Abstract
Background Mental health problems are common in people with substance misuse problems. However, there is a paucity of evidence regarding prescribing of psychotropic medications for people with comorbid mental health and substance misuse problems. Objective To explore the views of service users attending an addiction service on the appropriateness of psychotropic medications prescribed for their co-existing mental health problems. Setting A specialist addiction service in the North of England. Method A phenomenological approach was adopted. Semi-structured interviews were conducted with twelve service users. Data were analysed using thematic framework analysis. Main outcome measure Service users’ views concerning the appropriateness of their prescribed psychotropic medications. Results The following themes captured service users’ views on the appropriateness of their medications: benefits from medicines, entitlement to medicines, and assessment and review. Service users mostly described benefits from their medications (including those prescribed outside guideline recommendations) and there was also an awareness of the adverse effects they experienced from them. It appears that people with substance misuse problems have a particularly strong sense of their own needs and seek to influence prescribing decisions. Service users further described varied practices regarding assessment and review of their medications with evidence of regular reviews while others identified suboptimal or inadequate practices. Conclusion Most service users described improved functioning as a result of their prescribed psychotropic medications. Prescriptions that are inappropriate in terms of their usual indications may well be justified if they assist in stabilising service users and moving them on to recovery.
Highlights
Lexchin [1] has described appropriate prescribing as ‘trying to maximise effectiveness, minimise risks and costs, and respecting service users’ choices [1]
Addiction service users appear to have a strong attachment to their psychotropic medications and a belief that they have a right to be prescribed whatever they feel they need
Prescriptions that are inappropriate in terms of their usual indications for users of specialist addiction services may be justified if they provide benefits and can be used to move people on to recovery
Summary
Lexchin [1] has described appropriate prescribing as ‘trying to maximise effectiveness, minimise risks and costs, and respecting service users’ choices [1]. People with substance misuse problems often have complex circumstances encompassing health, social and economic problems [4, 5], with service users attending specialist addiction clinics being more likely to have higher levels of dependence, multi-morbidities, functional impairment, social problems and use of multiple medications when compared with those who are not help-seeking [6, 7]. These complex needs may influence prescribing decisions in this population [7, 8]. There is a paucity of evidence regarding prescribing of psychotropic medications for people with comorbid mental health and substance misuse problems
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