Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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836. To ask the Minister for Health the data collected on trends in the prescribing of psychoactive psychotropic drugs here, especially to children, over the past 20 years; if the collected data indicates an overall rise in problems associated with prescribed medications, especially with opioids, stimulants, antidepressants and antipsychotic drugs in terms of tolerance, withdrawal and dependency; the measures being taken to address any rise in prescription rates and associated problems regarding prescription medications; and if he will make a statement on the matter. [19402/17]

Catherine Byrne (Dublin South Central, Fine Gael)
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Medication therapy is one of a number of tools available to health professionals for the treatment of children with mental health difficulties. It is however essential that the medicines in question are safe and that appropriate prescribing guidelines are followed by the health professional treating the child.

Before a medicine is made available to the public, it undergoes an authorisation process whereby the medicine’s safety, quality and efficacy is assessed, based on the results of clinical trials. All medicines have side effects so it is only when the risk benefit analysis is positive, i.e. that the potential benefits to the patient outweigh the potential risks that the medicine receives an authorisation.

Once available a medicine is then subject to ongoing monitoring and evaluation through a process of pharmacocovigilance which operates at EU wide level to monitor the use of medicines in large numbers of patients and manage and analyse information on suspected adverse reactions to medicines.

European reviews of certain antipsychotics, antidepressants, stimulants and opioids have resulted in updates to product information in order to support better informed prescribing and use of these medicines in various patient groups including children. Important safety updates are communicated by the Health Products Regulatory Authority (HPRA) to health professionals via their Drug Safety Newsletter. The HPRA, in conjunction with its European counterparts continues to review the safety of authorised medicines and take appropriate regulatory action when necessary.

In Ireland there are a number of sources of prescribing guidelines. More recent guidelines include a Consensus Statement issued by the College of Psychiatry on the use of benzodiazepines in specialist mental health services (2012), Guidance issued by the Irish College of General Practitioners on Child and Adolescent Mental Health: Diagnosis and Management (2013), and the Medical Council Guide to Professional Conduct and Ethics for Registered Medical Practitioners 2016. Section 42 of the Medical Council Guide states for example that doctors should keep up to date with developments in medication safety and seek independent, evidence-based sources of information on the benefits and risk of the medicine. It also states that doctors should be aware of the dangers of drug dependency when prescribing benzodiazepines, opiates and other drugs with addictive potential and should take reasonable steps to make sure they are not inappropriately obtaining drugs from multiple sources.

The Health Service Executive (HSE) has also been actively involved in ensuring appropriate prescribing of psychotropic drugs. Reports are sent to GPs on a regular basis setting out the number of benzodiazepine and ‘z’ drug prescriptions dispensed to their patients and these reports allow GPs to compare their prescribing patterns to that of their peers. The reports also highlight where patients are on these medications for longer than the recommended period.

In terms of research data, the Drug Use in Ireland and Northern Ireland Drugs Prevalence Survey 2014/2015, commissioned by the National Advisory Committee on Drugs and Alcohol (NACDA) in Ireland and the Department of Health in Northern Ireland contains data on prevalence rates for sedatives/tranquillisers and anti-depressants. For young adults aged 15 to 34 and over lifetime prevalence (ever used) for sedatives/tranquillisers was 8.9% (down from 10.1%, the prevalence rate reported in the last survey in 2010/2011). The lifetime prevalence of anti-depressant use for the same age group was 8.3% (an increase from 6.8%, the prevalence rate reported in 2010/2011).

The Prevalence Study do not provide information on the number of children prescribed sedatives/tranquillisers and anti-depressants. The Health Service Executive (HSE) has some limited data on prescribing tends for children on the General Medical Services (GMS) scheme pharmacy claims database. A 2015 research study on benzodiazepine prescribing in children carried out an analysis of GMS data over a 9 year period (2002 -2011). The study found that prescription rates decreased slightly during the 9 year period and that prescription rates follow a similar pattern to those in other European countries. However the data is limited insofar as it only relates to medicines reimbursed under the GMS schemes and does not include prescriptions paid for by patients privately.