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Prescribed medicines that can cause dependence or withdrawal symptoms: the care you should expect

Some medicines can cause problems because the body gets used to taking them. This can mean that people might need bigger doses to get the same effect (called tolerance), and they might have unpleasant side effects (called withdrawal symptoms) when they stop taking the medicine. Medicines that are associated with tolerance and withdrawal symptoms are known as ‘dependence forming’.

Medicines that can cause dependence are often used for long-term conditions that can be difficult to treat. Some strong painkillers (called opioids) and medicines for anxiety and sleep problems can cause dependence. Medicines used to treat depression (antidepressants) can cause withdrawal symptoms when they are stopped. Sometimes these medicines can work well, but often there are other treatments that might work better, and these should be tried first.

Before you decide to take one of these medicines, your healthcare professional should tell you about other treatment options that might work better, explain the risks of dependence or withdrawal symptoms, and give you time to think about your choices.

Making decisions together

Decisions about treatment and care are best when they are made together. Your healthcare professionals should give you clear information, talk with you about your options and listen carefully to your views and concerns.

To help you make decisions about treatments, think about:

  • What matters most to you – what do you want to get out of the treatment?
  • What are you most worried about – are there risks or downsides to the treatment that worry you more than others?
  • How will the treatment affect your day-to-day life?
  • What happens if you do not want to have a treatment?

If you need more support to understand the information you are given, tell your healthcare professional.

Read more about making decisions about your care.

Taking and stopping your medicine safely

When using medicines that can cause dependence or withdrawal symptoms, it is important that people understand the possible risks and benefits of taking them, that they are prescribed correctly and that they are not taken for longer than they are needed. People can find it difficult to stop taking their medicine when they want to or need to, but healthcare professionals can help them to safely reduce their dose until the medicine is no longer needed. This process is sometimes difficult and may take several months or more.

This guideline should make a difference to people taking these medicines by making sure that:

  • you can have support during appointments from a family member, carer or advocate if you want
  • you have an agreed management plan that sets out details of your medicine, when it will be reviewed and who to contact if you have problems
  • your healthcare professional tells you what to look out for that might suggest you are developing dependence to your medicine
  • your healthcare professional helps you to find and take the smallest dose of the medicine that works for you by starting at a low dose and gradually increasing this, if necessary, under close supervision
  • if both your prescriber and specialist healthcare professionals are involved in your care, the person who first prescribed your medicine clearly explains who is responsible for prescribing and reviewing your medicine
  • you have regular medicines reviews as often as you need them, and these happen more often when your dose is being adjusted
  • when you decide with your healthcare professional to reduce your dose or stop taking the medicine, you agree on a schedule to gradually reduce your dose and have regular check-ups throughout the withdrawal process.

Where can I find out more?

The Medicines A to Z on the NHS website has more information about specific medicines.

The following organisations are drug and alcohol treatment providers offering free and confidential support to people who use prescription medications or illicit drugs:

To share an experience of care you have received, contact your local Healthwatch.

NICE is not responsible for the content of these websites.

We wrote this guideline with people who have been affected by medicines dependence and withdrawal, and staff who treat and support them. All the decisions are based on the best research available.

ISBN: 978-1-4731-4509-2

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