£500m wasted each year in England on dependency-forming medicines

CEP and the All-Party Parliamentary Group for Prescribed Drug Dependence is releasing new research which estimates that around half a billion pounds of taxpayers’ money is wasted each year in England on medicines that can cause dependency, including antidepressants, painkillers and sleeping pills.

This research follows the publication in 2019 of Public Health England’s Prescribed Medicines Review, which established that over a quarter of the adult population in England (26.3%) had been prescribed a dependency-forming medicine in the previous year.

In this new research, titled ‘The estimated costs incurred by the NHS in England due to the unnecessary prescribing of dependency-forming medications’, and published in the journal Addictive Behaviors, the authors define unnecessary prescribing as prescribing that either contravenes current NICE guidelines, or where no evidence exists for efficacy or continued clinical need, despite long-term use.   

The research team from the University of Roehampton, the University of Greenwich and University College London (UCL) included academics, psychologists, a psychiatrist and an economist, as well as clinicians and persons with lived experience.  The researchers reviewed data relating to the same drugs that were covered by the PHE 2019 review: antidepressants, opioids, gabapentinoids, benzodiazepines and Z-drugs.

The new research estimates that, over the period April 2015 to March 2018, up to 21.3% of the costs of prescriptions of antidepressants, up to 72% of benzodiazepines, up to 76% of z-drugs and up to 53% of opioids were unnecessary.  In addition, up to 54.4% of the costs of gabapentinoid prescriptions for pain and up to 12.6% of gabapentinoid prescriptions for psychiatric conditions were unnecessary.

This led to estimates of unnecessary annual prescription costs of up to £43.2m for benzodiazepines, up to £28.5m for Z-drugs, up to £288m for opioids, up to £158.5m for gabapentinoids and up to £65.1m for antidepressants. The estimated annual unnecessary costs of prescribing for all five classes of medicines ranged between £493m to £564m, when unnecessary consultation and dispensing costs were included.

In addition to identifying substantial unnecessary prescription waste (including costs incurred through unnecessary consultations and pharmacy dispensing), the research notes that the harms caused by dependency-forming drugs may also lead to other significant costs that the study did not estimate, including higher disability costs, lost tax revenues as well as rising workplace absenteeism and low-productivity costs.  

Danny Kruger MP, chair of All Party Parliamentary Group for Prescribed Drug Dependence commented: ‘This research reveals that £500m of public money is being wasted on unnecessary prescriptions that in many cases also cause harm, with lives sometimes devastated by the impact of dependency and withdrawal.  The economic argument is now clear – a fraction of these wasted costs should now be invested in a helpline and dedicated withdrawal support services, as recommended by Public Health England back in 2019.  This investment will benefit both public health and the public purse.’

Dr James Davies, co-lead author of the new research, commented: ‘The scale of the prescribing problem in England has been clear since the 2019 Public Health England report, which showed that one quarter of all adults are prescribed a dependency-forming drug each year with wide scale long-term use.  However, for the first time we now conclude around £500m each year in England alone is being wasted on these drugs.  Yet – unlike illicit drug and alcohol services – there is currently almost no government-funded support to help patients to withdraw from these drugs safely, which is needed in order to reduce patient harms and prescription waste.’

Dr Ruth Cooper, co-lead author of the new research, commented: ‘Uncovering such high estimates of potential waste during a period of intense financial pressure on the NHS is concerning. Our mental health services are at breaking point. Psychoactive medications such as antidepressants and benzodiazepines are too often used as the default and only treatment, with poor investment in non-drug alternatives for mental health problems. To help reduce waste, we must engage in careful deprescribing programmes, freeing up resources for more investment in psycho-social alternatives of proven efficacy.’

Professor Joanna Moncrieff, one of the article’s authors, commented: ‘We need to address the massive levels of unnecessary prescribing that have led to this shocking waste of NHS resources. The evidence suggests that most people derive no benefit from taking these drugs on a long-term basis, and may suffer From protracted and severe withdrawal reactions. We need a cultural shift in our approach to helping people deal with pain, anxiety and depression, so that it is no longer centred on the use of medication.’