DSH Tranquilisers, 8th December 2011

Dail discussion on minor tranquilisers in intentional overdoses.

Deputy Dan Neville

I welcome the opportunity to raise the issue of the use of minor tranquilisers in intentional overdoses and attempted suicide.

In 2010, the national deliberate self-harm registry recorded 3,568 intentional overdoses involving minor tranquilisers, benzodiazepines. These account for 30% of all self-harm presentations at accident and emergency departments in 2010. Access to these medications is through prescription, illegal purchases through the Internet and purchases on the streets. Given the rate of use in overdoses, it is clear there is an oversupply of such medications at present. In September 2010, a European initiative between regulatory authorities and Interpol seized large quantities of Internet purchased medications, including minor tranquilisers.

Anecdotal evidence would suggest that these medications are regularly prescribed to people suffering from common medical health complaints, such as anxiety or mild depression. Such prescriptions are often repeated without the patient being advised to seek alternative therapies for their symptoms. While there is no doubt that such medications have a place in treating certain mental health as well as other medical conditions, it is important that greater controls be put in place to prevent people accessing sufficient amounts to use in an intentional overdose. Raising awareness with the Pharmaceutical Society of Ireland, the Irish College of General Practitioners and the College of Psychiatry would seem the most logical way to reduce prescriptions of these medications. I suggest the Department of Health and the HSE should seriously consider making an approach in this regard to these organisations.

The objective of Reach Out, the national strategy for action on suicide prevention published in 2005, states it is necessary to “limit access to the means and methods of self-harm and suicide”. It is internationally recognised and repeatedly proven that restricting the means of suicide is a key approach in suicide prevention. There are many examples to support this throughout the world, including the restriction of firearms. Even in the United Kingdom, following the introduction of catalytic converters, there was a considerable drop in the levels of suicide.

The HSE is currently running a campaign to reduce the overuse and over prescription of antibiotics. It should now look at a similar campaign to reduce the overuse of minor tranquilisers. Overdosing is a common method of self-harm, involving 71% of all self-harm acts registered last year and more so among women, 77%, than men, 65%. Of all intentional drug overdoses, 42% involved a minor tranquiliser, representing 3,568 overdoses, as I already mentioned. A high proportion of overdoses involving minor tranquilisers have been observed since 2004, without any significant change and with an over-representation of men. Almost half of all female overdoses, 48%, and 36% of all male overdoses involved an analgesic drug.

Deputy Fergus O’Dowd

I thank Deputy Neville for raising this issue, which I am taking on behalf of the Minister for Health, Deputy James Reilly. I would like to acknowledge, as does everybody in the House and throughout the country, the tremendous work Deputy Neville has done and continues to do in bringing issues relating to suicide to the attention of people.

The problem of suicide is a grave problem facing all of us. Deaths by suicide are particularly tragic. Unlike death from accident or illness, death by suicide brings with it a kind of guilt and emotional devastation for the people who knew the victim. Minor tranquilisers, including the benzodiazepines, are medicines often used to treat conditions such as anxiety and insomnia. These and other tranquilisers are prescription-controlled medicines in Ireland. Therefore, they may only be supplied on foot of a prescription issued by a medical practitioner. Mail order supply, including over the Internet, of prescription medicines, such as minor tranquillisers and benzodiazepines, is prohibited in Ireland. The supply of prescription medicines by mail order, including over the Internet, can be associated with significant health risks for patients and the public and consequently, the Irish Medicines Board works closely with the Revenue Commissioners’ Customs Service to protect the public from the illegal mail order supply of medicines such as these.

The Department of Health is aware that there is increasing evidence of the inappropriate use of benzodiazepines in Ireland. Overuse of benzodiazepines is, unfortunately, an international issue and not specific to Ireland. With the HSE, the Department is currently engaged in the development of policy and the consideration of measures to improve practices regarding the use of benzodiazepines and related substances within the health system, such as the re-issue of the good practice guidelines for clinicians to prescribers, pharmacists and all relevant health professionals. The Department is also reviewing legislative measures under the misuse of drugs regulations to introduce stricter controls on benzodiazepines and related substances, such as the possible introduction of import and export license controls and the introduction of stricter prescription-writing controls. Such measures are intended to address both the inappropriate use of benzodiazepines and related medicines in Ireland and the potential for such medicines to be used for the purposes of intentional overdose or self-harm.

Deliberate self-harm may be an impulsive act and that is why it is important to get the message out to people that unused and unwanted medications should not be left around the home and should be brought back to the pharmacy for safe disposal. Reach Out, our strategy document for action on suicide prevention, highlights the need to limit access to means and methods of self-harm and suicide. The HSE’s National Office for Suicide Prevention will be working with the National Suicide Research Foundation and other relevant stakeholders in 2012 to establish a national action plan to address the issue of how the inappropriate and potentially harmful access to medication can be reduced.

Deputy Dan Neville

I take the opportunity to welcome the allocation of €35 million, as promised in the programme for Government, for the development of mental health services. It is very important that of that €35 million, €4 million is being ring-fenced for suicide prevention measures and suicide research, as well as for postvention suicide bereavement groups, to develop an understanding of what happens in regard to the 600 people who die by suicide every year and the 70,000 who attempt to commit suicide and self-harm.

Given the high proportion of tranquilisers used in self-harm, the approach the Minister of State has outlined is welcome. I reiterate what he said that the Irish Medicines Board has strongly advised consumers not to purchase medicines from unauthorised sources, as there can be no guarantee they are genuine or safe. Some of them have been shown to contain too little or too much of the active ingredient, while others contain the wrong active ingredient. As a result, there is a real danger that they will damage the health of those who use them.

Furthermore, criminal networks are behind many of the activities related to the online sale of counterfeit medicines. Therefore, purchasers may be exposing themselves to potential credit card fraud and identity theft in giving their personal details on websites which medicines for purchase. The availability of minor tranquilisers for purchase needs to be examined and dealt with.

Deputy Fergus O’Dowd: I thank the Deputy for his comments which I will ensure are brought directly to the attention of the Minister for Health, Deputy Reilly. The HSE’s National Office for Suicide Prevention is responsible for overseeing implementation of the national strategy for action on suicide prevention. The budget for suicide prevention measures is approximately €9 million, which includes the annual budget of €4.1 million of the National Office for Suicide Prevention and €5 million used to fund resource officers for suicide prevention, self-harm nurses in accident and emergency departments and the development of local suicide prevention initiatives. An additional €1 million was provided in 2011.

I am very much aware of the campaign the Deputy conducts so vigorously and effectively. People like him are campaigning and seeking to bring these issues to our attention. The Minister will be in direct contact with him about the issues raised.

The Dáil adjourned at 9.25 p.m. until 10.30 a.m. on Friday, 9 December 2011.