To: See Distribution List

Eich Cyf/Your Ref:

Ein Cyf/Our Ref:

6th August 2014

DearColleague,

RE: APoSM REVIEW OF TRAMADOL/PRESCRIPTION ONLY MEDICINES

The Minister for Health and Social Services has asked the Advisory Panel on Substance Misuse (APoSM) to review the Welsh Government policy response to the increase in drug-related deaths related to tramadol and other prescription only medicines.

As part of this work, APoSM are seeking to receive evidence from a wide range of interested parties on the issues/factors that may have contributed to this increase and on what existing initiatives are in place or could be instituted to tackle this worrying trend. Tramadol has abuse liability and may also be associated with dependence. In addition, deaths related to tramadol in England and Wales increased from 83 (3 in Wales) in 2008 to 175 (14 in Wales) in 2012. Tramadol prescribing rates in Wales are also higher than in England. In June 2014, the UK Government reclassified tramadol as a controlled class C substance, and placed it within Schedule III of the Misuse of Drugs Regulations (but exempted from the safe custody requirements).

We recognise that tramadol is one of only several medicines used for pain relief, and so we are also seeking any views you might have in relation to a range of other medicines used in the relief of pain, particularly (but not exclusively) those listed in the box below.

APoSM would like to invite you to submit written evidence as part of this inquiry in preparation for a formal evidence gathering day on Monday 6th October 2014 when oral presentations will be received. Invitations to present at the formal evidence gathering day will be issued following consideration of written submissions in early September 2014. We would therefore request that written evidence is submitted by Wednesday 3rd September 2014 to Daryl Kent at:

We would appreciate it if you could kindly address the questions in Annex A within your written evidence, you may also wish to tailor your evidence to a local Welsh perspective.

The Tramadol sub group membership is listed at Annex B. Further details about APoSM can be found at;

We thank you for your assistance in this matter and look forward to hearing from you.

Yours sincerely,

Professor Phil Routledge

Tramadol Sub-Committee Chair

Enc:

Annex A

Q.1 In your view, is there a problem of inappropriate use of:
a) Tramadol
b) Any other medicines used for pain relief
Please expand on your comments:
Q.2 In your view, is there a problem of dependence on:
a) Tramadol
b) Any other medicines used for pain relief
Please expand on your comments:
Q.3 Do you know of medicine diversion and illicit supply, and if so where are supplies coming from with regard to?
a) Tramadol
b) Any other medicines used for pain relief
Please expand on your comments:
Q4 Are you aware of any measures to address any issues highlighted in questions 1 to 3 with regard to :
a) Tramadol
b) Any other medicines used for pain relief
Please expand on your comments:
Q.5 If you answered “yes” to Question 4, please could you describe these initiatives and your views on their possible impact in regard to:
a) Tramadol
b) Other medicines used for pain relief
Please expand on your comments:
Q.6 What further action should the healthcare and other relevant sectors take to resolve any concerns you may have relating to:
a) Tramadol
b) Other medicines used for pain relief
Please expand on your comments:

Annex B

Tramadol Sub-Group of APoSM

Professor Philip Routledge, OBE / Head of Department of Pharmacology, Therapeutics and Toxicology, Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University
Kyrie James / Member of the International Association of Women Judges
Associate-Rapporteur for the UK Rapporteur’s Working Party on Vulnerable Persons of the International Association of Refugee Law Judges
Member of the Council for Immigration Judges
Richard Ives / Consultant, Educari-the Learning organisation
Rosemary Allgeier / Principal Pharmacist in Public Health, Public Health Wales
Josie Smith / Research Scientist, Public Health Wales
Dr Geoff Page / Criminologist, University of York
Dr Rossana Oretti / Consultant Psychiatrist, Cardiff Community Addiction Unit
Prof. Raymond Hill / Professor of Pharmacology, Imperial College London

Distribution List

CONSULTEES (Medicine)

Royal College of Psychiatrists- National Addiction Faculty and Welsh faculty

Royal College of Physicians (Wales)

The Royal College of General Practitioners

General Practitioners Committee Wales

The British Pain Society

CONSULTEES (Pharmacy)

The Royal Pharmaceutical Society (RPS)

The Proprietary Association of Great Britain (PAGB)

Community Pharmacy Wales (CPW)

The National Pharmacy Association (NPA)

The Company Chemists' Association (CCA)

The Association of Independent Multiple Pharmacies (AIMp Ltd)

CONSULTEES (Pharmacology/ Clinical Pharmacology)

British Pharmacological Society

HEALTH BOARDS

Chief Executives

Medical Directors /Assistant Medical Directors

Finance Directors

Nurse Directors

Chief Pharmacists

Medicines Management Committees Chairs & Secretaries

Medicine Information Pharmacists

NATIONAL PUBLIC HEALTH

Consultants in Pharmaceutical Public Health

Directors of Public Health

Consultants working in Public Health Wales (PHW)

WELSH GOVERNMENT

Representatives of Welsh Government / WHSSC

ALL WALES MEDICINES STRATEGY GROUP (AWMSG)

AWMSG members and deputies

New Medicines Group (NMG) membersand deputies

All Wales Prescribing Advisory Group (AWPAG) members and deputies

All Wales Therapeutics and Toxicology Centre (AWTTC) Members

OTHER BODIES:

Community Health Councils Wales

Individual Community Health Councils

General Practitioners Committee Wales

Association of British Pharmaceutical Industries (ABPI)

Substance Misuse Workforce Wales

Substance Misuse Advisory Regional Teams

Welsh Pain Society/Pain Community Centre (Cardiff University)

Prescribing Advisors

Patient groups – Action on Pain and Pain Concern

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