Letters Prison environment and health

Replace clonazepam with an alternative antiepileptic drug to reduce drug misuse

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7809 (Published 19 November 2012) Cite this as: BMJ 2012;345:e7809
  1. Rhiannon England, general practitioner1,
  2. Neera Dholakia, general practitioner1,
  3. Emma Tukmachi, general practitioner1,
  4. Theresa Murphy De Souza, general practitioner1,
  5. Bronwen Moss, general practitioner1,
  6. Shazia Ovaisi, general practitioner1
  1. 1Holloway Prison, London N7, UK
  1. rhiannon.england{at}nhs.net

As a group of GPs who work in a women’s prison we welcome the series on prison medicine.1 We want to raise a matter that has profound implications for prison care and for primary care prescribing—the widespread misuse of prescription drugs obtained from GPs and drug services.

Predominant among these is clonazepam—usually prescribed by primary and secondary care for epilepsy. Almost without exception this diagnosis will not have been confirmed by video telemetry because the “fits” we see in prison are clinically not epileptic in nature.

We routinely replace clonazepam with alternative antiepileptic drugs, such as lamotrigine, and have had no clinical problems arising from this policy.

We would welcome a change to clonazepam becoming a hospital prescribed drug only, because there is no merit in having another benzodiazepine available in primary care when dependence on this group of drugs is such a big problem. It could then be restricted to the treatment of intractable epilepsy confirmed by video telemetry.

We would also welcome a more general debate on the diagnosis of pseudoseizures in the prison population and management with psychological techniques rather than drugs. A discussion of other prescription drugs such as mirtazepine, gabapentin, and tramadol, which are much more commonly used for this relatively young population than seems warranted, would also be useful.

We are aware that this has implications for the wider prescribing of potentially addictive drugs in primary care—from analgesics to psychotropic drugs.


Cite this as: BMJ 2012;345:e7809


  • Competing interests: None declared.