicit<br />

substance misuse but not stand alone tranquilliser addiction unless illicit. They are not<br />

commissioned to carry out this function and there is a recognition that the needs <strong>of</strong> the<br />

cohort you refer to are significantly different to those who are illicit substance<br />

misusers.<br />

NHS North West London is a partnership <strong>of</strong> NHS Brent, NHS Ealing, NHS<br />

Hammersmith & Fulham, NHS Harrow, NHS Hillingdon, NHS Hounslow, NHS<br />

Kensington & Chelsea and NHS Westminster.<br />

Yours sincerely,<br />

Andrew Lall<br />

Freedom <strong>of</strong> Information Lead<br />

Wiltshire PCT NO – Misuse only<br />

Further to your request for information below, NHS Wiltshire is able to provide the following<br />

information.<br />

NHS Wiltshire does not formally commission a dedicated treatment service for people with<br />

addiction problems in relation to ‘over the counter’ medications. The Wiltshire Service is for<br />

misuse <strong>of</strong> alcohol and illicit drugs.<br />

It is worth noting that there is an increase noted in the misuse <strong>of</strong> ‘street’ available<br />

benzodiazepines, and that our specialist (T3) service does take referrals for some individuals<br />

requesting Benzodiazepine withdrawal, where a clear care package is set up and key<br />

worked. Benzodiazepine withdrawal is considered to be very complex and needing specialist<br />

intervention.<br />

The Wiltshire Tier 2 service sometimes work with a client’s GP on giving advice where<br />

needed on a reduction plan, and give the client support during the reduction liaising with<br />

the GP throughout, which might take some time.<br />

Wiltshire DAAT has also supported a programme <strong>of</strong> Continuous Pr<strong>of</strong>essional Development<br />

sessions over the last few years, for those GPs signed up to the Drugs Misuse Locally<br />

Enhanced Service. One <strong>of</strong> these sessions approximately a year ago focussed specifically on<br />

the prescribing <strong>of</strong> ‘Benzos and Z drugs’. The overheads for this particular session are being<br />

shared across all Wiltshire GP practices.<br />

I hope this information is <strong>of</strong> assistance. Should you wish to request further information<br />

please do not hesitate to contact me atfoi@wiltshire.nhs.uk .


Kind regards,<br />

Susannah<br />

Wirral PCT NO – I rang Kim Loughran who confirmed that there are no <strong>services</strong> apart from a small support<br />

group comprising ex-addicts and that she has requested <strong>services</strong> in the past as they are needed but to no<br />

avail. She was aware <strong>of</strong> benzo.org.uk and really wanted to do something about what she described as a<br />

massive and hidden problem.<br />

On receipt <strong>of</strong> your email, I contacted Kim Loughran at Wirral Drugs Service for<br />

advice. I have worked with Kim previously and know that she works mainly with<br />

opiate dependency rather than tranquilliser dependency.<br />

However, she would like to speak to you and discuss the support that is available<br />

currently on the Wirral. There are some support groups I believe. She is aware there<br />

is a need for more support and it is useful for her when patients get in touch. Kim’s<br />

contact numbers are 0151 604 7303 and 07500 881794 so please give her a call.<br />

In addition, one <strong>of</strong> my colleagues in Medicines Management has done some work<br />

with a few patients who are trying to withdraw from benzodiazepines. Her name is<br />

Sheena Davies. Sheena only works here on Thursdays and Fridays so I cannot ask<br />

her for advice today and I am not sure what projects she is working on currently.<br />

Would you be happy for me to pass your contact details on to her?<br />

I hope this is helpful and will put you in touch with Sheena if you wish.<br />

Kind regards<br />

Helen Dingle<br />

Prescribing Adviser<br />

T. 0151 643 5319 (Internal ext. 1077)<br />

M. 07900 495713<br />

NHS Wirral<br />

Wolverhampton City PCT NO – Healthy Minds Service provides CBT and not appropriate ITA withdrawal<br />

support and advice<br />

Thanks again for your email .<br />

With regards to your query below I have had a response back from Dr Ravindran, Mental<br />

Health Lead for Wolverhampton Clinical Commissioning Group who advised that he was not<br />

aware <strong>of</strong> a specialised service for patients that where dependendant upon prescribed<br />

benzodiazepine/z drug tranquillisers/sleeping pills. However he explained that the GP<br />

together with the help <strong>of</strong> the Healthy Minds Service can deal with the issue and seek help if<br />

needed.<br />

I hope the information above answers you questions, but if you have any further comments<br />

please do not hesitate to contact PALS.<br />

Regards<br />

Patient Advice and Liaison Service (PALS)<br />

Wolverhampton City Primary Care Trust

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