Survey of services John Perrott - APPGITA

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Survey of services John Perrott - APPGITA

Survey of PCTs in England recording provision of services for involuntary

tranquilliser addiction by John Perrott, 1 June 2012

Background note: Ministers in the Department of Health have asserted that there are

services for involuntary tranquilliser addiction (ITA) in most areas in England.

According to the author of this survey, and to members of the All Party Parliamentary

Group on Involuntary Tranquilliser Addiction (APPGITA), this assertion is incorrect.

The NTA review, by its own terms of reference, is a review on substance misuse.

On Page 16 of the NTA review it states that “94% of those partnerships who

responded positively to the questionnaire reported that there was local service

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

medicines.” The “partnerships” questioned by the NTA were defined in the review as

DATs which are Drug and Alcohol Teams and these are services provided within

PCTs.

The Survey

This survey was conducted in April – May 2012 by John Perrott, an expert patient and

a member of APPGITA. Contact details may be obtained from the Office of Jim

Dobbin MP at the House of Commons email dobbinj@parliament.uk

John Perrott conducted his survey by sending a questionnaire to 149 PCTs to verify

this statement in the NTA review. The responses he received are as follows:

83 PCTs NO SERVICES

11 PCTs PARTIAL SERVICES (very limited provision)

6 PCTs YES (provide services meeting most of John Perrott’s criteria listed below)

19 PCTs ESCALATED TO FOI. RESPONSE STILL OUTSTANDING

30 PCTs NO REPLY

Methodology:

Copy of email sent to 149 PCTs on 10 April 2012:

“Dear Sir/Madam,

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

dependent 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 of the availability of withdrawal advice and

support?

In my experience the Drugs and Alcohol Teams routinely do not treat involuntary

tranquilliser addiction but only illicit addiction.

The Department of Health have referred me to PALS.

Kind Regards,

John Perrott

If more information was required, the first email was followed up by a second email

or by telephone and the following description of specialised withdrawal support was

provided:


1. Conversion to a longer-acting benzodiazepine like diazepam.

2. Provision of withdrawal schedules.

3. Knowledge of the Ashton manual.

4. Provision of appropriate psychological support.

5. Provision of a help-line.

6. Any other details of such referral processes.

PCT Responses (alphabetical order)

Each PCT response is preceded by John Perrott’s comments in red.

A

Ashton, Leigh and Wigan PCT YES Provided by CITA

Our response is below:

The PCT commissions an outside provider to place counselors in practices to

provide one to one support to patients that are withdrawing from these drugs.

The counselors are based in approximately a quarter of our practices at any

one time. This is normally practices where there is a high level of prescribing

of benzodiazepines and Z drugs. In addition, there is a referral service where

practices that do not have their own allocated counselor can refer their patients.

If you are not satisfied with the information you have been provided with, make

a complaint or wish to request an internal review you should write to Pauline

Brown, Information Governance Manager at the above address. This should be

done within a reasonable period of time from receiving this response.

If you are not satisfied with our review under the Freedom of Information Act, you

may apply directly to the Information Commissioner for a decision. Generally,

the Information Commissioner’s Office cannot make a decision unless you have

exhausted our complaints procedure. The Information Commissioner can be

contacted at:

Locality Chairman: Alan Stephenson.

The Information Commissioner’s Office, Wycliffe House, Water Lane,

Wilmslow, Cheshire, SK9 5AF

If you need any further assistance, please do not hesitate to contact me quoting

the above reference number.

Yours sincerely,

Andrea Hughes

Information Governance

Barking and Dagenham PCT NO see Redbridge

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

tranquilliser project at Camden MIND and this is for Camden and Islington residents only and also is a

charity and not an in-house NHS service


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

The DAT only deals with misuse.

Thank you for your email.

Please visit the link below for details of how to contact PALS.

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

-service-pals/

Many thanks

Enquiries team

NHS Barnsley

Bedfordshire PCT NO

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

My colleague in the Medicines Management team has advised that NHS Bedfordshire do not

commission separate services for patients who have an addiction to prescription drugs.

However, you should discuss with your GP the issues you have with dependence and advise

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

gradual dose reduction to help you come off these drugs. The local Shared Care service may

be able to offer support and advice to the GP on appropriate dose reductions.

Please let me know if you require any further information.

Regards

Diane Sollars

Public Liaison Officer

Public Engagement and Communications

NHS Bedfordshire

Berkshire East PCT and Berkshire West PCT NO

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

recommended route for this is to discuss and gain the clinical support of your GP.

Regards

Mrs Terry Pascucci

Patient Advice and Liaison Service Officer

Patient Experience Team

NHS Berkshire

Berkshire West PCT NO - See Berkshire

Bolton PCT NO, not at time of response

Dear John at the moment people taking that prescribed drug is under review a new model is

being developed and that will include support for a wider variety of clients

The alcohol and drugs service based at wood street Bolton may be able to provide

psychological support however the medical management for yourself will still come under

your GP hope this has been a help to you

Regards

Val pals officer Lever Chambers


Bournemouth and Poole Teaching PCT also Dorset PARTIAL – I spoke to Mark Harris who

showed great understanding of the problem and although they do not have a

dedicated service they will work with GPs and would offer reduction advice and

psychological support and have one member of staff who has benzo addiction as a

special interest.

Dear Mr Perrot

Thank you for your enquiry below. Please accept my apologies for the delay in responding.

In instances where an individual is solely dependent upon prescribed benzodiazepines, in

most cases a suitable reduction plan can be agreed with the prescriber. The prescriber may

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

management and reduction plan where required. Additional psychological support can also be

obtained through drug & alcohol support services.

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

Best wishes

Mark Harris

Senior Commissioning Manager - Substance Misuse

NHS Bournemouth, Poole & Dorset

Discovery Court

Canford House

551-553 Wallisdown Rd

Poole

BH12 5AG

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

part-funding of an outside/voluntary/charitable organisation, insufficient compared

with the magnitude of the problem and not an in-house service provided by the NHS.

Thank you for your recent email.

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

informed that the PCT commission a benzodiazepine withdrawal service through the Bridge

Project based at Salem Street in Bradford and this is for any adult residing in Bradford who

requires help and support to reduce or cease their use of benzodiazepines

The service the PCT offers is mainly delivered from GP practices, although home visits may

be available. Advice, information, guidance and counselling are provided on all aspects

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

individual programme is agreed to enable gradual reduction in benzodiazepine use in a highly

supportive environment. The specialist worker educates clients in the use of anxiety

management techniques and uses structured interventions including cognative behavioural

therapy.

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

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

into GP practices to review/assist reduction.

I hope that information that I have so far provided above will prove useful and I will make

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

that I can be of any further assistance please do not hesitate to contact me.

Regards

Emma

Brighton and Hove City PCT PARTIAL – I had a long discussion with Charlie Freeman

who is a substance misuse nurse and works part-time as a specialist benzo reduction

worker. He is very experienced and showed substantial understanding of the problem.

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

long-term support for sufferers of ITA as one person working part-time. He also said

that benzo misprescribing in Brighton is a huge problem. Through Charlie’s efforts

Brighton and Hove have many initiatives to try to tackle the problem.

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

Charge Nurse for the Substance Misuse Service and specialises in working with GP practices

around Benzo's.

I hope this helps.

Kind regards,

Tanya

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

Bristol and District Tranqilliser Project part funded by Bristol PCT BUT this is only through part-

funding of an outside/voluntary/charitable organisation and not an in-house service

provided by the NHS.

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

information you had requested.

I have been advised that as part of the partnerships of the local Drug Action Team, NHS

North Somerset funds a local service called Battle Against Tranquillisers. I am advised this

organisation is able to provide a service for anyone with any kind of tranquilliser addiction or

dependency, regardless of how they have arrived at that position. You may find their website

of interest: http://www.bataid.org/

If you would like to discuss what services they offer then I am sure they would be happy to

respond directly to you about that.

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

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

With many thanks and kind regards,

Lucy

Lucy Delaney

PALS Officer (Monday-Thursday)

NHS Bristol

Buckinghamshire PCT same as Oxfordshire NO – Substance misuse only and harm minimisation

Bury PCT NO

Thank you for your email and apologies for the delay in response.

There isn’t a specific service that deals with the cohort of people with

dependence to prescribed medication. The patient would be referred to their

GP for advice and support.

If you require any further information please do not hesitate to contact me.

Regards,

Joanne Maclean

PALS and PPI Support Officer

T: 0800 328 3166

NHS Bury


Calderdale PCT NO

Freedom of Information Act 2000

I am writing in respect of your recent enquiry for information held by NHS

Calderdale under the provisions of the Freedom of Information Act 2000.

You asked for the information relating to the patients who are dependent upon

prescribed only benzodiazepine and z drug tranquillisers and sleeping tablets. In

response to your request, please find details below.

Please can you tell me what services your PCT/CCG provides for patients who

are dependent 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 of the availability of withdrawal advice and

support including:

1. Conversion to a longer-acting benzodiazepine like diazepam.

2. Provision of withdrawal schedules.

3. Knowledge of the Ashton manual.

4. Provision of appropriate psychological support.

5. Provision of a help-line.

6. Any details of such referral processes.

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

misuse service will manage people with this type of addiction if they are also addicted

to street drugs but do not take referrals for this type of addiction only.

The Medicines Management Team have run initiatives (benzodiazepine reduction

clinics) with some GP practices to inform and encourage good management and to

help patients withdraw from benzodiazepines. But day to day management will be

down to the individual GP.

Chair: Angela Monaghan

Chief Executive: Mike Potts

Clinical Commissioning Executive Chair: Dr Alan Brook

There is no current guidance in place to support practices with benzodiazepine

reduction but practices would be signposted to suitable UK guidelines and

information sources as

required.

Yours sincerely

Anna Lewandowska

Information Governance Officer

Camden PCT PARTIAL – patients have access to the Minor Tranquilliser Project at Camden MIND

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

of an outside/voluntary/charitable organisation, insufficient compared with the magnitude

of the problem and not an in-house service provided by the NHS.

Central and Eastern Cheshire PCT NO Also see Wirral. This is substance misuse treatment

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

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


FREEDOM OF INFORMATION ACT REQUEST

Please find detailed below Central & Eastern Cheshire PCT’s response to your FOI

request.

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

who are dependent upon prescribed only benzodiazepine and z drug tranquillisers and

sleeping tablets and who do not abuse these or other substances.

The Drugs and Alcohol Team (DAT) commission a Health Trust to provide a

substance misuse service and Shared Care scheme to dependent drug users which

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

commissions inpatient detoxification provision.There is a number of patients who are

abusing prescription medicine but who are not in the drug treatment service or

working outside of the Shared Care scheme. Wider services to provide support

include IAPT services, reablement and pain management services.

General Practice is encouraged and supported to prescribe hypnotics in line with

NICE guidance. From time to time, practices will review patients prescribed

hypnotics for longer than the recommended 2-4 weeks and offer encouragement to

reduce the use of hypnotics. This will include advice on good sleep hygiene and a

programme of conversion to diazepam and reduction in dose if needed, together with

the option of referral into more specialist services. Overall, the PCT prescribing of

hypnotics is below the national average.Would you please include details of the

availability of withdrawal advice and support including:

1. Conversion to a longer-acting benzodiazepine like diazepam.

All contracts with commissioned providers stipulate the need to meet the aim to

provide a range of interventions for individuals with drug misuse problems in line

with the national 2007 Drug Misuse and Dependence UK Guidelines on Clinical

Management and NICE 2007 Drug Misuse guidance.

2. Provision of withdrawal schedules.

As above - policies are held by commissioned providers on withdrawal schedules and

conversion of prescription where assessment indicates in line with national guidance.

3. Knowledge of the Ashton manual.

There is knowledge of the Ashton manual but we do not refer to this in contracts as it

is not in the above national guidance.

4. Provision of appropriate psychological support.

As above - in line with national guidance and stipulated in contracts. Psychological

support available through drug services, mental health services and wellbeing

activities.

5. Provision of a help-line.

No specific local help line for prescribed benzodiazepine, z drug tranquillisers or

sleeping tablets only. Talk to Frank website available nationally.

6. Any details of such referral processes. Referral pathway to the drug service from all

universal and specialist services.

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 of Travel Strategy focus to this

area of work.

Some DATs do treat tranquilliser addiction and we realise we need to address this

locally in line with the National Drug Strategy and emerging health pictures. We are

aware that prescription medicine (POM) and Over the Counter (OTC) medicine can

bring comfort to many people suffering from a wide range of ailments and the overall


use of prescription drugs has increased nationally. It is clear some people can develop

problems with the use of certain medicines that have the potential for dependency

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

been a major

focus of drug treatment policy, national data does suggest that the use of these

medicines are reported as problematic by a significant proportion of the drug

treatment population. We also recognise that dependent drug users may often take

POM/OTC medicines for quite different reasons than the rest of the population, for

example, to enhance the effects of illegal drugs or to manage their after effects. It is

clear that while some people might develop problems from the directed use of these

medicines others can develop problems that stem from their non-directed use.

We will focus on helping both involuntary and illicit addiction.

I hope this sufficiently answers your enquiry but please do not hesitate to contact

Gary Shenton, contact details at the top of the letter, should you require any further

information.

Yours sincerely

Kathy Doran

Chief Executive

NHS Cheshire Warrington Wirral

Pp Alex Dalgarno

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

services and showed a good understanding of the needs of ITA sufferers. They have 3 offices across the

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

symptoms and provide home visits and the GPs work with therapeutic volunteers.

I have been sent this information from our Joint Commissioning Manager,Cornwall & Isles of

Scilly Drug & Alcohol Action Team (DAAT)

Some GPs offer supported reduction programmes and Add action do offer support. Their

Central office is:

Trevint House

Strangways Villas

Truro, TR1 2PA

01872 263001

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

House a ring to see if they are able to help.

Best wishes

Wendy PALS Team

NHS Cornwall and Isles of Scilly

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

with Mind and also NECA in their 7 treatment services

Thank you for your email.

It is difficult to comment or provide advice to you on the basis of the information provided.

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

discuss your query in more detail.


Alternatively if you would like to email me your contact telephone number, a member of the

PALS team will be happy to phone you.

I look forward to hearing from you.

Best wishes.

Katharine Humby

Patient Advice and Liaison Service (PALS) Manager

Coventry Teaching PCT also Warwickshire NO

The PCT does not provide any services for patients who are dependent upon prescribed

drugs. The GP, will of course, provide necessary treatment but I believe the CWPT provide

the substance misuse services.

Hope that’s ok

Regards

Harpal Bains

Patient Advice & Information Assistant

NHS Coventry

Nursing Directorate

Christchurch House

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

there are no such services in Cumbria.

NHS Cumbria does not deliver this service but if you would like to contact Cumbria

Partnership Foundation Trust on 01228 602020 they will be able to help

Thank you

Shirley Forrest

Executive Assistant/PALS

NHS Cumbria

Tenterfield

Brigsteer Road

KENDAL

Cumbria. LA9 5EA

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

deal with illicit use only.

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

response may differ slightly between the two areas. I have contacted the Derby City Lead

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

information below:

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

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

prescribing G.P. in the development of management and support plans - to assist in recovery

from prescribed medications.

The City’s Drug treatment services are primarily concerned with providing substitute

medication for illicit drug use. The rationale for this in relation to prescribed medications is

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

treatment to be undertaken directly by drug treatment agencies, and as such a supportive

partnership approach is favoured within the City.

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

more than happy to approach our Senior Commissioning Manager Mr. M. Burrows, -

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

to the same enquiry for Derbyshire response


Please do not hesitate to contact me, should you require this additional feedback

Kind regards

Colleen March

PALS Patient Advice & Liaison Service

Please note, i have a new address:

NHS Derby City

Derbyshire County PCT NO – See Derby City

I have forwarded the email you have sent onto the PALS team for the Derbyshire County &

Derby City Cluster. They will be in touch with you soon.

With kind regards

Clair Shipley, High Peak Locality, North Derbyshire

Doncaster PCT NO Substance misuse only

Drug Interventions Programme

The Drug Interventions Programme focuses on the illicit use of heroin and cocaine

by people who have committed a 'trigger' offence, so the scheme is very specific in

terms of the clients to whom services are provided. In terms of other illicit drug use

our staff would signpost clients or other members of the public to other services. In

relation to the substances referred to in the query, we would most likely refer the

individual to their GP.

New Beginnings

In regards to question 4, New Beginnings runs a CBT restructuring programme

designed for people seeking support or help due to problematic addiction issues that

is able to focus on some of the cognitive issues that would be experienced by people

suffering from either assisted withdrawal or detoxification from such drugs. In regards

to item 5 there is a website www.drughub.co.uk, which is a local site of information

and support for Doncaster services.

Substance Misuse Service – Doncaster (The Garage)

If this is an iatrogenic problem then we would generally advise the service user to

ask their GP to refer to the consultant psychiatrist for a consultation and advice on

managed withdrawal by the GP within practice.

Dorset PCT see Bournemouth and Poole Teaching PCT PARTIAL

Dudley PCT see Walsall PCT No

FREEDOM OF INFORMATION ACT 2000 – NHS Dudley PCT -

InvoluntaryTranquilliser Addiction - Ref: FOI/000144

Thank you for your email received on 14th May 2012.

Your request for information as detailed below has now been considered.

However unfortunately Dudley PCT do not provide or specifically commission


services for patients dependent on benzodiazepine or Z drugs but who do not abuse

them.

Eastern and Coastal Kent PCT NO - See Medway

East Riding Of Yorkshire PCT NO

Your Request for Information

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

following information under the Freedom of Information Act 2000.

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

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

not abuse these or other substances.

No services are currently provided by NHS East Riding of Yorkshire for patients who are

dependent upon prescribed only benzodiazepine and z drug tranquillisers and sleeping

tablets and who do not abuse these or other substances.

NHS East Riding of Yorkshire is looking to develop a service for 2013/2014

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

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

East Riding of Yorkshire by visiting our website at www.eastridingofyorkshire.nhs.uk.

Yours sincerely

Emma Parker

Corporate Affairs Administration Manager

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

tranquilliser project at Camden MIND and this is for Camden and Islington residents only and also is a

charity and not an in-house NHS service

Gateshead PCT NO – See South Tyneside

Gloucestershire PCT NO

Our Reference: Freedom of Information request No. 1366/1666, seeking information

on Services for Involuntary Tranquilliser Addiction, which we received on 23.4.12.

I am writing to confirm that the Trust has now finished its search for the information

you requested, which was as follows:-

ANSWER: Treatment for involuntary tranquiliser addiction is not something that is

specifically commissioned in isolation by the PCT or DAAT.

Occasionally we receive requests from GPs or other psychiatrists about tranquiliser

dependence in people with no other addictions and we would suggest the use of the

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

topics, e.g, insomnia and depression, and is a Heather Ashton product.

We are not aware of any local helpline and long term psychological support would

not be available in this trust unless there were co-existing mental health problems

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

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

wish

to make a complaint or have a review of our decision, you should write to:-

Service Experience Manager,

2gether NHS Foundation Trust,

Rikenel,

Montpellier,

GLOUCESTER. GL1 1LY

Tel: 01452-891138

e-mail: complaints.2gether@glos.nhs.uk

Yours sincerely,

Trish Bluett (Mrs.),

Information Governance Officer.

Greenwich Teaching PCT NO CRI is Crime Reduction Initiatives and substance misuse treatment

Freedom of Information Act Request

Thank you for your request under the Freedom of Information Act.

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

a

similar format to your request.

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

dependent upon prescribed only benzodiazepine and z drug tranquillisers and sleeping

tablets and who do not abuse these or other substances?

The Greenwich Medicines Management team support the GPs within our CCG

with prescribing information and usage of these drugs. The GPs are supported to

review individual patient’s medication and are they obtain support from CRi to

help patient who want to reduce the usage of these medicines. For those patients

who require additional support, the service is provided via the Drugs and Alcohol

service run by CRi.

Would you please include details of the availability of withdrawal advice and

support?

Please contact CRi for further information on the availability of withdrawal advice

at the following address:

821 Woolwich Road,

Charlton,

London SE7 8JL

Halton and St Helens PCT NO See Sefton and Liverpool

Hammersmith and Fulham PCT NO Also see Westminster

I am writing from NHS North West London which administers Freedom of Information Act 2000

(FOIA) requests on behalf of Westminster, Hammersmith & Fulham, Kensington & Chelsea,

Brent, Harrow, Hounslow, Hillingdon and Ealing PCTs. This response is on behalf of INWL PCTs

(Hammersmith and Fulham, Kensington and Chelsea, and Westminster)You requested the

following:

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

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 of the availability of

withdrawal advice and support?

In my experience the Drugs and Alcohol Teams routinely do not treat involuntary tranquilliser

addiction but only illicit addiction.

The response to your request is as follows:

Practitioners within the INWL PCTs are advised to follow the advice in the British National

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

indiscriminately and that routine prescribing is undesirable. Where 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 normal rhythm is re-established; broken sleep with

vivid dreams may persist or several weeks.

There is no specialised service addressing the patients who are dependent upon prescribed only

benzodiazepine and z drug tranquillisers and sleeping tablets and who do not abuse these or

other

substances within INWL PCT area. The Royal College of General Practitioners would offer advice

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

information

and guidance available from National Institute for Clinical Excellence (NICE) and easily accessed

via NHS North West London is a partnership of NHS Brent, NHS Ealing, NHS Hammersmith &

Fulham, NHS Harrow, NHS Hillingdon, NHS Hounslow, NHS Kensington & Chelsea and NHS

Westminster.

You are correct in your assumption that the specialist drug and alcohol services within INWL

PCT’s catchment does treat tranquiliser addiction when combined with illicit substance misuse

but not stand alone tranquilliser addiction unless illicit. They are not commissioned to carry out

this function and there is a recognition that the needs of the cohort you refer to are significantly

different to those who are illicit substance misusers.

Specialist services do offer advice and guidance however would refer individuals back to primary

care services for the management of their care which might include a withdrawal regime.

Yours sincerely,

Andrew Lall

Freedom of Information Lead

Hampshire PCT also Isle of Wight and Southampton NO

Further to your e-mail of 10 April 2012, I have been informed by our Head of Medicines

Management that some GP’s support benzodiazepines withdrawal, however, he is not

aware of any other support. He has also commented that previously, we did offer a service

through one of our Medicines Management nurses; if GP’s needed such a service he has

confirmed we could consider that as an option.

Our Community Pharmacy Lead has reported that there is nothing that involves Community

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

I do hope this information helps.

Yours sincerely

Samantha Johnson

Quality Facilitator

SHIP (Southampton, Hampshire, Isle of Wight & Portsmouth PCT)

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

experienced tranquilliser project at Camden MIND and this is for Camden and Islington residents only and

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


Harrow PCT NO – Have only dealt with codeine products

I am writing from NHS North West London which administers Freedom of

Information Act 2000 (FOIA) requests on behalf of Westminster, Hammersmith &

Fulham, Kensington & Chelsea, Brent, Harrow, Hounslow, Hillingdon and Ealing

PCTs. This response in on behalf of NHS Harrow.

You requested the following:

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

dependent 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 of the availability of withdrawal advice and

support?

In my experience the Drugs and Alcohol Teams routinely do not treat involuntary

tranquilliser addiction but only illicit addiction.

The response to your request is as follows:

The drug treatment provider (Compass Harrow) do not usually receive referrals for

those who are addicted to other tranquilisers, however they have had to develop

reduction regimes for clients who are referred on some codeine based pain killers. In

this situation they would work in partnership with the prescriber to look at a reduction

regime, usually the Prescriber would continue the prescribing with support and advice

from a specialist doctor at Compass, and also receive Psychosocial interventions

alongside this. They have done this with GP’s and also consultants who may have

prescribed this medication after an operation or as on-going pain relief, this

arrangement has worked really well.

In regards to Benzodiazepines again the treatment provider would support the

prescriber to reduce this medication and in some cases where the reason for the initial

commencement is due to mental health we would support a referral to the CMHT and

Liaise with them. They would normally only take over the prescribing in

circumstances where the client is being prescribed an opiate substitute by us and this

would always be on a reduction regime. All clients would be offered Group work and

one to one support alongside any other intervention or support for the Prescriber.

If you require any further information please do not hesitate to contact me.

Yours sincerely,

Andrew Lall

Freedom of Information Lead

Havering PCT NO - see Redbridge

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

treating substance misuse of mainly opioids. They did not understand withdrawal symptoms or the

reassurance and support required during withdrawal and would apply inappropriate psychosocial

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


group work. When I explained what services should consist of they agreed that they did not offer services

and retracted their claim.

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

offer full support to you.The route in would be to call the team on 01432 263 636 and make an

appointment to see them.

Do let me know if there is anything else that I can do.

Kind regards,

Mark O'Donnell

Patient Advice and Liaison Service (PALS)

Hertfordshire PCT NO – Had long discussion with Naomi from PALS.

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

would have the responsibilty to provide advice initially by providing a withdrawal treatment

plan. The GP can discuss any aspects outside their expertise with other NHS medical

professionals including those based at the PCT.

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

369704.

Regards

Naomi

Naomi Davies

Patient Experience Co-ordinator

Quality and Patient Experience Team

NHS Hertfordshire

Hounslow PCT NO – Provider of response had no experience or understanding

Dear Andrew,

The response you sent me from Hammersmith and Fulham and Westminster

PCTs were fine.

However, I will need much more detail from Hounslow. I require the

information for Jim Dobbin MP to inform the next meeting with Anne

Milton MP Public Health Minister. Further details required are as

follows:

Details of the characteristics of a proper withdrawal service including:

1. Conversion to a longer-acting benzodiazepine like diazepam.

2. Provision of withdrawal schedules.

3. Knowledge of the Ashton manual.

4. Provision of appropriate psychological support throughout what may

be a prolonged withdrawal and post withdrawal period of up to a year

or more.

5. Provision of a help-line.

6. Any other referral details

Who provided the reply and which organisation e.g. a DAT?

The reply cites Hounslow and Surrey; does the response apply to the

whole of Surrey PCT as well?

What does a group programme consist of, which other self-help groups

referred to? Are they NHS funded/National Treatment Pool

funded/voluntary sector?

Whoever wrote this asked what I mean by treat; I mean provision of 1.-5. above.

The person providing this response also asked about the level of

addiction. I mean people who have, through no fault of their own,

become addicted to tranquillisers, prescribed to them by their doctors

beyond the 2-4 week guidelines, many for years and decades, and have

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


prescribed tranquillisers or other substances.

If these people needed help, what would be offered to them.

I do need this information rather urgently now as my original request

went out on 10 April 2012 so an early response would be appreciated.

From FOI Please see below a response to your follow up query;

I cannot answer all that as the service is new and all the pathways are not fully

established .

It did not ask for withdrawal regimes.

What I answered is that in the first instance one would assess the pt at the request of

the gp and there maybe a huge variety in the pt referred that would require differing

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

the gp. My initial response answered the question would we see them or not, the

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

refuse to see them.

Isle Of Wight NHS PCT also Hampshire and Southampton NO

Further to your e-mail of 10 April 2012, I have been informed by our Head of Medicines

Management that some GP’s support benzodiazepines withdrawal, however, he is not

aware of any other support. He has also commented that previously, we did offer a service

through one of our Medicines Management nurses; if GP’s needed such a service he has

confirmed we could consider that as an option.

Our Community Pharmacy Lead has reported that there is nothing that involves Community

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

I do hope this information helps.

Yours sincerely

Samantha Johnson

Quality Facilitator

SHIP (Southampton, Hampshire, Isle of Wight & Portsmouth PCT)

Islington PCT PARTIAL – patients have access to the Minor Tranquilliser Project at Camden MIND

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

of an outside/voluntary/charitable organisation, insufficient compared with the magnitude

of the problem and not an in-house service provided by the NHS.

Kensington and Chelsea PCT NO see Hammersmith and Fulham

Kirklees PCT NO – however they do have a good guidance.

Freedom of Information Act 2000

I am writing in respect of your recent enquiry for information held by the PCT under the

provisions of the Freedom of Information Act 2000.

You asked for information relating to involuntary tranquilizer addiction.

In response to your request please find below the following response:

There are no specifically commissioned services to manage the group of patients who are

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

general practitioner will manage these patients.


The PCT does provide guidance and advice to GPs looking after patients who wish to stop

taking benzodiazepines. Kirklees has adopted the Calderdale guidelines for this purpose

(attached). The PCT’s Medicines Management team has occasionally provided additional

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

If you are unhappy with the outcome or service you have received in relation to your

request and wish to make a complaint or request a review of our decision, you should

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

may have. Alternatively, you can write to the Head of Patient Safety and Risk at:

Broad Lea House

Bradley Business Park

Dyson Wood Way

Bradley

Huddersfield

HD2 1GZ

Knowsley PCT YES – Showed a good understanding of the needs of ITA sufferers and services reflect

this.

Dear Mr Perrott,

Hello, I am one of Knowsley Primary Care Mental Health Services Benzodiazepine Reduction

Therapists. I have been asked to give you some information about our Benzodiazepine

Reduction Programme. My colleague Don Charnock and I developed an evidence-based

holistic reduction programme which has now been available within our primary care mental

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

reduce from prescribed tranquillizers and sleeping tablets in an individualized and openended

way.

In answer to your specific queries:

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

follow, when appropriate, in accordance with the BNF (British National Formulary) guidelines

for withdrawal from Benzodiazepines, and in liaison with a patients GP.

2. Provision of withdrawal schedules – we work collaboratively to suit individual circumstance,

supporting each step closely and taking account of psychological readiness, other stress, comorbid

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

according to need. This will of course be within BNF recommendations and with the

agreement of the GP.

3. Knowledge of the Ashton manual – our programme was devised in line with this by a

Benzodiazepine Reduction Therapist with many years previous experience at CITA (Council

for Involuntary Tranquillizer Addiction).

4. Provision of appropriate psychological support – our therapists are all qualified counsellors

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

prescribed medication. We support the patient as required whether the need is simply to

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

supporting nutrition if required.

5. Provision of a help-line – unfortunately we are not able to offer this as Benzodiazepine

Reduction is a small part of a general primary care mental health service. However, when a

reduction is in progress a therapist usually provides a flexible level of support appropriate to

the stage the patient is at, for example: initial weekly face to face sessions, option for

alternate telephone support sessions, and telephone check-ins during difficult periods. As

each therapist holds a mixed caseload they are not always contactable by phone when in

clinic, but messages are taken and they call patients back as soon as they can.

If you wish to have a copy of the Benzodiazepine Reduction Programme booklet for more

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

would like this.

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

usual referral process, marked FAO Benzo Reduction. You would be assessed over the

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


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

specialist clinician.

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

do so.

Yours Sincerely and best wishes,

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

Therapist / Benzodiazepine Reduction Therapist - Specialist Clinician

Knowsley Primary Care Mental Health Service

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

In response to the questions your asked in relation the availability of services that support

people that are involuntarily addicted to tranquilliser, we would expect them to be supported

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

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

London & Maudsley Mental Health Foundation Trust.

Unfortunately we are not aware of any informational materials that have been produced that

provide information on withdrawals or support.

If you any further information related to treatment provision then our borough consultant

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

below.

mike.kelleher@slam.nhs.uk

Kind regards

Kenneth Gregory

Joint Commissioning Manager - Substance Misuse

Social Inclusion

Integrated Commissioning Directorate

NHS Lambeth

1 Lower Marsh,

SE1 7NT

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

place

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

and are leaders of quality service provision. I agree with you, I think it is imperative that we

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

clinical governance policies as well as prescribing guideline developed locally. They

incorporate all necessary information (including benzodiazepine conversion table) for

prescribers and are easily available to all health professional in the trust. There is a protocol

for gradual reduction but we encourage prescribing clinicians to treat each individual

separately and cater to their needs and requirements.

We have, for a long time now, believed that psychosocial interventions are equally important

(if not more) to address the complex problem of addictions. Nearly all our clinical staff are

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

interviewing style and we engage them in social behavioural network therapy. Our clinical

staff have a variable background which ranges from psychiatric nurses, midwives, general

nurses, whilst we also have two senior clinical psychologist, one CBT therapist, three

consultant psychiatrist and a junior psychiatry trainee doctor at the unit. Apart from the

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

flexible and we take referrals from anyone and deal with all patients above 18 years of age

(there is no upper age limit).

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 of any assistance to you in this

campaign.

If you have any further queries, please feel free to contact me again.

Kind regards,

Dr Yasir Abbasi

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

Honorary Senior Lecturer/ University of Leeds

Clinical Lead for Dual Diagnosis/ Leeds Addiction Unit

Leicestershire County and Rutland PCT PARTIAL – Spoke with Mike Haj from LCPT and they are aware of

the needs of ITA sufferers and provide reduction schedules, are aware of the Ashton manual and can

provide a wide range of therapies including 1:1 for sleep, anxiety and depression including acupuncture. He

said they would be overwhelmed if this cohort all required withdrawal support.

Hi Caroline,

Thank you for this information which leads me to another couple of questions please. Are these

in-house therapists knowledgeable regarding benzodiazepine withdrawal, do they follow the

Ashton manual? What psychological support do they provide?

Would you please provide contact details for the outreach service.

Thanks John

You will need to approach Leicestershire Partnership Trust (LPT) for the answer to your

questions below, as they provide the service and employ the therapists. We are a

commissioning organisation, and therefore would not have this level of detail about how

particular clinical staff at LTP operate.

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

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

details below:

Paget House

2 West Street

Leicester

LE1 6XP

Tel: 0116 225 6400

I hope you are successful in getting the information you require from LPT.

Kind regards

Caroline

Customer Services Officer

Medical Directorate

NHS Leicester, Leicestershire County & Rutland

Lewisham PCT NO

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

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

trust that the information detailed below will help.

Please note that Lewisham Drug and Alcohol Team (DAAT) do not commission specific

interventions for the client group detailed below. However, the commissioned service Crime

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

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

recovery.

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

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

Anonymous etc, however the first point of call would be via the GP.

Should you require further information, please let me know.

Kind regards

Jenny McFarlane

Patient Advice & Liaison Service (PALS) & Complaints Officer

NHS South East London Lewisham Business Support Unit

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

NHS funded and struggling to maintain a service due to a lack of funding.

M

Manchester PCT PARTIAL at time of response and new service cannot be evaluated until in place

Please find attached a response to your email requesting information

regarding services for patients who are dependent upon prescribed only

benzodiazepine and z drug tranquillisers and sleeping tablets I am sorry that

this information did not get to you in the first instance.

I liaised with the Public Health regarding your enquiry and the response from

them is that the short answer to your question is no. This is not currently

commissioned. A number of our current providers however, including Greater

Manchester West (GMW), Lifeline, and Addiction Dependency Solutions

(ADS) will see people with these problems. GMW has reported that the

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

providers will start to deliver (and the current services provided by those

providers mentioned above will be de-commissioned.) The 3 new providers

are being commissioned to work with adults who have problems with any drug

including those mentioned.

If you would like further information you can contact Marie Earle Programme

Lead for drug treatment in Public Health Manchester who can be emailed

at m.earle@manchester.gov.uk.

Once again, please accept my apologies for any delay in you receiving this

information.

Regards

Sue Curzon

PALS & Complaints Lead Officer

PALS & Complaints Team

NHS Manchester

Room 3, 1st Floor

Higher Openshaw Primary Care Centre

Ashton Old Road

Openshaw

Manchester

M11 1JG

Medway PCT NO – I rang Bobbie Walkem-Smith – there are no services in Kent or Medway

Reference my previous email, I have received a further response from the

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


"There is no formal service but the staff at KCA will sometimes provide advice

and support for these patients if the GP is prepared to provide the prescribing

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

I hope this information is helpful.

Kind regards

Bobbie Walkem-Smith

PALS Officer

NHS Kent and Medway

Middlesbrough PCT see Stockton-on Tees NO

Milton Keynes PCT same as Buckinghamshire NO – Substance misuse only and harm minimisation

Newcastle PCT NO

Within Newcastle there is Bridge View Drug Treatment Service – this service does not

provide services to patients who do not misuse prescribed only medication. The service is

only available to patients that abuse prescribed only medication and other substances.

I trust that this answers your request.

If you are unhappy with the response you receive to a request for information made under

the Freedom of Information Act 2000, you should contact us as soon as possible giving us

reasons why you believe we have not satisfied the requirements of the act. The matter will

then be considered by one of our executive directors who will respond in writing.

You will receive a letter about the outcome of this review, inviting you to contact the

Information Commissioner if you remain dissatisfied with our response.

Yours sincerely

Nicola Gannon

Information Access/HQ Manager

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

demonstrated a good understanding of the needs of ITA sufferers and commitment to this cohort. TADS

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

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

another area. Denise sounded very committed.

I have now had a response from a colleague who has given this response:-

‘the TADS service in Norfolk do work with people with prescribed addictions. This is

usually via a shared arrangements with GP’s to provide specialist oversight of a

reduction regime. The service would also offer counselling for anxiety/ underlying

mental health issues that may accompany the medication reduction’.

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

to the TADS service for your information, if I can be of any further assistance in this

or any other matter then please do let me know.

Kind regards

Susan Rixham

PALS – NHS Norfolk and Waveney

North East Essex NO

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


The PCT does not provide any such services.

If the individual is not abusing prescription drugs but is dependent on the drugs being

prescribed then responsibility would lie with the prescriber to deal with and provide a

managed withdrawal and replacement.

If you have any queries about this response, please contact us at the above

address, quoting the reference number given.

If you are unhappy with the service you have received in relation to your request and

wish to make a complaint or request a review of our decision, please write to us

at the above address.

If you are not satisfied with the outcome of your complaint or querying of the

information provided, you may apply directly to the Information Commissioner (IC) for

a decision. Generally, the IC cannot make a decision until you have exhausted

the PCT’s FOI complaints process. The Information Commissioner can be contacted

at: The Information Commissioner's Office, Wycliffe House, Water Lane,

Wilmslow, Cheshire SK9 5AF.

Yours sincerely

Liz Mason

Freedom of Information Officer

North Lincolnshire PCT PARTIAL – This is really an appendage to the misuse services and the

response does not reflect the needs of ITA sufferers especially support and reassurance. As

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

In a scenario where a service user attends through our direct access service

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

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

care planning is undertaken at direct access, a referral is 'actioned' and an appointment

offered within 21 days of initial referral.

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

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

based pain killers. Clients offered care planning, key working and controlled reduction/

community detox. The same service is offered for Z drugs.

Unsure what is being referred to as tranx, is this referred to under banner of z drugs?

Hope this helps, in terms of the future demand for services we are aware of the need to meet

this demand under our treatment model and the various partners involved in meeting this

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

months, which is apparently not a reflection of the problem. An area that needs more attention

going forward as culture of substance misuse is changing.

Substance Misuse Service – North Lincolnshire (The Junction)

The Junction specialist service has supported cases of this nature, including providing

advice and information, planned detoxification programmes, access to counselling/

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

number 01724 85591 GP's can refer in writing.

North Tyneside PCT NO – This is substance misuse treatment and the taper is too rapid

The following information relates to Project Answer, a drug treatment service in North

Tyneside.

Details of the availability of withdrawal advice and support including:

1 Conversion to a longer-acting benzodiazepine like diazepam.

For z drugs we would simply reduce the dose but transfer to multiple dispense at

the chemist.


2 Provision of withdrawal schedules.

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

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

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

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

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

3 Knowledge of the Ashton manual.

Yes

4 Provision of appropriate psychological support during what can be a prolonged withdrawal period.

a) benzo support group every Wednesday afternoon

b) CBT for any underlying anxiety and depression 1:1

c) complimentary therapies for relaxation, sleep etc.

d) appropriate anti-depressant prescribing where indicated

5 Provision of a help-line

No help-line from this service but there are a number of national tranquillisers

support groups (web-based) they can get involved in.

6 Any other details of referral processes.

Referral = self, GP, any other health care professional etc. We would then contact the GP to take over the

script of benzodiazepine or z drugs.

Bevan House

1 Esh Plaza

Sir Bobby Robson Way

Great Park

Newcastle upon Tyne

NE13 9BA

North Yorkshire and York PCT NO

Our Senior Commissioning Manager has suggested that you speak to your GP. He has stated

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

patients as you described but with the knowledge of the GP as there are higher risks

with benzodiazapines if not safely managed.

Your GP can contact our Commissioning team if they experience any problems with obtaining

help.

I hope the above is useful,

Many thanks,

Dianne E Lowe,

Patient Relations Officer,

NHS North Yorkshire and York

Northamptonshire Teaching PCT NO - but they do have withdrawal protocols. However, one step of their

protocol misinterprets the BNF guidelines and states - Step 2: Reduce diazepam dose in fortnightly steps of

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

and would represent a dangerous abrupt withdrawal when down to lower doses.

Thank you for contacting our service.

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

situation with you and can be contacted on 01604 651360.

We do not have a specific commissioned service for situations such as you highlighted below

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

information on benzodiazepine protocol which gives examples of the approach that could be

taken.

I hope this information is helpful

Kind Regards

Alison Berlie Complaints Dept

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

Oldham Tranx run by Barry and Sue Haslam.


Many thanks for your enquiry.

I have been informed that the Addiction Dependency Solutions service (ADS) based

on Greaves Street in Oldham, have qualified specialists that assist with

benzodiazepine withdrawal advice and support. They do this via GP health centres

and have satellite services at most Oldham GP practices. Clients can self refer and be

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

with them today and was assured that they do treat involuntary tranquiliser addiction

as well as illicit addiction.

Hope this information is of use to you.

Kind Regards

Michele Warburton

Patient Advice & Liaison Service (PALS)

NHS Oldham

Oxfordshire PCT NO – Substance misuse only and harm minimisation

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

• The BNF has clear guidance for managing the withdrawal of prescribed

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

approach is usually taken

• The DAAT commissioned Drug Services usually treat the illicit drug use; for licit

prescribed addiction, they can offer some support to the GP, or offer an informal

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

The Drop-In sessions are provided by Oxford Health (in partnership with The Oasis

Partnership) across the county as part of the new Harm Minimisation Service, the ‘Drop-In’

is not treatment, but can offer brief interventions for the individual, patients can self –refer .

For more information about the Drop –in contact Roy

Walsh, Roy.Walsh@oxfordhealth.nhs.uk

I hope this is helpful.

Kind regards

Akhbar

Redbridge PCT also Barking and Dagenham, Havering and Waltham Forest NO – I

rang RDAS and they only deal with illicit use

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

request has been passed to me as it is deemed to be a Freedom of

Information request. We apologise for the delay this has caused in providing

a response.

I have obtained the information requested and am able to respond as follows

concerning services for involuntary tranquiliser addiction.

Drug treatment services in Redbridge provide advice and information for

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

access 1:1 support, group work and aftercare. Redbridge Drug and Alcohol

Service (RDAS) provide detoxification for opiate users (heroin and

methadone).


Anyone requiring detoxification for non-opiate drugs such as tranquilisers

would be referred to an (inpatient) detoxification service that specialises in

detoxification for benzodiazepines, etc. This is due to the more intensive

clinical supervision required for tranquiliser detoxification.

To further assist you the contact details for the Redbridge Drug and Alcohol

Service are as follows:

Redbridge Drug and Alcohol Service (RDAS)

Tel: 0300 555 1180

3rd Floor, Ilford Chambers

11 Chapel Road

Ilford Chambers

Ilford

IG1 2DR

rdas-ilford@nelft.nhs.uk

We trust this information will prove to be of assistance to you.

If you are dissatisfied with the handling of your request you have the right to

ask for an internal review. Internal review requests should be submitted

within two months of the date of receipt of the response of your original letter

and should be addressed to:

Sue Brown

Freedom of Information Officer

NHS outer north east London

Redcar and Cleveland PCT NO see Stockton-on-Tees

Rotherham PCT NO – Substance misuse

Substance Misuse Service – Rotherham (Clearways)

In secondary care we have a number of patients (approximately 40 at any one time

out of around 450 individuals) who receive benzodiazepine prescriptions, always in

the context of a methadone programme or treatment for alcohol dependency. These

individuals usually have significant anxiety problems, often in the context of very

poor physical health related to their substance misuse.

At present there are just two individuals who are receiving nitrazepam

prescriptions and three receiving temazepam from secondary care services: the rest

are prescribed diazepam so that they can be supported in having their benzodiazepine

medication more easily controlled, especially when reductions and discontinuation are

appropriate and can be managed.

It should be noted that, in the Rotherham service, the greater proportion of

treatment for drug and alcohol dependency problems is provided through individual

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

drug/ alcohol worker support to the practices.

Within primary care individuals being treated for alcohol or drug, generally

opiate, dependency that also have a benzodiazepine dependency should be switched

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

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


prescribing issues.

Presumably within the primary care setting there will be individuals who are

prescribed benzodiazepines by their GP and have long standing prescriptions and

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

illicit supplies in addition to their prescriptions. However, these individuals will be

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

or referred in to the secondary care services. Therefore, the Trust does not hold any

information regarding this group and individual GPs would need to be approached by

if detail regarding this patient group is required.

Psychological support is integral to the provision of drug/ alcohol treatment

for patients both in secondary and primary care drug and alcohol treatment.

Many GP practices have primary care mental health workers based within

their premises that can provide support and counselling to individuals but, again, this

information would need to be requested from the GP practices.

Referral in to the services is open with the majority of service users either

self referring via the Single Point of Contact (SPOC) number or for those accessing

Shared Care via their GPs. An additional significant route in to treatment is via the

Criminal Justice System.

There is no identified local help line for benzodiazepine dependant

individuals, or for other drug or alcohol users.

Salford PCT NO

Thank you for your query. I have liaised with our Prescribing Team, our

Mental Health Commissioning Team, and our GP with Special Interest in

Mental Health, and I have the following information to feed back to you:

Salford has no specialist services that are commissioned to

specifically support people withdrawing from prescription meds (

including opiates such as codeine and tramadol as well as Z drugs, BDZs) as

their core business however, there is certainly support available via a number

of routes.

GPs are the first port of call - many of whom would be perfectly capable of

supervising a structured withdrawal programme from their

medication. Community Drug Teams do not always get involved as they see

their core business as illicit drug use. However, they will often assess in relation to

complex/challenging cases and advise, without necessarily managing the patient but

discharging back to GP with a tailored management plan.

Sometimes it can be appropriate for primary care-based psychological

therapy services to engage, particularly where the individual with the drug

dependency hasn't previously accessed that type of intervention, and may

have, for example, anxiety or depression-based problems. We know that our

local therapy services (such as IAPT service) are certainly managing many

patients who have co-existing dependency on prescription drugs.

The GP is the main route into the additional specialist services cited above,

and our Salford GPs are fully conversant with the referral criteria and

processes.

I hope this information answers your query.


Kind Regards

Gina Magson

Complaints & PALS Officer

Customer Care Team

NHS Salford

Sandwell PCT NO – Swanswell deal with substance misuse

Thank you for your enquiry.

Drug and alcohol services, in Sandwell, are provided by an organisation called Swanswell. In

the first instance, the patient would have to approach their GP. Each patient is treated on an

individual basis. Swanswell may advise the GP on how to treat the patient or the GP may

refer the patient to Swanswell as necessary.

Please do not hesitate to contact PALS if you require further information.

Regards

Avery Faulkner

(PALS Lead Officer)

Sefton PCT No – they refer to the experienced and long established voluntary charity CITA which is not

NHS funded and struggling to maintain a service due to a lack of funding.

Good afternoon John

Your email of 10th April 2012 has been passed to me for response.

I would hope that your GP would be signposting you to services which could be of

help to, however, if you are a Sefton patient, you could contact CITA (Council for

Information on Tranquillisers, Antidepressants and Painkillers) who may be able to

offer you advice and support.

Their website is as follows: http://www.citawithdrawal.org.uk/

I hope this information is of some help to you.

Kind regards

Pauline Delamar

Customer Access Team

NHS Merseyside

Shropshire County PCT NO - See Telford and Wrekin

I received your enquiry from Soma Moulik on the 11 th April.

My first response to you was on the 11 th April 2012 at 16:02, I then responded further on the

same date at 16:34.

The information is as follows:

After speaking to our Medicines Management team for clarification, they advise patients to

see their GP. If the GP feels it is clinically appropriate to do so, they will then refer the

patient on to the appropriate which is the Substance Misuse Team.

Alternatively you can contact the team direct on 01743 255740.

I hope that this answers your enquiry

Kind regards

Sharon

Sharon Smith

Self Care Management/PALS Lead

NHS Telford & Wrekin


South Gloucestershire PCT PARTIAL – refer to BAT part-funded charitable organisation not in-house

NHS service.

The South Gloucestershire Drug and Alcohol Action Team provides access to Battle Against

Tranquiliser’s which is a charity based in Patchway. The single point of contact is 01454

868750 and service users can access the treatment if they are using prescribed drugs illicitly

or through involuntary addiction.

If a person would like to ask some basic questions, there is a helpline 0844 8269317 or they

can access the website at www.bataid.org

When a service user calls the Single Point of Contact number, they go through an

assessment process and are offered a one to one meeting to ascertain need; however they

do not have to go any further than telephone assistance if they do not want to. Treatment is

free and they can access it for as long as they need.

I hope this is useful to you, if you need any more information or would like to get in touch,

please feel free to email/call me back.

Sarah Jenkins

PALS Manager

Southampton City PCT also Hampshire and Isle of Wight NO

Further to your e-mail of 10 April 2012, I have been informed by our Head of Medicines

Management that some GP’s support benzodiazepines withdrawal, however, he is not

aware of any other support. He has also commented that previously, we did offer a service

through one of our Medicines Management nurses; if GP’s needed such a service he has

confirmed we could consider that as an option.

Our Community Pharmacy Lead has reported that there is nothing that involves Community

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

I do hope this information helps.

Yours sincerely

Samantha Johnson

Quality Facilitator

SHIP (Southampton, Hampshire, Isle of Wight & Portsmouth PCT)

South Tyneside PCT NO

Please accept my apologies for the delay in responding to you.

Following your e-mail to the Patient Advice and Liaison Service (PALS) on 10 April

2012 I am now in a position to respond.

I have liaised with the Head of Service for Substance Misuse, South Tyneside NHS

Foundation Trust and the have provided the following response.

“Thank you for your request for information about what services our PCT/CCG

provides for patients who are dependent upon prescribed only benzodiazepine and z

drug tranquillisers and sleeping tablets and who do not abuse these or other

substances. South Tyneside NHS Foundation Trust provides treatment and care for

people who misuse substances in two localities of Gateshead and South Tyneside.

We do not provide services to patients with involuntary tranquilliser addiction.

Patients who have these problems are treated through their General Practitioner in a

primary care setting with support from practice pharmacists on withdrawal

programmes. Other voluntary services in the locality may be involved depending on

the individual needs of the patient.”

If you have any queries with the information I have provided please do not hesitate to

contact me.


Kindest regards,

Gemma

Gemma Evans

Patient Advice and Liaison Officer

Customer Services Department

South Tyneside NHS Foundation Trust

Yes, we cover Gateshead PCT, South Tyneside PCT and Sunderland TPCT.

Regards,

Gemma

Southwark PCT NO

I passed your enquire to Ms. Cuthbert, Clinical Advisor for Substance Misuse Commissioning,

who replied that in Southwark we have some specialist GPs with experience in managing

drug withdrawals/reductions but we do not have specific services for people who are

dependent on prescribed only benzodiazepines and other sleeping tablets and tranquillisers.

If you can let us know which GP practice you are registered with or where

you live in Southwark, we may be able to assist you further.

Best Regards,

Antonio Labigalini

PALS and Complaints Officer

Southwark Business Support Unit

South West Essex PCT NO

In reply to your FOI request of 18 May we have pleasure in supplying you with the following

information:

Our drug addiction services do not facilitate a service for treating these patients but do

provide support and guidance to GPs based on the "Drug misuse and dependence: UK

guidelines on clinical management". However, the Charity 'Open Road' also support GPs

with prescribing advice and withdrawal plans when required.

We do not have any service level agreements for this particular service but we are working on

a Benzodiazepine prescribing and withdrawal policy which will cover this.

More information may be obtainable from one of the PCT's providers; SEPT ( South Essex

Partnership Trust ).

They can be contacted at: SEPT, Trust Head Office, The Lodge, The Chase, Wickford,

Essex, SS11 7XX Tel: 0300 123 0808.

They also have a useful website: www.sept.nhs.uk

We thank you for your enquiry and hope this meets your requirements. Please do not

hesitate to contact me if I can be of further assistance.

Kind regards

Janet Lawn

Janet Lawn | Customer Services Team Leader | NHS South West Essex


Staffordshire PCT NO

and North Staffordshire PCT NO and the letter from the Clinical secretary points out that despite the need

and also their obvious understanding of the problem, there are no services.

Apologies for the delay in responding to your email, however the email account that your

correspondence had been forwarded to had been temporarily suspended during a IT transfer.

I have liaised with the Head of Medicines Management over your query and he has advised

that there is no specialised service to assist with the withdrawal of the prescribed

medications. Discussing the withdrawal with the patients GP is the first step. All Gp's have

guidance on the withdrawal of these types of medication and can assist in the process.

If the issue is that this has already been discussed with the GP and the advice provided has

not been helpful, then if the GP's contact details are provided we can discuss that with the GP

practice directly, or our office can assist with locating a new GP for the patient to register with.

I hope this has helped, however if you would like clarification or further assistance, please do

not hesitate to contact our office.

Kind regards

Michelle Kiernan

Complaints & Enquiries Officer

Complaints & Enquiries Office

NHS Staffordshire Commissioning Support Services

Please accept my sincere apologies for the delay in my response, but I hope I now have the

answers to your questions; please see the attached and the copy response below.

Kind Regards,

Cath Barratt

Cath Barratt

Admin Assistant

NHS Staffordshire Commissioning Support Services

St George's Chambers

31 Merrial Street

Newcastle

Staffs

ST5 2AE

Tel: 0845 602 6772 Extn: 1529

Fax: 01782 298228

Dear Cath,

In answer to Mr Perrott’s query below,

He is correct in that the Drugs and Alcohol Teams routinely do not treat involuntary

tranquilliser addiction, only illicit addiction.

The PCT/CCG does not provide a specific service for these patients and it would be

something they would need to discuss with their prescribing doctor who should have

sufficient expertise to offer a safe withdrawal programme within their own practice.

There are unfortunately many patients in this predicament in the Stoke-on-Trent area,

Stoke-on-Trent is the one of the highest prescribers of these type of drugs in the West

Midlands.

Benzodiazepine hypnotics should be used only if insomnia is severe, disabling or

causing the patient extreme distress. The lowest dose that controls symptoms should

be used, for a maximum of four weeks and intermittently, if possible. Due to the lack


of evidence of differences in the effects of zaleplon, zolpidem, zopiclone and the

shorter-acting benzodiazepines, NICE recommends that doctors should prescribe the

cheapest drug, taking into account the daily dose required and the cost for each dose.

If treatment with one of these hypnotic medicines does not work, the doctor should

not prescribe one of the others. Treatment should only be changed from one of these

hypnotics to another if side-effects occur that are directly related to the medicine.

NICE confirms that there is no compelling evidence of a clinically useful difference

between zaleplon, zolpidem and zopiclone (the so called ‘Z drugs’) and shorter-acting

benzodiazepine hypnotics from the point of view of their effectiveness, adverse

effects, or potential for dependence or abuse. There is no evidence to suggest that if

patients do not respond to one of these hypnotic drugs, they are likely to respond to

another.

Risks associated with long term use of hypnotic drugs have been well recognised for

many years. Nevertheless, despite these national safety warnings and guidance,

overall prescribing of hypnotics is not decreasing.

As a result, this is one of the prescribing areas we are asking GPs to focus on in terms of

attempting to reduce inappropriate prescribing. (And has been a focus for a number of years

now) please note, this focus is on the use of these drugs as sleeping tablets (hypnotics) and

not for anxiety (anxiolytics), it is also recognised that only certain patients are suitable for

withdrawal.

Commonly, to aid the withdrawal process, patients are first transferred onto a longer acting

tranquiliser (benzodiazepine) such as diazepam. This allows a more gradual reduction in drug

concentration and can delay the emergence of withdrawal symptoms, allowing a smoother

withdrawal process.

I am currently working on adapting a rather lengthy document to aid GPs in benzo/Z drug

withdrawal and once this has been developed we plan to distribute this to GPs.

In terms of patient support, we have a number of patient information leaflets, but again

these may need updating slightly, I have attached for information.

In summary, if Mr Perrott is interested in withdrawing from his medication, he will need to

speak to his prescribing GP (Should his GP require any additional support, this can be offered

from the Medicines Management team)

In case Mr Perrott is interested, (although I must warn you it is a very large document), I

have attached the Welsh Medicines Partnership document that I plan to adapt for our local

GPs. He may find some general useful information regarding withdrawal, again, this is

something I hope to put in a patient friendly version.

I hope this helps, please do not hesitate to contact me if I can be any further assistance.

Kind Regards,

Stockport PCT NO – Misuse only, an ITA asked for help and was offered a rapid withdrawal in rehab only.

They have a reasonable guidance but this is for GPs and there is no specialist support or helpline or even

referral to the charities.

Further to my email below, please see response to each point from our Associate Director

Medicines Management and Long Term Conditions:

1. Conversion to a longer-acting benzodiazepine like diazepam.

Practices have guidance available to them from the prescribing team

http://stockportmanagedcare.co.uk/wp-content/uploads/2008/12/Guidance-onbenzodiazepines-and-z-drugs-Stockport.doc

2. Provision of withdrawal schedules.

This is defined within the guidance


3. Knowledge of the Ashton manual.

The guidance issued is based on the information in this manual but as you will see is focused

on the professional rather than on the patient.

4. Provision of appropriate psychological support throughout what is often a prolonged

withdrawal and recovery period of up to a year or more.

This is provided by the GP practice however if there concurrent mental health problems

patients can be referred to the out IAPT/mental health services as appropriate. The

Community drug team will only see people who also are using other illicit drugs.

5. Provision of a help-line.

There is no helpline in Stockport

6. Any further details of such referral processes.

I hope this information is useful.

Yours sincerely

Nazie Gerami

PALS, Complaints & Claims Manager

Corporate Service

NHS Stockport

Stockton-on-Tees Teaching PCT see Middlesborough and Redcar and Cleveland NO – I

rang them and treatment is based on substance misuse and ITAs would be referred to

Crime Reduction Initiative (CRI)

The Drug and Alcohol Teams are provided by the local Councils not the Primary Care Trusts.

The contact details are:

Stockton - Tel 01642 528474

The specialist GP practice for Stockton is The Birchtree practice, tel: 01642 633561

The specialist GP practice for the Middlesbrough area is the Fulcrum practice, tel: 01642

354550

You would need to contact the practices and the Drug and Alcohol Teams to ask the

questions you have.

I hope this helps.

Shirley Stephenson

Patient Relations Officer

NHS Tees

Stoke On Trent PCT NO see Staffordshire

Suffolk PCT NO – First number unobtainable, Suffolk Recovery Service is for Substance Misuse. Rang them

and they have not heard of the Ashton manual.

Thank you for your email regarding involuntary tranquiliser addiction. There are 2 options

available to you. Firstly you could contact the Tranquilizer Withdrawal Support which is 24

hour service on 01284 702550. Alternatively you can contact Suffolk Recovery Services on:

0808 1783 285 to see if they are able to offer advice and withdrawal support or signpost you

to a more appropriate service. If you do not find these appropriate services I would suggest

that you speak with your doctor for further help and advice.

I hope this information is helpful, and if you have any further queries or concerns, please do

not hesitate to contact us.

Kind regards,

Lucy Blake I PALS Officer I NHS Suffolk

Sunderland Teaching PCT NO – See South Tyneside


Surrey PCT NO

NHS Surrey does not currently commission such a service and this is a gap that has been identified.

When undertaking routine inquiries on controlled drugs monitoring the lack of support for patients

who have become addicted to prescription drugs has been noted. A survey of GP practices was

carried out to gain an understanding of the potential number of patients who have become addicted

to their prescribed meds. The feedback indicated that GP’s felt the level of patients addicted to

Benzos and Z drugs was equivalent to that of opioid addiction.

We understand that GPs are providing support to patients and extra support is available to GPs from

the DAAT if the patient is willing to engage. The mental health trust, Surrey and Borders Partnership

Trust has indicated that it routinely sees patients addicted to their medication. They are happy to

have individual cases referred to them.

Whether CCGs would look to commission a specialist service in the future, we don’t know.

I hope this is of help.

Regards

Laura Dennett

Public Engagement Manager

Communications and Engagement Lead: Surrey Heath Clinical Commssioning Group

Sutton and Merton PCT NO Cecilia will also deal with the FOI for Surrey, Richmond, Kingston and

Wandsworth.

Sutton and Merton do not commission any specific services for prescribed drug dependency; individuals

concerned about such dependency should discuss the matter with the prescriber who is normally the

General Practitioner

Thank you for your request for information about Services for involuntary traquilliser addiction.

Your request was received on 18/04/2012 00:00:00 and I am dealing with it under the terms

of the Freedom of Information Act 2000.

In some circumstances a fee may be payable and if that is the case, I will let you know. A fees

notice will be issued to you and you will be required to pay before we will proceed to deal with

your request.

Any information we provide following your request under the Freedom of Information Act will

not confer an automatic right for you to re-use that information, for example to publish it. If you

wish to re-use the information that we provide and you do not specify this in your initial

application for information then you must make a further request for its re-use as per The reuse

of Public Sector Information Regulations 2005 www.opsi.gov.uk/psi-regulations/ this will

not affect your initial information request.

If you have any queries about this letter, please contact me. Please remember to quote

the reference number: FOI12-157 in any future communications.

Yours sincerely,

Cecilia Tapping,

Governance Manager

and FOI Lead

020 8251 0589

Swindon PCT NO – not at time of response


Further to my email of the 12th April 2012, I would like to apologise for the delay in

providing a response to your enquiry.

NHS Swindon’s Head of Medicines Management had advised me to speak to the

Assistant Director for Mental Health Commissioning. I have now received a response

and in a position to feedback to you.

As you have correctly stated in your email the statutory drug and alcohol services no

longer provide services for involuntary tranquilliser addiction. However, there are

currently plans to re-commission the drug and alcohol service in Swindon. This will

include providing a service to support those patients who are either prescribed or

purchase over-the-counter tranquilliser medication through detox. Patients will need

to be referred by their own GP in order to access the drug and alcohol service for an

assessment.

There is also a national organisation www.benzo.org.uk for patients who may wish to

self-manage their detox for involuntary tranquilliser addiction. It has been advised by

the Inclusion Drug Service Manager that the Ashton Manual which is available online

should be used as a reference guide.

‘Battle Against Tranquillisers’ is a helpline that can provide information and advice

for involuntary users of tranquillisers. They can be contacted on 0844 826931.

I hope you find the above information useful.

Kind Regards

Melissa Probets

PALS/Complaints Administrator

NHS Swindon

Tameside and Glossop PCT PARTIAL - This PCT employs an in-house benzo reduction worker to support

withdrawal but compared to the magnitude of the problem this would be insufficient if all those in the PCT

iatrogenically addicted needed support.

Please find attached response letter to your recent FOI request.

Regards

Jackie Gordon

Risk and Complaints

Tameside and Glossop NHS

Telford and Wrekin PCT No – I spoke to the service manager of Shropshire Drug and Alcohol team and they

do not provide services for ITA sufferers. They only provide services for illicit use.

Dear Mr Perrott

My understanding from my colleagues that the GP’s will refer patient’s to the Substance

Misuse Team.

There is a web site and below is the link to the page

http://www.shropshire.nhs.uk/Care-and-Treatment/Out-of-Hospital-Services/Alcohol-and-

Drug-Misuse/

Alternatively you can contact the team direct on 01743 255740

Kind regards

Sharon

Self Care Management/PALS Lead

NHS Telford & Wrekin

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

I originally anticipated. The contact details I have been given to provide you with are:

If the patient is aged 11-25 they can contact Phoenix Futures, the number is: 0161 905 1013

If the patient is aged over 25 they can contact the Trafford Drug Service, the number is: 0161

786 8250.

Having contacted Trafford Drugs Service to ask specifically about services for involuntary

tranquiliser addiction, they explain that for prescribed medications a patient can contact them

direct on the number given above and they will liaise with the patient’s GP to determine if and

how they can assist. If they can’t help for any reason they will ensure a patient is re-directed

appropriately.

Jasmine Clarke

Head of Customer Care and Experience

NHS Trafford

Wakefield District PCT No

Thank you for your email. Having made enquiries I am not aware of any specific

withdrawal services currently commissioned within the Wakefield District, it is my

understanding that services/support would be available locally by your own GP/GP

Practice, is this something your have already looked into?

I have contacted Spectrum Community Health for guidance and it may be worth your

contacting them directly on 01924 330500 to discuss your issue.

I hope this information helps.

Kind regards

Sarah Deakin

PALS Officer

Patient Advice & Liaison Service

NHS Wakefield District

Walsall Teaching PCT see Dudley NO

FREEDOM OF INFORMATION ACT 2000 – NHS Dudley PCT -

InvoluntaryTranquilliser Addiction - Ref: FOI/000144

Thank you for your email received on 14th May 2012.

Your request for information as detailed below has now been considered.

However unfortunately Dudley PCT do not provide or specifically commission

services for patients dependent on benzodiazepine or Z drugs but who do not abuse

them.

Waltham Forest PCT NO - see Redbridge

Warrington PCT NO – I rang Pathway to Recovery and although they provide a basic diazepam taper when

I gave my own case as an example of converting from Ativan to diazepam, and then requiring specialist

support throughout the withdrawal and post-withdrawal period, they do not provide a service at this level.

Also, they did not seem to expect withdrawal symptoms which points to their dealing mainly with high dose

benzo abuse; their main provision is for illicit crack cocaine and opioid use.

I have now been able to obtain the information that you require.


Such services are commissioned by NHS Warrington from the Service called ‘Pathway to

Recovery’, to which you can self present. This Service offers one to one support via a

keyworker, and will liaise with your GP.

You can telephone or attend in person, but should attend in good time to have an assessment

done, so it is best to attend a few hours before closing time. You should ask for the Duty

Worker.

Contact details:

Pathway to Recovery

14 Bold Street

Warrington

(Opposite the Museum Library)

Telephone 01925 415 176

Opening Times:

Monday, Wednesday, Thursday and Friday 9.00 am to 5.00 pm

Tuesday 9.00 am to 7.00 pm

I do hope that this information is of assistance to you.

With kind regards

Marie Montgomery

Patient Relations Manager

NHS Warrington

Warwickshire PCT NO – See Coventry

Thank you for your enquiry. The response that I gave you on 3 May 2012 applies to Coventry

PCT and Warwickshire PCT. Both PCT's make up the Arden Cluster.

Kind regards,

Gerald Dadley

Freedom of Information Officer

Western Cheshire PCT NO Also see Wirral. This is substance misuse treatment and anyone

who refers patients to “Talk to Frank” (misuse helpline) as a specialist helpline as the

author of this response has done, does not understand ITA treatment.

Please find attached NHS Western Cheshire’s response to your request for information received on 23rd

May 2012 regarding Services for involuntary tranquiliser addiction:

You asked:

1) Please can you tell me what services your PCT/CCG provides for patients who are dependent upon

prescribed only benzodiazepine and z drug tranquillisers and sleeping tablets and who do not abuse these or

other substances. The DAT commission a Health Trust to provide a substance misuse service and Shared

Care scheme to dependent drug users which meets the need for identifiedreferred patients who are drug

dependent. The DAT also commissions inpatient detoxification provision. There is a number of patients who

are abusing prescription medicine but who are not in the drug treatment service or working outside of the

Shared Care scheme. Wider services to provide support include IAPT services, reablement and pain

management services.

2) Would you please include details of the availability of withdrawal advice and support including:

1. Conversion to a longer-acting benzodiazepine like diazepam. - All contracts with commissioned

providers stipulate the need to meet the aim to provide a range of interventions for individuals

with drug misuse problems in line with the national 2007 Drug Misuse and Dependence UK

Guidelines on Clinical Management and NICE 2007 Drug Misuse guidance.

2. Provision of withdrawal schedules. - As above - policies are held by commissioned providers

on withdrawal schedules and conversion of prescription where assessment indicates in line

with national guidance.

3. Knowledge of the Ashton manual. - There is knowledge of the Ashton manual but we do not

refer to this in contracts as it is not in the above national guidance.

4. Provision of appropriate psychological support. As above - in line with national guidance and

stipulated in contracts. Psychological support available through drug services, mental health

services and wellbeing activities.

5. Provision of a help-line. - No specific local help line for prescribed benzodiazepine, z drug

tranquillisers or sleeping tablets only. Talk to Frank website available nationally.

6. Any details of such referral processes. Referral pathway to the drug service from all universal

and specialist services.

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 of Travel

Strategy focus to this area of work. Some DATs do treat tranquilliser addiction and we realise

we need to address this locally in line with the National Drug Strategy and emerging health

pictures. We are aware that prescription medicine (POM) and Over the Counter (OTC) medicine

can bring comfort to many people suffering from a wide range of ailments and the overall use

of prescription drugs has increased nationally. It is clear some people can develop problems

with the use of certain medicines that have the potential for dependency and abuse. While

historically, problems in relation to POM/OTC medicines have not been a major focus of drug

treatment policy, national data does suggest that the use of these medicines are reported as

problematic by a significant proportion of the drug treatment population. We also recognise

that dependent drug users may often take POM/OTC medicines for quite different reasons than

the rest of the population, for example, to enhance the effects of illegal drugs or to manage

their after effects. It is clear that while some people might develop problems from the directed

use of these medicines others can develop problems that stem from their non-directed use.

We will focus on helping both involuntary and illicit addiction.

I hope this sufficiently answers your enquiry but please do not hesitate to contact Laura Wentworth,

Governance Office on 01244 385041 or e-mail foi@wcheshirepct.nhs.uk, should you require any further

information.

As part of our commitment to improving our services, I would be grateful if you would take the time to tell

us how we dealt with your request for information by completing a short customer satisfaction survey. The

survey is completely anonymous and should take no more than a couple of minutes to complete.

The survey can be found on our public website via the following link Freedom of Information customer

satisfaction survey

Yours sincerely

Kathy Doran

Chief Executive

NHS Cheshire, Warrington and Wirral

West Essex PCT NO – See North East Essex

Further to your enquiry I have now received information which I believe answers your first two

questions. However we do not have the information to be able to answer your other queries

as these fall with our provider services. Our provider service for mental health is North Essex

Partnership NHS Foundation Trust and you can contact their PALS team direct on 01245

546433 or email pals@nepft.nhs.uk .

Please do not hesitate to contact us with any further queries.

Kind regards.

Karen Weatherill

PALS Officer

NHS West Essex

West Kent PCT NO – See Medway

Westminster PCT NO

The response to your request is as follows:

Practitioners within the INWL PCTs are advised to follow the advice in the British

National Formulary (BNF) with regards to prescribing hypnotics, and that they should

not be prescribed indiscriminately and that routine prescribing is undesirable. Where

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

normal rhythm is re-established; broken sleep with vivid dreams may persist or

several weeks.

There is no specialised service addressing the patients who are dependent upon

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

do not abuse these or other substances within INWL PCT area. The Royal College of

General Practitioners would offer advice and support to GP’s progressing a

withdrawal regime with their patient. There is also information and guidance available

from National Institute for Clinical Excellence (NICE) and easily accessed via the

internet.

You are correct in your assumption that the specialist drug and alcohol services within

INWL PCT’s catchment does treat tranquiliser addiction when combined with illicit

substance misuse but not stand alone tranquilliser addiction unless illicit. They are not

commissioned to carry out this function and there is a recognition that the needs of the

cohort you refer to are significantly different to those who are illicit substance

misusers.

NHS North West London is a partnership of NHS Brent, NHS Ealing, NHS

Hammersmith & Fulham, NHS Harrow, NHS Hillingdon, NHS Hounslow, NHS

Kensington & Chelsea and NHS Westminster.

Yours sincerely,

Andrew Lall

Freedom of Information Lead

Wiltshire PCT NO – Misuse only

Further to your request for information below, NHS Wiltshire is able to provide the following

information.

NHS Wiltshire does not formally commission a dedicated treatment service for people with

addiction problems in relation to ‘over the counter’ medications. The Wiltshire Service is for

misuse of alcohol and illicit drugs.

It is worth noting that there is an increase noted in the misuse of ‘street’ available

benzodiazepines, and that our specialist (T3) service does take referrals for some individuals

requesting Benzodiazepine withdrawal, where a clear care package is set up and key

worked. Benzodiazepine withdrawal is considered to be very complex and needing specialist

intervention.

The Wiltshire Tier 2 service sometimes work with a client’s GP on giving advice where

needed on a reduction plan, and give the client support during the reduction liaising with

the GP throughout, which might take some time.

Wiltshire DAAT has also supported a programme of Continuous Professional Development

sessions over the last few years, for those GPs signed up to the Drugs Misuse Locally

Enhanced Service. One of these sessions approximately a year ago focussed specifically on

the prescribing of ‘Benzos and Z drugs’. The overheads for this particular session are being

shared across all Wiltshire GP practices.

I hope this information is of assistance. Should you wish to request further information

please do not hesitate to contact me atfoi@wiltshire.nhs.uk .


Kind regards,

Susannah

Wirral PCT NO – I rang Kim Loughran who confirmed that there are no services apart from a small support

group comprising ex-addicts and that she has requested services in the past as they are needed but to no

avail. She was aware of benzo.org.uk and really wanted to do something about what she described as a

massive and hidden problem.

On receipt of your email, I contacted Kim Loughran at Wirral Drugs Service for

advice. I have worked with Kim previously and know that she works mainly with

opiate dependency rather than tranquilliser dependency.

However, she would like to speak to you and discuss the support that is available

currently on the Wirral. There are some support groups I believe. She is aware there

is a need for more support and it is useful for her when patients get in touch. Kim’s

contact numbers are 0151 604 7303 and 07500 881794 so please give her a call.

In addition, one of my colleagues in Medicines Management has done some work

with a few patients who are trying to withdraw from benzodiazepines. Her name is

Sheena Davies. Sheena only works here on Thursdays and Fridays so I cannot ask

her for advice today and I am not sure what projects she is working on currently.

Would you be happy for me to pass your contact details on to her?

I hope this is helpful and will put you in touch with Sheena if you wish.

Kind regards

Helen Dingle

Prescribing Adviser

T. 0151 643 5319 (Internal ext. 1077)

M. 07900 495713

NHS Wirral

Wolverhampton City PCT NO – Healthy Minds Service provides CBT and not appropriate ITA withdrawal

support and advice

Thanks again for your email .

With regards to your query below I have had a response back from Dr Ravindran, Mental

Health Lead for Wolverhampton Clinical Commissioning Group who advised that he was not

aware of a specialised service for patients that where dependendant upon prescribed

benzodiazepine/z drug tranquillisers/sleeping pills. However he explained that the GP

together with the help of the Healthy Minds Service can deal with the issue and seek help if

needed.

I hope the information above answers you questions, but if you have any further comments

please do not hesitate to contact PALS.

Regards

Patient Advice and Liaison Service (PALS)

Wolverhampton City Primary Care Trust

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