The Guardian

Inappropriate prescribing 'cutting lives short'

Sarah Boseley, health editor

Friday June 20, 2008

The use of so-called "chemical cosh" antipsychotic drugs to subdue
people with dementia will be curbed as part of a government strategy
to help the growing numbers of people with the condition.

In an interview with the Guardian the social care minister, Ivan
Lewis, made it clear he was unhappy with the number of dementia
patients, usually in care homes, who are being heavily sedated, with
risks to their health. "I'm really perturbed by this question of the
inappropriate prescribing of drugs," he said. "We sometimes dehumanise
stories like this - it is my or your mum and dad who is being
over-medicated."

Lewis, who has pledged "to drag dementia out of the dark ages",
announced an immediate review of the use of the drugs, which according
to the Alzheimer's Society are being inappropriately given to an
estimated 100,000 people. It will look at the use of drugs generally
to change the behaviour of people who may be agitated because of their
condition, and at why GPs were prescribing two drugs in particular -
the atypical antipsychotics risperidone and olanzapine - to so many
dementia patients in the face of official guidance that they should
not be used.

As long as ago as 2004 the Medicines and Healthcare Products
Regulatory Authority (MHRA) restricted the prescribing of these drugs
because of evidence that dementia patients taking them were three
times as likely to suffer a stroke. The dangers, said the MHRA,
"outweigh the likely benefits in the treatment of behavioural symptoms
of dementia".

Liberal Democrat MP Paul Burstow, who campaigns on this issue, said
immediate action was necessary and pointed out that the authorities in
the United States had put a "black box" warning on the drugs. "The
evidence is already compelling: these drugs don't treat dementia, they
cut lives short," he said. Lewis said the review was needed because
there were circumstances in which the prescription of the drugs for
dementia patients might be necessary.

Professor Sube Banerjee, consultant in old-age psychiatry at the
Maudsley hospital in London, who is advising the department on the
dementia strategy, said it was not easy to tell who was
overprescribing, but "the reality is that the scale of the
prescription makes it clear that these aren't just the exceptions we
are seeing". There are alternatives to drugs for managing patients'
agitation, he said. Early diagnosis and training doctors, nurses and
care staff to help and manage patients was key.

Neil Hunt, chief executive of the Alzheimer's Society, said the drugs
worsened the problems dementia patients were suffering, reducing their
mobility and their grip on reality.

The review will report in September, to coincide with the official
launch of the national dementia strategy which, in its consultation
form published yesterday, has three aims: to increase awareness of
dementia and remove the stigma of it, to ensure early diagnosis and
intervention, and to improve the quality of care people receive.

Link:
http://www.guardian.co.uk/society/2008/jun/20/longtermcare.socialcare?commentpage...