Australia: Codeine abuse leads to calls for painkiller rethink

Once again a foolish minority can apparently reduce otherwise good options for the responsible majority.  The regulatory attack on painkillers is very vigorous because some people overuse them.  And that often leaves available alternatives -- such as paracetamol -- that are quite unsafe if recommended doses are exceeded. 

APC's ("Bex" etc.) were banned to prevent a few cases of kidney disease but their preferred replacemnent -- paracetamol -- causes thousands of destroyed livers.  My own preferred remedy for post-operative pain -- Di-Gesic (Dextropropoxyphene plus a bit of paracetamol) --  has now been banned because some addicts were using it

Senior health officials are warning of a looming public health crisis from abuse of over-the-counter painkillers.

Doctors are frustrated by admissions of critically injured patients to emergency rooms after sustained use of painkillers that contain a mixture of codeine and ibuprofen, such as Nurofen Plus.

While many take the drugs responsibly, the consequences for those who do not can be so severe that some doctors and pharmacists believe it's time to review the sale of these drugs.

Frankie Bean began using Nurofen Plus 24 hours a day to stave off the chronic pain of Lupus disease, an auto immune condition that leaves her in pain every day.

"Initially it was just that I could work and I could have my life back and I was really excited about that, so I was just willing to do whatever it took to do that," she told ABC1's 7.30.

"But then I sort of started realising that I was a bit hooked on it. I didn't want to be, but I didn't want to give up my life again."

The constant use of pain killers lowered her blood pressure so badly she passed out at work.

The next thing I knew my sister was by my side balling her eyes out and I was passed out out the front of my work and I was on the ground and there were ambulance people around me taking me off to the hospital.

"I was just at work and I hadn't felt good in the morning, like I was getting a bit dizzy and stuff and I just put it down to Lupus," she said.

"The next thing I knew my sister was by my side bawling her eyes out and I was passed out out the front of my work and I was on the ground and there were ambulance people around me taking me off to the hospital."

Weeks later Ms Bean quit cold turkey and now says she will never take the tablets again.  "I had headaches, I vomited a lot, I was absolutely horrible to be around," she said.  "It is something that people don't realise, I had no idea that I could get addicted to codeine."

Now she has turned to yoga every morning to help with the joint pain.

Doctor Matthew Frei runs a drug treatment clinic in Melbourne and knows first hand how addictive codeine can be.  "It is a close relative of drugs like morphine and heroin, so yes, it is an addictive drug," he said.  "We're a bit unusual in Australia in that you can purchase codeine over the counter, that's not the case in all parts of the world."

It is quite a scary and foreign idea to someone who has not had much contact with the drug-using culture to be offered a treatment that's usually offered to heroin addicts.

"It is quite a scary and foreign idea to someone who has not had much contact with the drug-using culture to be offered a treatment that's usually offered to heroin addicts," he said.

"However, the principles of addiction to codeine or prescription opioids, to all the opioids are very similar."

Back in the 1950s and 1960s people were getting addicted to Bex headache powder [APCs], which contained caffeine.  The serious problems that resulted saw them banned in 1977.  [It was actually the Phenacetin in them which was seen as a problem.  If caffeine is a problem we should ban coffee!  But guess what phenacetic metabilizes into?  Paracetamol!]
Dr Frei says drug addiction is a marketing manoeuvre for these over-the-counter pain killers.

"It's using an anti-inflammatory agent, linking it to another drug which causes the patient to keep on taking it because of the withdrawal symptoms they get when the effect wears off, and thereby accumulating bigger and bigger doses," he said.

"This is headache powders [APCs] revisited."

Today's compound analgesics are known by their popular brand names like Nurofen Plus, Panafen Plus and Mersyndol.

The codeine in the drugs gets consumers hooked, but the real danger is the ibuprofen they contain which in large doses is toxic and can cause internal bleeding.

One of my worst moments in the last few years was when I was up all night with a young man who was otherwise well, who was bleeding torrentially from a giant ulcer in his stomach which was caused by compound analgesics.

"The peptic ulcers can also be lethal, in fact, one of my worst moments in the last few years was when I was up all night with a young man who was otherwise well, who was bleeding torrentially from a giant ulcer in his stomach which was caused by compound analgesics," he said.

There has been at least one death from over the counter codeine in Australia and Dr Foy says it was only through good fortune that this young patient survived.

"This man needed 14 units of blood and we were running out of blood, and by the time he was anesthetised, he was in really big trouble, but fortunately for him there was a very good surgeon handy who moved quickly and stopped the bleeding and he has now recovered," he said.

Since 2008 doctors around the country have been documenting scores of cases of codeine abuse some leading to peptic ulcers, kidney failure and even pancreatitis.

Dr Foy says it is extremely frustrating to see young people turn up with life threatening conditions created by codeine and ibuprofen abuse.

"It is an extremely unpleasant sensation to be up in the middle of the night with somebody who looks as though they're going to die to no purpose. It's pointless," he said.

SOURCE






Faddist British doctors

James LeFanu comments:

Dear Dr Le Fanu

My husband is 76, in good general health and until recently was on no medication whatsoever. He suffers a few aches and pains after many years of playing various sports, and some acid reflux, but is otherwise fit, active and healthy. He eats a varied diet with occasional treats and is not overweight: his waist measurement has increased by perhaps half an inch in the last thirty years.

We recently had occasion to change our GP, and my husband decided that he would like an ‘MoT’ just to check his general health. He was told that he had ‘borderline’ Type 2 Diabetes and was prescribed one Metformin tablet daily. He was advised that, being otherwise completely asymptomatic, his readings were purely a function of age. We read the diet advice and decided that no changes were necessary. Tests on his sight and his feet have not shown any cause for concern.

He saw the practice nurse for the results of a routine check-up yesterday and was told that everything was fine, and he has ‘the blood pressure of a twenty year old’. His blood sugar level is 5.1. However, the nurse said she thought he should be prescribed statins and asked him to see the doctor.

Neither of us are very happy about this – someone who is to all intents and purposes fit and healthy may shortly be on two types of permanent medication with the associated possible side effects. My concern is that the practice saw a gentleman in his mid-seventies on no medication and perhaps interpreted this as a challenge.

We would appreciate your comments.
Mrs J Charlesworth

Dear Mrs Charlesworth,

Thanks for being in touch. As you will have surmised your husband is a casualty of the current vogue for family doctors to boost their income by over diagnosing and over treating their patients for medical conditions they do not have.

The notion of borderline diabetes (like borderline hypertension) is a fictional construct promoted by the pharmaceutical industry to increase the number taking their pills. It is based on the false supposition that the benefits of treating those with symptomatic diabetes can be extrapolated to those who have no symptoms but in whom biochemical testing reveals their blood glucose is marginally raised above an arbitrarily defined ‘normal’ level.

Neither, and for similar reasons, does your husband require statins. This can I appreciate be a tricky situation, but I am sure it is best dealt with frankly: your husband should stop his Metformin and request his name be removed from the practice’s diabetes register.

SOURCE