This is a guest post by Graeme Dixon of Agencia.
Supporting a vulnerable population
Is there a huge, under-reported, un-noticed and potentially devasting domestic abuse issue with misuse of prescribed medication? If so, do we have an opportunity to turn this problem into an opportunity to identify and support a highly vulnerable population?
For the last 12 years, I have worked in the area of addiction and focused mainly on prevention through early intervention. A lot of my work has been in the criminal justice arena, and I had regular contact with both victims and perpetrators of domestic abuse. Since 2014, I have been working for Agencia on the risks involved in misuse of opioid painkillers, (both prescribed and over-the-counter), and this work has led me to believe there is an opportunity to take a proactive approach to identifying and supporting domestic abuse victims who are also misusing prescribed medication.
Many victims suffer in silence, sometimes self-medicating with alcohol and illicit substances. With anxiety, depression and other mental health issues often occurring as a result of the abuse, how many victims are also taking prescribed medication to cope? We know from a recent Public Health England Report: ‘in England in the year 2017 to 2018, one in 4 adults in England were prescribed benzodiazepines, z-drugs, gabapentinoids, opioids for chronic non-cancer pain, or antidepressants.’
Agencia runs a highly successful painkiller addiction service called ReWire. ReWire analyses data to establish patients most at risk from misuse of prescribed opioids and supports them in changing their behaviour. The project has been successful, however, whilst developing ReWire, it became clear that there were small pockets of research, both nationally and internationally that indicated domestic abuse victims were more likely to be at risk. On sharing our findings, it is clear that many GPs and other health and social care professionals share the same concerns. We’ve also heard of victims potentially being forced to divert their prescriptions to their abusers, or access to medication being used as a form of control. I must stress that this evidence is anecdotal, but it was widespread. You can see a description of the Rewire service in the video below.
Prescribed Opioid Misuse Indicator
ReWire uses a software tool to assess risk across a patient population and then the Prescribed Opioid Misuse Indicator (POMI) questionnaire to establish individual risk. What made the approach unique was, we were initially funded to provide some dedicated psychosocial support to supplement the usual GP appointments, and it quickly became clear that patients appreciated the additional time to discuss their concerns and the structured support sessions that were available. Initially, we were not focused on the domestic abuse possibilities; that awareness came later, as we were sharing our experience and picking up on further research.
The risks of prescribed medication
There is a need to get the message out to criminal justice professionals, domestic abuse teams and other health and social care organisations about the real risks to health and wellbeing associated with prescribed medication. It is worth re-iterating, 1 in 4 of the population is prescribed potentially addictive medication. It is also clear from research and our own work that prescribing levels tend to be higher in more deprived communities. Post COVID, there will be less opportunities for the ‘face-to-face’ conversations where individuals can build relationships of trust where they become more likely to disclose their concerns, be it about abuse or misuse, so a more intelligence-led and proactive approach to raising these issues will have to be found. Early indications are that prescription levels are going up, and with them, the potential for problems to arise.
The importance of support
There are no easy solutions to these issues, and there is a need for further research. There is also a need for action, and one of the clearest messages coming through our ReWire work is that the individuals identified as being at risk often had concerns, and, with a little support, are capable of making significant positive changes. Making one successful change can often be the catalyst for other changes. Simple actions that any professional can take include raising the subject of prescribed medication with service users, and having an awareness of the support which is available, both locally, and increasingly online.
Over the years, this issue has become a passion for us. We have seen the difference that can be made to individuals and their families (for this is often a family issue). The threats from prescribed medication are often almost invisible, hidden in plain sight. Hopefully, this will begin to change, as so many things are changing at this hugely challenging time.