New NICE guidance to tackle prescribed drug dependence fails to listen to patient evidence

The National Institute for Health and Care Excellence (NICE) has today published new guidelines which are intended to support the safe prescribing and withdrawal of medicines that can cause dependence, including antidepressants, opioids, gabapentinoids and benzodiazepines.

There are several positive changes in this new guidance, including the need for doctors to offer alternatives to these drugs, as well as the requirement for a written management plan at the start of a prescription.

However, the guidelines fail to provide simple instructions for slow tapering, which is the most important intervention for safe withdrawal.  Currently many patients report being taken off their drugs too quickly, which can lead to devastating and long-lasting withdrawal symptoms.

This method of slow, ‘hyperbolic’ tapering (often over many months or longer) has been developed over many years based on the experience of thousands of patients, and is supported by several articles in medical journals.  And yet the new guidelines provide no information on how slowly to taper, how frequently to reduce and by how much. Without these details, doctors are unlikely to change their current practice.

NICE claims on its website that it takes ‘a comprehensive approach to assessing the best evidence that is available.’  However for these guidelines it has not done so.  The APPG for Prescribed Drug Dependence wrote to the NICE committee as part of the guidelines consultation process to point out this failure to include this patient-developed evidence and to provide relevant links to published research.  

In response, the committee claimed that only ‘randomised controlled trials were prioritised’ and that our proposed evidence was not of ‘sufficient quality’ and as result ‘none of the suggested recommendations are relevant for inclusion’.

Yet NICE states on its website that acceptable evidence ‘can include qualitative and quantitative evidence, from the literature or submitted by stakeholders. It can also include observational data and testimonies from experts.’   

Danny Kruger, chair of the APPG for Prescribed Drug Dependence, said: ’It is very disappointing that these new guidelines fail to include the simple instructions for slow tapering which are desperately needed by doctors to support safe withdrawal from these drugs.  This is because important evidence developed with patient groups has been ignored, as it doesn’t meet NICE quality standards.  We will be urging NICE to reconsider both this evidence and their process to ensure that patient experience is properly represented in future.’


Date: April 2022

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