Dr. Mark Murphy:

I might start and then let my colleagues continue. Each of those drug classes is a separate issue which needs to be looked at separately. We have to stand over safe, high-quality prescribing. Are there cases when certain drugs should not have been prescribed? There is no doubt. There are human errors, complex phenomena and there may be certain doctors who might overprescribe a certain drug. That might be the case. It is true in every health care system. As training bodies and health care professionals, we all want to do our best and need a robust postgraduate education infrastructure which facilitates colleagues to have the very best evidence base and understanding of cost-effectiveness. We also need to provide them with time so that they can share those decisions with patients.

Some of the drug classes are more problematic than others. The case has been made for anti-depressants, which it is very appropriate to prescribe in very challenging psychological and social circumstances for patients without psychological services. Benzodiazepines are sedative medications. While raw prescribing shows that is going up, the extent to which people are prescribed a benzodiazepine for over eight weeks, which is known as chronic benzodiazepine prescribing, has decreased in the past 15 years. I have not started a patient on a benzodiazepine for more than eight weeks in five years. While I prescribe benzodiazepines once every few weeks, it is a short course and it relates to a variety of phenomena, for example, severe, acute bereavement. I give one tablet for back spasm where there is extreme pain. That is not wrong or inappropriate. Prescribing for more than eight weeks, however, is largely a legacy issue. Some patients are addicted and have been on the drug for more than 15 years. The ICGP works with colleagues in the RCPI and the HSE on guidelines to manage benzodiazepines and opiates. We will continue to work with these guidelines. It is a challenge to tell an 82 year old who has been on a benzodiazepine to try to come off it. It is a challenging issue. While we can probably do better, we have to be mindful of the personal and unique circumstances of patients. We will continue to promote the highest quality and standards going forward.