SPECIAL REPORT: Our €40m drug problem

Almost 2.3 million prescriptions were written for anxiety and depression drugs in 2012, enough to cover more than half the population.

An Irish Examiner investigation has found 330,000 public patients were prescribed those drugs that year at a cost of €40m to the State.

The figure is likely to be closer to 500,000 when private patients are taken into account.

It also found substantial variations in prescribing rates and in the cost of drugs around the country.

In some counties, one in five public patients are prescribed anxiety and depression drugs compared to one in 10 in other regions.

The figures are based on an analysis of the top five most frequently prescribed anti-depressants and anti-anxiety drugs under the General Medical Services (GMS) scheme in 2012.

The number of prescriptions written for all five drugs increased between 2011 and 2012, by up to 25% in the case of anti-depressant Sertraline.

In Limerick, 10% of the total population was prescribed anti-anxiety pills or anti-depressants, the highest percentage in the country. This figure jumps to 21% for those with medical cards

In South Tipperary, 9.9% of population are on anti-depressants, rising to 21.7% of those with medical cards.

In the Cork North Lee area, just under one-in-10 people are using these drugs, rising to one-in-five for those with medical cards.

The percentage was lowest in Dublin South, at 4.3%.

One possible explanation is that medical card coverage in Limerick is 47%, compared to 20% in Dublin South, therefore more prescriptions were issued under the GMS scheme.

However, this argument is challenged by the figures for Donegal, where 56% of the population has a medical card (the highest percentage in the country) but where the percentage of the total population prescribed these drugs is lower than Limerick, at 7.3%.

The populations of both areas are similar.

Digging deeper, the percentage of GMS patients prescribed these drugs in Donegal is the lowest in the country.

In fact, the figure is just over one in 10 (13%) compared to one in five in many other areas of the country. The percentage is highest in Cork South Lee, at 23.5%.

The State spent almost €40m on 2.3m prescriptions for the top five in 2012, covering 330,000 patients.

However, if we were to include private prescriptions, it would push the figure closer to 500,000.

This is at a time when less than a quarter of the 251 mental health posts approved for last year have been filled.

Martin Kenneally, director at the Centre for Policy Studies at University College Cork, who has published a working paper Why Do Drug Prescribing Rates Differ Across Irish Regions said it is hard to understand the variations “in the absence of any in-depth research linking them with the prevalence of illness”.

Mr Kenneally’s paper found the GMS prescribing rate in the north west was “around 25% below the national GMS norm”, which echoes our findings here.

He also found substantial variations, as did we, in the cost of public medicines in the different regions.

To date however, Mr Kenneally said, “these regional differences have attracted little research attention”.

For example, Diazepam, brand name Valium, the most popular benzodiazepine under the GMS scheme, costs €24.49 per patient in Donegal and €59.27 in Dublin North Central.

The most prescriptions for Diazepam are written in Cork North Lee, where the cost per patient is €40.99, more than €15 dearer than Donegal.

Consultant psychiatrist Dr Siobhán Barry, writing into today’s Irish Examiner, said the variations in prescribing described here provided grounds for “a more in-depth analysis by health economists”.

In relation to therapies available to public patients diagnosed with an anxiety disorder or depression, we asked the HSE if they were offered therapy or counselling as a first treatment step.

The HSE said those with mild to moderate anxiety and/or depression would “usually be offered therapy at primary care level” under its Counselling in Primary Care (CIPC)”.

However, when asked how many patients are on the waiting list to access to CIPC, the HSE said there were 478 waiting longer than three months; 39 waiting longer than six months; and six waiting more than nine months.

The HSE blamed most of the delays on “specific requirements” of patients, “for example, they can only attend on a Monday morning, or after 4pm, or are waiting to be seen in a particular area”.

Galway registered the highest number of prescriptions per person, with a prescription rate of 8.4 compared to an average of six to seven per person across most local health offices.

Top pills

- Escitalopram (Lexapro), up 9.3%, from 542,317 in 2011 to 592,704 in 2012.

- Diazepam (Valium/Anticalm), up 1.6%, from 506,508 to 514,350.

- Alprazolam (Xanax), up 2%, from 456,466 to 465,698.

- Venlafaxine (Efexor/Venlofex), up 11.2%, from 353,005 to 392,615.

- Mirtazapine (Mirap/Mirtazapin), up 18%, from 256,431 to 302,586.

- Citalopram (Cipramil), up just under 1%, from 295,998 to 298,648.

- Sertraline (Lustral), up 25%, from 185,312 to 231,500.

 - Number of prescriptions written for each drug under the GMS between 2011 and 2012

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