Category Archives: Articles

A collection of articles from various sources on Prescription and OTC (over the counter) drugs.

Seratonin Syndrome

ABSTRACT
Serotonin syndrome is an iatrogenic disorder induced by pharmacologic treatment with serotonergic agents that increases serotonin activity. In addition, there is a wide variety of clinical disorders associated with serotonin excess. The frequent concurrent use of serotonergic and neuroleptic drugs and similarities between serotonin syndrome and neuroleptic malignant syndrome can present the clinician with a diagnostic challenge. In this article, we review the pathophysiology, diagnosis, and treatment of serotonin syndrome as well as other serotonergic disorders.

Full article – https://academic.oup.com/painmedicine/article/4/1/63/1816666

We have an “app” for that!!

A big thank you to Peter Ruppert’s team for their diligent work developing a handy tool to track symptoms of adverse effects to medication and withdrawal.

Adverse Effects, Discontinuation and Withdrawal Symptoms Tracker

BrainZaps! Is a new solution for those who are on and thinking of coming off medication.

Discontinuation Syndrome can have some serious and uncomfortable effects, including Brain Zaps, a sensation of an electrical shock in the brain or throughout the body that can manifest in different ways. These symptoms stop many people each year from successfully weaning off of their medication, especially if they have been taking higher doses throughout the years.

Download it here

Go to the website at http://brainzaps.io/ for more information on the app (in beta currently).

or directly from

Brain Zaps at Google Play Store


Apology from PAST.Wales

With sadness, once again there was an attempt to hack our website yesterday. The intruder(s) attempted to plant malware and redirect the site to a spurious website. Thankfully it was caught early, (within the hour), and repaired before any damage was caused.

The identity of the intruder(s) is not known as yet however we are making further investigations in partnership with our hosts.

We wish to reassure that no data was stolen or modified and no client or personal data was breached.

However, if you were affected please email@past.wales with your experience, and we truly apologise for any inconvenience caused – and have since retightened security once more.

Positive response from Welsh Gov to the issues of dependency with prescribed medication

Welsh Government have accepted nine out of ten of the recommendations brought forward by Stevie Lewis’s petition.

It is important we distinguish between substance misuse, as the harmful use of substances such as drugs and alcohol; and dependence arising from the therapeutic use of medicines whether they are prescribed or purchased.

This paragraph is so important – to distinguish between misuse and inadvertent dependency.

We commend Welsh Gov for it’s deliberation and thoughtful response to this petition

Petitioner Stevie Lewis
Prescribed Medication Petitioner

We have accepted nine of the ten recommendations set out in the report and a Government response to each is annexed to this letter for the Committee’s consideration.

The Summary

Recommendation 1.
Greater recognition should be given to prescription drug dependence at a national level in both policy and strategy, including within the next Substance Misuse Action Plan and the Substance Misuse Treatment Framework. This should include a clearer distinction between substance misuse and prescription drug dependence, and identification of specific actions to help prevent dependence upon prescription medications and support people affected.
Response: Accept

Recommendation 2.
The Welsh Government should confirm and explain its position on whether SSRI and SNRI antidepressants should be formally recognised as potentially leading to problems of dependence and withdrawal.
Response: Accept

Recommendation 3.
The Welsh Government should restate and emphasise antidepressants should not be routinely prescribed for mild depression in guidance to healthcare professionals, and should provide assurances that sufficient alternative treatment options, such as psychological therapies, are available across Wales.
Response: Accept

Recommendation 4.
The Welsh Government should ensure that additional guidance is produced and promoted in relation to safe tapering of prescription medications, both for patients and health professionals.
Response: Accept

Recommendation 5.
The Welsh Government should provide an update on the actions carried out in response to Recommendation 8 of the Health and Social Care Committee’s inquiry into Alcohol and Substance Misuse published in August 2015.

(This was not a matter brought up in the initial petition and has a different pinciple. ed AJ)

Recommendation 6.
The Welsh Government should determine whether SSRI and SNRI antidepressants should be added to the list of drugs targeted for reduction, and should introduce a national prescribing indicator to support closer monitoring of prescribing volumes and patterns across Wales. This indictor should be used to identify areas where further investigation or intervention may be required.
Response: Reject

(comment – Saddened this wasn’t accepted as it would be a huge leap to monitor how much and for how long SSRI and SNRI’s are prescribed for and therefore have foresight into how many patients will struggle and be affected by their withdrawal. Gov could then plan a coherent strategy in knowledge of how many will require assistance going forward. ed AJ)

Recommendation 7.
The Welsh Government should investigate, as a priority, the potential for a national rollout of a service based upon the Prescribed Medication Support Service operating within Betsi Cadwaladr University Health Board, in order to ensure that specific advice and support is available for people who require assistance with prescription medication.
Response: Accept in principle

Recommendation 8.
The Welsh Government should create opportunities for a coordinated strategy and greater information-sharing between health boards in relation to prescribed drug dependence, with a view to improved sharing of best practice and to ensure equity of services and support to patients.
Response: Accept

Recommendation 9.
NHS Wales should make better use of the expertise of pharmacists to support evidence-based prescribing, patient monitoring including regular patient reviews, and increased provision of help with tapering and withdrawing from medication.
Response: Accept


Recommendation 10.
The Welsh Government should conduct and publish an assessment of the sufficiency of the advice available to people experiencing prescription drug dependence and withdrawal through the DAN24/7 helpline, including the adequacy of training for operators. The Welsh Government should ensure that the availability of advice related to prescribed drug dependence is promoted appropriately.
Response: Accept

For access to the full petition and its history
http://www.senedd.assembly.wales/mgIssueHistoryHome.aspx?IId=19952

https://past.wales/wp-content/uploads/2019/05/Government-Response-to-Committee-Report.pdf

Dependency v addiction!!!

Since our inception in March 2018 we have been highlighting the difference between “DEPENDENCE” and not “ADDICTION” to prescribed medication.

There is a difference

Patients did not make the choice to become dependent on prescribed medication – they followed the advice of their medical professionals to arrive at the point where they are dependent on medication – without being given an informed choice on how its impact would affect the brain and body, and how difficult and sometimes dangerous it is to discontinue taking these medications.

Addiction—or compulsive drug use despite harmful consequences—is characterized by an inability to stop using a drug; failure to meet work, social, or family obligations; and, sometimes (depending on the drug), tolerance and withdrawal. The latter reflect physical dependence in which the body adapts to the drug, requiring more of it to achieve a certain effect (tolerance) and eliciting drug-specific physical or mental symptoms if drug use is abruptly ceased (withdrawal).

Physical  dependence can happen with the chronic use of many drugs—including many prescription drugs, even if taken as instructed. Thus, physical dependence in and of itself does not constitute addiction, but it often accompanies addiction. This distinction can be difficult to discern, particularly with prescribed pain medications, for which the need for increasing dosages can represent tolerance or a worsening underlying problem, as opposed to the beginning of abuse or addiction.

(https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/there-difference-between-physical-dependence)


Informed consent is the process by which the treating health care provider discloses appropriate information to a competent patient so that the patient may make a voluntary choice to accept or refuse treatment.
It originates from the legal and ethical right the patient has to direct what happens to his or her body and from the ethical duty of the physician to involve the patient in his or her health care.

(https://www.benzoinfo.com/2016/08/27/what-is-informed-consent/)

Public Perception

The media adore using the sensationalist term “addiction” though to most of us who have lived experience of medication dependency it is an abhorrent term which gives the public the wrong impression of the damage caused by prescribed medicines.

Addicts make an initial informed choice to take a drug – dependent patients have merely followed medical treatment guidelines.

Addict or Dependent
Dependent – not Addicted

The perception of the public of the impact of medications is nebulous at best – to park the term “addict” on a vulnerable patient is a heinous issue, individuals struggling to live with conditions, to add the label of “addict” is extremely dangerous and could even be fatal.

A client was dubbed an “addict” by family and friends for medication dependence, it caused great trauma and reduced their self esteem to pieces. She felt alienated and indeed more suicidal.
After a lengthy discussion with the person with regard to the issue they did feel better as it was not their fault – she had only followed doctors orders and had become dependent, very different to an “addict” who begins a journey with an informed choice.

Anxiety and Medication

“It’s a vicious circle,” Dr. Miller says. “So the person starts taking the medication because they’re anxious. The medication, however, affects the brain by actually making you more anxious. So pretty soon, people feel like without this medication, ‘I’m anxious all the time.’ When in fact, what they’re experiencing is just withdrawal from the medication.”

Duh! And we as patients don’t know??

Sad. Patient experience is disregarded.

Full article

https://news4sanantonio.com/news/local/the-pills-doctors-are-calling-the-next-drug-crisis

Avoiding Withdrawal Syndrome for SSRIs Requires Months, Not Weeks, and a More Gradual Curve, Paper Concludes

New research questions conventional practices regarding rapid withdrawal from selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors, which are sometimes prescribed for migraine, peripheral neuropathy, and other neurologic disorders. Neurologists who prescribe these drugs said the study recommendations fit with their own clinical experience.

Tapering patients off selective serotonin reuptake inhibitors (SSRIs) should be done much more slowly and gradually than currently recommended, over a period of months rather than weeks, in order to avoid withdrawal syndrome, a team of researchers suggested in a paper published online March 5 in Lancet Psychiatry.

Although serotonin and norepinephrine reuptake inhibitors (SNRIs) were not the subject of the paper, studies show they show the same hyperbolic dose-response pattern, said the paper’s first author, Mark Abie Horowitz, PhD, a neurobiologist who is currently a clinical research fellow at University College London and a psychiatry trainee at Prince of Wales Hospital in Sydney, Australia.

“The clinical data also show that withdrawal symptoms from SNRIs last much longer than the one to two weeks ascribed to them by standard texts, much more in the region of months,” Dr. Horowitz told Neurology Today. “Tapering protocols suggested for SSRIs in the paper also apply to SNRIs; they should occur over at least months, down to doses close to one-fortieth of therapeutic doses and titrated to individual tolerability.”

The study authors proposed what they call a “pharmacologically informed method for tapering SSRI treatment.”

For instance, reducing doses of citalopram in steady 5 mg decrements resulted in serotonin transporter inhibition hyperbolically rising from 3 percent when the dose was cut from 20 mg to 15 mg, to 6 percent when the dose was cut from 15 mg to 10 mg, to 13 percent when the dose was cut to 5 mg, and to 58 percent when cut to zero.

“These large reductions in inhibition could account for the paucity of success of previous tapering regimens, and particularly for the difficulties with withdrawal symptoms that patients have towards the end of their taper, at low doses,” the study authors concluded.

Rather than taper by fixed amounts, the study authors recommended that clinicians taper the dose by following a hyperbolic slope. In the case of citalopram, for instance, the dose would be dropped from 20 mg, to 9.1 mg, to 5.4 mg, 3.4 mg, 2.3 mg, 1.5 mg, and then to 0.8 mg, 0.4 mg, and finally to zero.

Neurologists who treat migraine, diabetic neuropathy, and other disorders for which SSRIs and SNRIs are sometimes prescribed said the recommendations fit with their own clinical experience.

“I have seen the withdrawal effect; it can go on for months,” said Richard B. Lipton, MD, FAAN, the Edwin S. Lowe Professor and vice chair of neurology at Albert Einstein College of Medicine, where he is also director of the Montefiore Headache Center. “I definitely agree with the authors of this paper on the need for more gradual tapering in some patients. I’ve certainly had certain patients buy pill cutters to cut an already low dose of an SSRI into quarters and take them daily, then take them every other day, to try to make the taper more comfortable.”

Dr. Lipton said he also agreed with the authors of the paper that current guidelines on tapering SSRIs should be reconsidered, and that randomized, controlled trials would be useful to more rigorously test the effects of a slower, more gradual tapering protocol.

Full article –

https://journals.lww.com/neurotodayonline/pages/articleviewer.aspx?year=2019&issue=04180&article=00004&type=Fulltext

#NHRW2019 Harm Reduction Wales

On Thursday 21st of March more than 300 delegates attended the National Harm Reduction Wales conference at the Mercure Hotel.

Organised by Josie Smith and her team from Public Health Wales seminars covered:

  • Physical Health and Wellbeing
  • Integrated Care and Service Planning
  • Emerging Threats and Opportunities
  • Psychological Health and Wellbeing


Katie Stone (Public Health and Social Policy lead – Harm reduction International) opened the conference with a talk on “Global and European perspectives on harm reduction.”

Next to speak was Dr Owen Bowden-Jones (Consultant Psychiatrist and Chair of the Advisory Council on the Misuse of Drugs) on the topic of of “Challenges for the UK and a focus on Wales”

Conference then broke to the respective seminars to explore the subjects in more detail.

Physical Health and Wellbeing
Preventing adverse consequences of substance misuse – Jan Keauffling (Healthcare for homeless people)
Sexual Health and Harm Reduction – Suzanne Williams
(Obstetrics, Gyneacology & Sexual Health) & Jane Fourweather (Sexual & Reproductive Health)
Achieving elimination of blood born viruses and tuberculosis – Dr Al Story (TB Find & Treat Service)


Integrated Care and Service Planning
Children and Young People Services – Meinir Williams-Jones (Barnardo’s Cymru)
Offender Health and Continuity of Care – Louise Forman (HMP & Probation Service Wales)
Models of Opioid Substitution Therapy Provision and Same Day Prescribing – Dr Mike Kelleher (Lambeth Addictions Consortium)

Emerging Threats and Opportunities
Online Prescribing Services – Aled Jones (www.PAST.Wales)
Benzodiazepines – Dean Acreman (Health Protection, PHW)
Changing Drug Markets & County Lines – DI Justin O’Keefe (TARIAN Reional Organised Crime Unit)

Aled Jones from PAST.Wales
Aled Jones from PAST.Wales
Dean Acreman PHW
Dean Acreman PHW/Wedinos

Psychological and Wellbeing
Alcohol and Longer Term Health Harms – Brian Robertson (Drink Wise Age Well)
Addiction and Dependence – Prof. Robert Rogers (School of Psychology, Bangor University)
Complexities in Mental Health and Substance Misuse – Dr Julia Lewis (Gwent Specialist Substance Misuse Service)

Dr Julia Lewis
Dr Julia Lewis

Conference then returned to the hall to hear from Tracey Breheny (Deputy Director Substance Misuse Government and Corporate Business, Welsh Government) on the direction the Welsh Government is driving Harm Reduction in Wales.

Q&A closed the conference with questions from the floor to the panel of speakers from the day.

panel during Q&A
Q & A session to close the conference
#NHRW
National Harm Reduction Wales

photographs coutesy of @jaystarphotography – many thanks

UK’s top paramedic Malcolm Woollard died of prescription drug overdose

Britain’s top paramedic, 57, was found dead in bed by neighbour after taking accidental overdose of morphine prescribed for his chronic back pain

Britain’s top paramedic died after overdosing on the 19 drugs he took for back pain each day, an inquest heard.

Professor Malcolm Woollard, 57, was found lying naked in his bed in Llangattock, near Abergavenny, South Wales in July last year.

He was discovered after a neighbour became concerned with mail piling up outside his house – but could have been dead for a week before he was found.

Pontypridd Coroner’s Court heard he had chronic back pain and was regularly admitted to hospital for taking too much morphine.

He was the first paramedic in the UK to be awarded the title of Professor and was Chairman of the British Paramedics Association

More….

https://www.dailymail.co.uk/news/article-6573327/Chairman-Paramedics-Association-Malcolm-Woollard-overdosed-prescription-drugs-inquest-hears.html