Addiction to painkillers.

Another one who misses the effectiveness of coproxamol. i have osteo and inflammatory arthritis, and have effective disease modifiers currently, after a tough year last year. I avoid pain killers during the day, very rarely take them, I keep occupied and try not to think about it. By the evening, I'm usually feeling both tired, and in pain. I often take 2 cocodamol when I go to bed, as it does take the edge off. If the pain isn't too bad, i do without. But, those nights I don't sleep as well, because the pain in my shoulders and hip always wake me if a turn over in my sleep. I loathe the way the DM sensationalises everything. The majority of people are well aware of the risks of addiction to cigarettes, alcohol prescription and street drugs. Some people are more easily led into addictions, or take themselves into dangerous places for so many varied reasons.
Lots of people take od's of paracetamol, which remain easily available. For those of us with chronic/sometimes severe pain, coproxamol was a blessing at times. Oh well, I won't moan on, because I feel fortunate to have a good GP and consultant who help me manage the condition so well. Thanks to them -

Presumably you had a dissecting aortic aneurysm which they have respected and replaced the diseased bit with a graft?
Have they told you you are likely to have another one?

jend . I'd be fed up too with all that.

Thatbags, I've been vegetarian for over 35 years, so eating even more fruit and veg is a problem. I worked out that I eat at least ten to twelve portions of fruit or veg a day.
But I have to have senna every day or two because I have to take alpha-blockers, betablockers, calcium channel blockers, aspirin and statins because I had an aortic dissection. So obviously I keep a good eye on my blood pressure, even though my GP does not.
It's impossible to know which medication causes which side effect because I was given them all together.
I suppose I am fortunate that I react to anything that could be addictive.
I had some really good hallucinations on Morphine and Tramadol, seeing things and people who were not there. Ibuprofen affects my breathing so that's another group of medication out. So does Chamomile.
I have always used alternative therapies before going to the GP, Greatnan, until this happened. Even things like yoga breathing could reduce blood pressure, but I cannot do it now as it hurts my ribs. I have all the Tens, etc., machines but dare not use them just in case they make me have another dissection.
Fed up!

I agree about the co-codamol, I find it useless the old coproxamol was very good!

I just use paracetamol at night, in the day only when the pain is unbearable. I do have amytryptolline at night occasionally, but I don't like the side effects, so I just suffer!
Thatbags a very interesting article, thanks.

Fentanyl patches are supposed to deliver a measured dose over a period of time, but several people died because they were chewing them to get a 'high'.
Taking the amount of codeine prescribed by your doctor is fine for most people, if they have not had previous addictions and don't attempt to top it up by the small amounts found in Neurofen Plus and Paramol.
One problem is that many people are experiencing other problems, apart from pain, when they first start on prescription pain-killers and the relief from depression and/or anxiety is very seductive.

I usually try to only take one paracetamol and one co-codamol at night because of the codeine induced constipation. Using paracetamol as needed.

I've been taking codeine for years (since the predecessor of co-codamol 30/500, co-proxamol, was banned because people were deliberately overdosing on it and dying). The constipation problem is easy to solve by eating more fruit and veg, especially prunes, capsicum peppers, and orange juice. Cabbage is pretty good too. And lentils.

Just by the by, co-codamol 10/500 is supposed to be the equivalent of co-proxamol. In my experience it isn't.

I think it's important to say that codeine can be addictive if you are not careful, not simply that it is addictive. I am not addicted to it.

jeni, you might find this article interesting: updates.pain-topics.org/2013/01/does-chronic-pain-raise-hypertension.html

In my daughter's case - yes! As well as paranoid delusions from long term use of codeine, panic attacks, mood swings, bizarre decisions. She was also given tramadol in hospital following a botched operation. As with most addictive substances, the relief or euphoria conferred by one pill soon becomes insufficient and more and more are needed just to stay 'normal'.
Sleeping pills are another potential source of dangerous addiction.
There are things that pain clinics can suggest if addiction might be a problem, such as TENS machines, massage, meditation or 'natural' remedies.

What appals me is the number of people I see who are prescribed long term benzodiazepines. They are very addictive, but a large number of people seem to be on them either for anxiety and panic attacks, or muscle spasm!
The mind boggles!

My husband was in pain for 15 years. He was on a morphine drip at one time, then given morphine based painkillers.
He had the problem that they made him constipated, which was another problem as he was doubly incontinent. So he decided not to take painkillers and was sent to a pain clinic, where he discovered that a painkiller based on capsicum worked better for him. That took about ten years to find out. When we moved to Durham, he was told that they would not give him that, but they would give him opioids and antidepressants.
When I was in hospital in April, I was on morphine and given Codeine, and Tramadol, to bring home, both of which are addictive, and cause constipation. As I am not supposed to strain when I go to the toilet, that is obviously ridiculous, so I stopped taking them. I was also given a repeat prescription of 200 paracetamol!
I put up with pain at the moment, telling myself that it's there for a reason, to make sure I do not do too much and end up back in hospital.

Does this happen to everyone who is addicted to painkillers? Do they then have to take loads of senna as well?

I wasn't suggesting that anyone close their eyes to the problem. I was trying to highlight what I actually see the problem raised in the article to be. Some people actually choose a lifestyle that will increase their chances of becoming addicted to something while they are fully aware that there is an addiction risk. That is all I was saying, and no amount of legislation to protect them from themselves will change that.

This, I feel, is a quite different problem from the one highlighted in the article. I thought the two issues were becoming mixed in some of the posts.

All drugs have side effects and there has to be a balance between risk, of which addiction is one, and benefit.

As Bags says, it is the management of the condition by the GP and the patient that is relevant, rather than the drug itself, and this is no easy task.

NICE has just issued new draft guidelines about the use of paracetamol in the management of osteo-arthritis. They are concerned that "higher doses of paracetamol could lead to multiple adverse effects, including heart, kidney and intestinal problems, and recommended GPs only prescribe the “lowest effective dose” for the “shortest possible time"," although the Medicines and Healthcare products Regulatory Agency maintain that there is no new evidence which would change the risk-benefit ratio.

If the draft guidelines are passed, this will present a real dilemma for GPs who are caring for patients with moderate to severe pain, and who are contractually obliged to follow NICE guidelines. The choice seems to be stronger but potentially addictive drugs, or tea and sympathy.

Yes, bags, I was aware that there are other addictions!
Unfortunately, many people are not aware that painkillers can be addictive, or are not sufficiently aware to notice the symptoms.
I don't see why the existence of other addictions should make us want to close our eyes to this one.
You have personal experience of having to take painkillers and you have not become addicted. You know that I have had a different experience. I merely want to alert people to the possibility of addiction.
I would like codeine to be removed from over-the-counter painkillers, and I would like doctors to be more vigilant when prescribing them.

Everyone knows addiction to drugs can be a problem. GPs, it seems to me, should be more aware of the problem than others. So does this problem of repeat prescrips arise because the GPs don't care, because they think their patient's addiction is less of a problem that the alternative, ot because they don't have the time or resources to help people overcome addiction?

It could be a combination of all three.

But, as I said, the problem highlighted in the DM article is GPs writing prescrips when, apparently, they shouldn't.

Addiction is the connection, greatnan. Nicotine and alcohol are addictive drugs.

I think I have posted often about my horror of smoking and I am certainly not promoting abuse of alcohol. However, I can't see why that has any bearing on the abuse of painkillers.

thatbags re your 12:34 post, you are 100% correct.

People kill themselves smoking or overindulging in alcohol consumption as well. It just takes longer.

The article seems really to be about doctors not recognising addiction even when it becomes obvious to them that the patient is taking more than is wise of the prescribed drug. My GP would not authorise a new prescription before the appointed time for the repeat. Why do some GPs carry on writing prescrips when they must know there is, or as least there is potentially, a problem? That, to my mind, is the issue here.

Greatnan I'm sorry to say there are loopholes that permit purchase for many prescription medications online, e.g. Solpadeine is available on Amazon in any quantity you want.

Bags true, not everyone becomes addicted and it is a minority who do. But it is a rising problem in the UK and a huge problem in the US - I think prescription med overdose have killed more people than illicit drugs in some American States.

No, of course not everybody who has to take painkillers over a long period becomes addicted, but the consequences for those who do are awful and withdrawal is very difficult. I am not suggesting that painkillers should not be available over the counter, but just that anybody needing to take them should read about the symptoms, causes, effects and treatment of addiction to them.
Pharmacists are supposed to sell no more than a packet of 24 (I think) at a time, but there is nothing to stop an addict going round all the pharmacists in an area, or going back every day, or getting somebody else to 'source' for them.

Chronic pain causes serious problems too, including depression. Not in my case, fortunately, but I can quite understand how it could and does.