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Don Lavoie is alcohol programme manager at Public Health England and Gul Root is lead pharmacist, Health and Wellbeing Directorate, Public Health England
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medicinesJune 8 2016

Resources to support health professionals to review inappropriate prescribing for people who have a learning disability and/or autism have been issued. In addition, representatives of national health profession bodies have pledged “sustained action to tackle the over-prescribing of psychotropic drugs to people whose behaviour is challenging.”

NHS England is leading the initiative with the support of the Challenging Behaviour Foundation (CBF). The campaign urges doctors to “help stop ‘chemical restraint’” of patients. It estimates 35,000 adults with a learning disability are being prescribed an antipsychotic, an antidepressant , or both, without clinical justification.

“Multiple psychotropic drug use often starts at a specialist level, which is then passed onto primary care for long-term management. Research published last year found that, in too many cases, these prescriptions are repeated without adequate review,” said NHS England.

Professor Sir Bruce Keogh, NHS England’s National Medical Director, said: “Reducing use of powerful drugs whenever we can is a good thing. We have managed this successfully in dementia; it’s now time to bring similar benefits to patients who have a learning disability.”

Those lending support to the campaign have signed the Stopping Over-Medication of People with a Learning Disability (STOMPLD) pledge. Signatories include Sandra Gidley, Chair of the English Board of the Royal Pharmaceutical Society, as well as representatives from the Royal College of General Practitioners, the Royal College of Psychiatrists, the British Psychological Society, and the Royal College of Nursing.

Ms Gidley commented: “For far too long people with learning disabilities have received poor health care. This group of patients are frequently prescribed antidepressants, sedatives and mood stabilisers in order to manage episodes of ill-health or challenging behaviour, which are not subsequently reviewed. These medicines can cause serious side-effects, poor health and even premature death.

“This pledge should act as a trigger to all health professionals to ensure that over-medication becomes a thing of the past. People with learning disabilities deserve better. A person-centred review should take place regularly and ideally every time a medicine is changed.”

The STOMPLD resource booklet sets out the background including current levels of prescribing and reasons for why it is important to stop prescribing inappropriate psychotropic drugs. It includes an algorithm for the review, reduction or stopping of psychotropic drugs in people with a learning disability, and also advice on how to raise awareness and help start changing prescribing behaviour at practices.

Other information includes advice on dose reduction, drug discontinuation, and potential clinical problems, as well as case histories and practice examples.

The STOMPLD Pledge reads:

Over-medication, and then lack of review, is a historic problem, but one that nobody knew the true scale of until recently.
It is estimated that on an average day in England, between 30,000 and 35,000 people with a learning disability are being prescribed powerful drugs, with serious potential side effects, without clinical justification and for too long. This is often despite evidence-based alternative interventions being available.
This inequality in care is unacceptable, and it is incumbent on clinicians and every other professional involved in an individual’s care to ensure they are acting in their patient’s best interest at all times.
We, the undersigned, representing professionals from across the NHS, therefore pledge to work together, and with people with a learning disability and their loved ones, to take real and measurable steps to stop over-medication.
We will each set out the actions our individual organisations will take towards this shared aim, and report regularly on the progress we have made – ensuring that we can be held to account.

Links:

NHS England announcement

NHS England STOMPLD resource

RPS comment

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