The Script Report
Happy pills, tranqs, benzos, cotton, mother's little helper, fizzies. For every pill in the growing variety of modern psychotropic medication, a pet name. Some, a product of abuse; others, fondness.
But with international studies questioning the growing use of prescription drugs such as antidepressants, US journalist Jon McClure, who specialises in analysing large volumes of data, examined 36 million prescription records from across the UK including 3.5 million scripts written by GPs in Northern Ireland.
The results of The Detail's Script Report suggest:
- Northern Ireland has prescribed proportionately more antidepressants than the 23 countries that were examined in a major international study that identified significant increases in use across much of the western world.
- The link between deprivation and antidepressant prescription rates is stronger in Northern Ireland than in England or Wales –but not as strong as might have been expected. NI consumed more than two-and-a-half times the antidepressants per head than in similarly wealthy economic areas in England.
- Antidepressant use is higher among women than men in NI, with antidepressant, opiate and sedative use higher among 35-64 years old. And while this is often attributed to the fallout from decades of violence in Northern Ireland, doctors now report growing usage in age groups too young to have directly experienced the Troubles.
- In addition to the findings on antidepressant prescription rates, the Script Report studied rates for over 50 drugs categorised as antidepressants, sedatives, painkillers, or anti-anxiety medicines. In more than 40 of the drugs, Northern Ireland prescription rates exceed those of England.
The advent of these drugs reviewed in the Script Report - antidepressants, anti-anxiety drugs, opioid painkillers and benzodiazepine sedatives – are said to represent a major medical advancement and greatly increased doctors' ability to help patients suffering from a range of conditions, but fears of over-prescription persist and recent international studies point to striking upward trends.
A senior medic interviewed for the Script Report cited greater pressure than ever on Northern Ireland GPs to prescribe such drugs to patients who believe they require medication, while in extreme cases doctors face intimidation from those aggressively demanding drugs.
Existing data also points to the misuse of prescription drugs by criminals, while drug deaths have also been repeatedly linked to mis-used medication.
An examination of the prescription history of every GP practice in Northern Ireland – data which has never been released before – cross-references GP prescriptions with the levels of deprivation in the area where they are based, plus the prevalence of depression in that area.
Doctors have told us that many factors can influence levels of prescribing of the types of drugs examined in the Script Report: the scale of need in the community they serve, better diagnosis, longer periods of treatment to ensure better patient outcomes, as well as patient pressure and new health policies that inadvertently fuel `self-diagnosis’ by patients.
But nevertheless, the Script Report raises fresh questions over the scale of prescription drug use in Northern Ireland as a whole. Our interactive charts and graphics illustrate links between prescription rates and deprivation. They also compare prescription rates for drugs in England and Wales with Northern Ireland.
In the six months of prescribing data that The Detail analysed, from April 2013 to September 2013, GPs in Northern Ireland prescribed enough antidepressant drugs to give every man, woman, and child here a 27-day supply at the Defined Daily Dosage limits. English GPs prescribed enough for 10 daily doses per registered patient. The figure in Wales was 19.
Statistics also indicate that England ranks highest in the rate of depression diagnosis and yet prescribes fewer antidepressants per patient than Northern Ireland and Wales.
The Script Report is an analysis of prescribing rates in Northern Ireland using recently released GP prescribing data.
The data comprises all prescriptions written by Northern Ireland GPs and filled between April and September 2013. The records are publicly available online via the Health and Social Care Business Services Organisation, but the data is so large, The Detail needed special database administration software to view it. The sheer size of the data generally puts it beyond reach for the average health care consumer.
The Detail focused on prescription rates for drugs which fell in to one of four categories according to their major indication in adults: antidepressants, anti-anxiety drugs, opioid painkillers and benzodiazepine sedatives.
Our analysis compares average prescription rates in Northern Ireland with those of GPs in England and Wales. (Only Scotland does not release comparable data in the UK.) The Detail also considered the level of economic hardship in a GP’s immediate community in making comparisons.
The goal of the project is to make the data transparent and useful to health care consumers, as well as to survey an important issue receiving significant public attention in recent years: the high or increasing prescription of psychotropic medicines.
Responding to the Script Report findings a spokesperson for the Department of Health for Northern Ireland said: “The Health and Social Care Board (HSCB) are currently establishing Primary Care Talking Therapies Hubs in each Trust area.
"When these Hubs are fully developed over the next 3 years the Hubs will improve access to low intensity psychological care, promote a culture of early intervention and reduce reliance on pharmacological interventions.”
The board said factors including public information campaigns had added to greater awareness of mental health issues.
It said it had made an initial investment of £1.7million to support the establishment of the Hubs and to extend the range and scope of psychological therapies across mental health services.
A spokesperson for the Board said: "The HSCB recognises that much more needs to be done in order to provide alternatives to drug therapy for people who present with common mental health needs."
Read the HSCB's complete response here, but first: