No REST for the vulnerable

The threatened closure of London’s only specialist support service for those battling tranquiliser dependency underlines the parlous state of UK healthcare for this patient group. By Harry Shapiro

Based in north London, REST (Recovery Experience Sleeping Tablets and Tranquilisers) has been providing a unique support, counselling, advice and advocacy service since 1988.  In recent years, REST has sailed through all external evaluations and performance reviews, won tender battles, gained over 90% satisfaction ratings from clients and is flagged as a model of good practice by the Department of Health. So it wasn’t quality of service but cash which prompted the Commissioning Manager for Camden’s Substance Misuse Services to inform REST that the service contract would be terminated at the end of March 2019 with the service subsumed into Camden and Islington’s existing drug and alcohol facilities. It costs less than £50,000 a year, shared between two boroughs, to run a service that clients say has literally saved their lives.

Here are just a few comments from grateful clients which could have been chosen from many examples of how valued and effective REST is:

“I feel extremely lucky to be part of this service. From day one I felt at ease as I thought I was going crazy. I felt so alone and alienated with horrific symptoms. This group has not only taught me about withdrawal symptoms but more importantly how to manage them. There really is nothing better than sharing, listening and discussing in a safe environment with people that actually get you.”

“REST provided me with excellent support through a tough period of my life, without the group I don’t know whom I could have turned to.  For my age I felt alone with my addiction and listening to the other members of the group really helped to put things in perspective.”

‘Thank you for your on-going kind support at the Thursday meeting I was desperate for a safe place to go to talk about how I was feeling regarding how lonely isolated and feeling like I was going insane and losing the plot, a really horrible place to be, but was helped immensely coming to the meeting and have started to push myself a bit more forward to go out and meet up with friends etc  and not isolate myself  as much,  as I don’t want to go back to that dark place again’

What’s happening to REST speaks to a much wider public health crisis. Statistics for England compiled by the All Parliamentary Group on Prescribed Drug Dependence are both stark and revealing:

  • Over 1 million patients are taking dependency-forming medications unnecessarily in England, including benzodiazepines, z-drugs, antidepressants and opioids.
  • 15.9 million prescriptions for benzodiazepines & z-drugs were issued in the community in England in 2016
    • Research published 2017 in the British Journal of General Practice suggests over 250,000 patients are taking benzodiazepines for at least one year (far beyond NICE guidance of two to four weeks)
    • Of these, around half are estimated to be willing to accept prescribed drug withdrawal services
  • 64.7 million prescriptions for antidepressants were issued in the community in England in 2016, an increase of over 200% since 2006
    • Research published in the BMJ has shown that the rise in antidepressant prescribing is mainly explained by increases in the proportion of patients receiving long-term treatment
    • 63% of patients experience withdrawal symptoms when stopping antidepressants
  • Researchers at the University of Roehampton estimate that 770,000 long-term antidepressant users in England are taking them unnecessarily
  • 23.9 million prescriptions for opioid analgesics were issued in the community in England in 2016, an increase of 200% since 2006
  • Using an estimate of 250,000 unnecessary long-term benzodiazepine & z-drug users in England, we calculate that their unnecessary use is costing the NHS in England:
    • £15.2m per annum
  • Using an estimate of 770,000 unnecessary long-term antidepressant users in England, we calculate that their unnecessary use is costing the NHS in England:
    • £44m per annum
  • In addition, we calculate that unnecessary GP consultations for unnecessary antidepressant and benzodiazepine / z-drug prescriptions may be costing the NHS in England:
    • £81m per annum
    • Assumes 4 per year per patient @ £20 per consultation
  • Total unnecessary costs of prescribing and consultations estimated to be £140.2m per annum
  • These figures do not include other costs to the economy e.g. disability claims and lost tax revenues, nor the costs of opioid prescribing and appointments.

The APPG, with the support of the BMA, the Royal Colleges, other public health bodies and major drug treatment agencies, has been campaigning for a national helpline and dedicated services. Not only is REST the only dedicated service for London, but astonishingly given the numbers, only one of possibly six facilities serving the whole country.

So what is likely to happen to REST’s clients if the service cannot be saved? Back in 2009, the government dismissed a report from the then-All Party Parliamentary Group on Drugs which similarly called for more dedicated help. The government claimed a lack of demand for dedicated services by quoting the small numbers coming forward to mainstream drug treatment services. But the whole point is that the majority of people with prescribed drug problems do not want to come forward for services primarily catering for an entirely different cohort of heroin and crack users. One of REST’s clients says she was turned away from the local service because she wasn’t using illicit drugs. It could be argued that the local service could be tooled up to have in post staff with the relevant experience. Except that won’t happen. If Camden and Islington are not willing to spend less than £50,000 to keep REST going, they are hardly likely to give the local service the necessary funding to run appropriate replacement activity.

As alarming as the overall figures are, they don’t tell the real tragedy of individual stories. It takes time for dedicated, experienced workers to build up trust and confidence in very isolated, frightened and vulnerable people, some of whom are too scared even to leave their own home. They deserve better than this, as do the tens of thousands of others across the country for whom there is precious little help at all.