Our fellow blogger (respect JD) did a piece on benzodiazepines following hearing a piece on this programme. What JD said is true but perhaps the “experts” in the ivory towers of academia and alongside the Thames ought to spend some time in the field.
At the infamous Café Michelle home of the Northernshire resistance a couple of us tuned our crystal sets to listen to the original piece (BBC Radio 4 Face the “Facts” 27/07/11) and would take issue with some of the points raised.
The alleged GP fuelled epidemic of benzo addiction is due to the “power of the pharmaceutical industry.” Interesting point GP bashing BBC reporter dude for is prescribing of benzos in a practice where no GP sees pharmaceutical representatives an illustration of your point? Or perhaps if you are a scientist might there be other hypotheses to consider, analyse and prove or disprove? Something we are sure you did at journalism school in your lecture entitled fact, science and sensationalism.
According to our local psychiatric colleagues who deal with addiction are the BBC and Government GP bashers aware that the biggest problem they are facing is a huge rise in illegal benzo imports from the Indian subcontinent and Far East?
Heroin addicts need several grams of alleged heroin a day to fuel an addiction but our local scrot population of illegal users seem to get by on 40-80mg a day of benzos usually Diazepam. For BBC journalists a gram is the same as 1000mg so if you do the share bys you might just see the points we are making.
Trafficing heroin carrys serious bird if caught and involves quantities of weight almost a 100 times greater than benzos. Given that the NHS run by politicians believes in a fixed price "free" market for healthcare can anyone see where the true (illegal) free market will head?
Current street prices for legit benzos are about £1-10 a tablet for drug addicts depending on supply and prescribed benzos get a mark up. This is about the same as a less than legit “gram” of heroin/talc/brickdust etc. We believe that 3mg Warfarin tablets have the same size and shape as certain benzos something we are more than happy to prescribe for those with a legit use.
If you are a drug dealer which substance might be most profitable and less risky?
The BBC programme said that the cost of a prescription for benzos for a month was less than 2 pounds. Lets say a pound fifty for one 5 mg tablet of diazepam a night for a month 28 in total.
Get a free prescription in the United Kingdom, unless you are one of the unlucky 10% who live in England and have to pay, and if you don’t actually need your benzos but tell your caring GP, who has no way of checking that you do, then your monthly prescription becomes a State funded up to £280 a month additional tax free income.
Is it any wonder that some of our benzo users regularly lose prescriptions to the point where if they see other doctors at other practices and the out of hours services they can obtain 500+ tablets in a 3 week period. That is a massive 5 grand for 3 weeks blagging and all state and taxpayer sponsored and legal.
Now some would argue why do GPs give in? Well going back a few decades when informed medical opinion tried reducing benzos in the same way as they did alcohol and heroin there were a few little problems like fitting. A few patients admitting fitting in the absence of the guidance now available does tend to make GPs cautious.
The addicts in the BBC programme cite a lack of support for the reason they could not come of. In our humble experience they need a lot of support sometimes for 2 years before they become clean. They also need a very cynical degree of supervision for some will lose their grandmother 24 times in a year, have problems with their children all 14 of them at least twice a week and as for the canine morbidity and mortality well we have exhausted our tissue boxes dealing with these excuses not to reduce but to increase their benzo use under such times of domestic "stress".
The BBC programme said that in 1988 a warning was issued. The oldest copy of a current BNF we have is from 1984 and it issues warnings of addiction and those of us young enough to have read this edition of the BNF were warned big time about the risks of addiction with benzos by our seniors then. A copy of the 1976-78 edition page 79 makes the observation that "Hypnotics are overprescribed and patients are kept on them for years". The following page makes this observation "There is no justification for using them for long periods".
Temazepam and Paracetamol were routinely prescribed by house officers as “prn” (as required drugs) to prevent being awakened because a patient could not sleep in hospital or had a headache and sometimes would be prescribed as a take home drug. We regularly used to stop these drugs being prescribed as take home medication but we know many other doctors did not.
Another problem locally is that local substance misuse services seem to regard benzos as the cure for opiate addiction and try to substitute them for heroin. We would suggest this is like trying to cure an alcoholic of drinking by saying stop the scotch and will we will prescribe you beer instead.
As a result a large number of benzo prescriptions are initiated by consultants that then get carried on by GPs who wish not to deviate from consultant led “shared care arrangements” = Party approved we will not pay for specialists whose price is fixed to look after difficult patients we will pay for “quality” and price reduction by sub contracting specialist services to GPs the only negotiable part of the new NHS market.
As a result GPs are seeing many multiply addicted patients using heroin, cannabis, methadone, alcohol, benzos, crack all of whom feel they are not supported but whenever they feel, sorry re grunt word, sh*t, see their GP for a panacea to “get them through”. After all 28 benzos = 28 wraps or £280 pounds for a Party approved ten minute consultation = £1680 an hour for something costing less than couple of quid.
There is a simple solution to this problem. Put benzos on the same prescribing status as anti malarial drugs and ensure that the only way patients can get them is on a private prescription. The NHS “market” would then decide.
If GPs were over prescribing them this should in theory lead to a reduction in demand as GP over supply would lead to a reduction in consumer demand as market costs apply. If it is in effect a patient led demand then benzo prescriptions would soar especially in young people who are buying them because they are so cheap. Perhaps the government could help with a benzo added tax (BAT) on such private services as a deficiet reduction scheme?
Obviously there would have to be a period whereby addicts could come off if they wished but we wonder where NHS market forces would lead?
Simples. No more BBC programmes regarding crap GPs and health ministers telling us that we need retraining.
Praise be to the Party for waking up at least a quarter of a century too late to benzos.
We here at ND Central need more training for this week we had to deal with the dog ate my benzos, my children put my benzos in the bin/washing machine/shredder/customs ceased my benzos, I am out of prison and on a self run heroin detox can I have some benzos, my benzos were on a window sill and the window was open because it was hot and they have melted . . . can I have another prescription?
How much more training do we need?
The answer to all of the above replacement requests will be no until we actually get a request to replace their lost paracetamol. Several decade’s collective experience totalling over a century in practice we have never had one of these requests ever. Wonder why? Perhaps the BBC should investigate the failure of GPs to replace lost paracetamol prescriptions “Millions of Britains are suffering unnecessary pain due to the failure of GPs to . . . ?
Contact Northern Doc:
Northern Doc was once a blog originally written by a group of GPs in Northernshire and expressed their experiences and frustrations of working in today's NHS. The pieces were compiled at social meetings after work and published anonymously in a once free society. Following the Government's Medical Council clamp down on freedom of thought, speech and expression by doctors and our belief that the views of a few doctors DO NOT represent the views of the profession as a whole their views will now be written by and published by a journalist who has previously contributed to the blog by virtue of social ties. Any inference that the word Doc means a doctor is now purely coincidental. This is as of the 22 April 2013.