THE Ministry of Health has issued new guidelines governing how doctors prescribe sleeping pills in a bid to address the problems of overprescription and addiction.

Doctors must now keep detailed records when they prescribe sleeping pills. These must indicate the dosage, duration of use, reasons for prescribing the pills and if there are any physical signs of illicit use.

Doctors must also alert the ministry and the Central Narcotics Bureau if they suspect that a patient is abusing the use of sleeping pills.

Since the new rules took effect in October, doctors have reported three patients to the authorities, although only one is believed to be an addict.

It is not known how many people in Singapore are addicted to sleeping pills, but about seven million pills are prescribed each year.

Although guidelines addressing the prescription of sleeping pills already exist, the updated version requires doctors to take extra precautions.

General practitioners were previously told not to give patients more than two weeks' supply of sleeping pills. They had to refer patients who were returning for more to psychiatrists.

The new guidelines provide more details on what doctors can and cannot do. For example, they have to refrain from giving out highly addictive pills like Erimin and Dormicum in the first instance. They should prescribe sleeping pills with hypnotic and muscle relaxant actions only when necessary and only for intermittent use - one pill in about two or three days.

The guidelines also now specify that doctors have to warn patients about 'rebound insomnia' - an inability to fall asleep after stopping treatment for insomnia.

The most commonly dispensed benzodiazepines are Dormicum, Erimin and Nitrazepam. Doctors often prescribe five to 10 tablets at one time to patients with sleeping problems.

College of Family Physicians president Goh Lee Gan said it is more important for doctors to explain good sleeping habits and try to find and tackle the root of the problem instead of prescribing benzodiazepines too freely.

In the last five years, 24 doctors have been brought before the Singapore Medical Council for dispensing sleeping pills too liberally. The council has heard six disciplinary inquiries this year.

Associate Professor Munidasa Winslow of the department of psychological medicine in the National University Health System said the new guidelines have raised awareness that sleeping pills can be addictive. 'It's now clearer to doctors that you have to take responsibility and face an audit.'

jessicaj@sph.com.sg