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GHA audit triggers fears about sedative addiction in Gibraltar

An audit by the Gibraltar Health Authority has found that powerful sedatives are being regularly prescribed to hundreds of patients in Gibraltar despite these drugs being highly addictive.

The audit was triggered after the manufacturer of a potent tranquiliser raised concerns about the number of pills it was supplying to Gibraltar given the size of the population.

Pfizer questioned why Gibraltar was buying large amounts of Xanax, a sedative that is commonly prescribed in the US to treat conditions such as anxiety but which is not prescribed by the NHS in the UK because it is highly addictive if not properly managed.

Xanax is a strong version of a type of drug known as benzodiazepines which are normally recommended for short-term treatment because they can quickly become addictive.

They are used to treat conditions ranging from insomnia and muscle spasms to backache and alcohol withdrawal.

But although being designed for short-term use, the GHA audit identified 930 patients in Gibraltar who were regularly being prescribed various types of benzodiazepines, including Xanax.

"There does appear to be a higher rate of use than is ideal for a community such as ours," said Neil Costa, the Minister for Health.

"The GHA has carried out an audit examine the use of this drug in Gibraltar with a view to improving the effective use of these drugs and managing a process of withdrawal for those who have been using them for longer than is optimal."

"The GHA is also looking to see how big a problem this is in the private sector, though the ability to influence behaviour in this sector is limited."

"The GHA regards this as an important health issue and is taking measures to address it."

"All prescribers in the Primary Care Centre are also being informed individually of the patients who are on long term benzodiazepines, so they can take steps to reduce their dependence in a managed way."

Mr Costa was responding to a question tabled by Independent MP Marlene Hassan Nahon in the Gibraltar Parliament on Friday.

Ms Hassan Nahon also urged the GHA to look into whether people were able to obtain these drugs without prescription.

According to the GHA data, of the 930 patients, 341 are male and 589 are female. The youngest patient is 18 years old and the oldest is 8l years old, with a median age of 67 years being the norm.

There are six different types of benzodiazepines being prescribed, with diazepam being the most frequently used.

According to the GHA, 100 patients are being prescribed two or more different types of benzodiazepines at the same time.

A total of 237 patients were being regularly prescribed Xanax or its generic version, Alprazolam.

Mr Costa said doctors say it is generally inappropriate to use these drugs beyond four weeks.

Not only does the effect of the drug decrease and require higher doses for the same impact, but they create dependence. In older people, they can lead to confusion and falls.

When the drug is stopped, users can experience severe withdrawal symptoms such as insomnia, irritability, tension, panic attacks, tremors, sweating, poor concentration, nausea, palpitations, headaches, muscle aches and sometimes even seizures and psychotic reactions.

"Withdrawal can be difficult since the initial symptoms for which the drug was prescribed might return, made worse by the symptoms from the withdrawal itself," Mr Costa said.

"Some people are therefore reluctant to stop the drugs."

"For these reasons withdrawal should be gradual and guided by clinicians who can help patients cope with any symptoms."

"A doctor with special expertise in this area has commenced a new service to address this, has been informed of the patients with the greatest level of addiction and is planning to reduce this in a managed way."