Survey of services John Perrott - APPGITA
Survey of services John Perrott - APPGITA
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