A report by the Mental Health Commission shows that more than half (57 per cent) of patients in acute or long-stay units were prescribed sedatives or benzodiazepines last year.

Clinical safety guidelines state that these drugs, which are typically used as medication for anxiety and as night sedation, should only be used after alternative therapies have been explored.

The commission’s report shows the rate of prescribing within individual psychiatric units ranged in some cases as high as 97 per cent.

It found that while the use of benzodiazepines has decreased slightly compared to figures collected in 2008, it continued to be high in many units.

“The lack of therapeutic services and programmes, as well as poor knowledge about the problems of benzodiazepine prescribing, may account for this,” the report found.

Inspection reports show that significant numbers of long-stay patients have been administered the drug for years even though guidelines state they should be used for the “shortest possible length of time and in the smallest possible dose”.

While small numbers of people may require benzodiazepines in the longer term, such as those who are severely dependent on them, the report says methods are available for withdrawing these kinds of patients from the drug.

It also found that the practice of combining more than one benzodiazepine was quite common (26 per cent of all residents) despite the lack of evidence of its therapeutic value.

Inspectors did, however, point out this practice has fallen significantly in recent years.

Former inspector of mental hospitals Dr Dermot Walsh yesterday said he had long-standing concerns regarding the overuse of these drugs.

“These are drugs of dependence and it’s clear they should only be used in short-term and acute situations, and usually for a very short period of time.

“It still amazes me when I see that patients are placed on these drugs almost on a routine basis when they come into hospital.”

He said the issue of benzodiazepines in medicine generally, especially primary care, was a problem.

The report also examines the use of anti-psychotic drugs which are used to treat symptoms of psychosis as well as schizophrenia and other mental health problems.

Inspectors found that 80 per cent of patients were receiving this form of medication.

Clinical guidelines advise against prescribing more than one anti-psychotic medication with limited exceptions. In its review inspectors found that 28 per cent of residents were receiving two or more anti-psychotic medications.

On a positive note, inspectors found that the practice of combining anti-psychotic medication is on the decrease and is below levels seen in international practice.

The use of doses of these medicines above the recommended dosage is also low (10 per cent) compared with international studies (in the UK it is about 20 per cent).

The report says there was evidence from a small number of centres that benzodiazepine prescribing had reduced and the quality of prescribing had increased following audits.

It says the vast majority of prescriptions authorising drugs to be administered to patients whenever it was required did not have a time limit or review date.

In its recommendations the report says each centre should conduct regular audits of medication prescribing and calls for training and education in safe prescribing.

URL: http://www.irishtimes.com/newspaper/ireland/2011/0504/1224296002783.html

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