Addicted to painkillers: Professor Kerryn Phelps looks at the dangers of pain relievers

Professor Kerryn Phelps examines the dangers of abusing and misusing common painkillers, and advises on alternative pain relievers.

Are we in the midst of an epidemic of painkiller misuse? If you live with chronic pain, you need to find ways of eliminating the cause, relieving the pain or learning to live with a tolerable level of pain. There are many techniques for achieving this, including medication. While medications, used properly, can improve your quality of life, unfortunately, there is a downside.

The Australian Drug Foundation says that, among Australians, the non-medical use of pharmaceutical drugs is at its highest level since 1998. More people die from drug overdoses, including from pharmaceuticals, than die on the road every year.

Types of drugs Paracetamol

Paracetamol is available over the counter and so commonly prescribed and used that it is easy to become complacent about its safety. However, it is also very commonly misused and accidental overdoses are frequent. The main risk of toxicity is liver damage. One of the pitfalls is that paracetamol is an ingredient in many combination analgesics so it is easy to accidentally double up.

Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are commonly used to help relieve pain from arthritis or other musculoskeletal conditions, migraine, gout, period pain and fever. You may recognise the ingredients such as aspirin, ibuprofen, naproxen, diclofenac and celecoxib. I recommend minimal (not daily) use of these medications, especially in older people, because of potentially dangerous side-effects, such as high blood pressure, gut ulceration and bleeding, and fluid retention. If you do need to take these medications temporarily, talk to your doctor or pharmacist, check for any possible interactions with other medications and follow directions carefully.

The opioids

A report published in the Lancet journal this year found that the use of opiates quadrupled in Australia from 2001 to 2013. Opioid analgesics are the stronger painkillers and they include codeine, hydrocodone, oxycodone, morphine and related drugs. There is a high risk of addiction and overdose with these medications. Opioid painkiller drug overdoses are estimated to have increased 95.8 per cent in Australia between 2007 and 2010, and it appears that deaths from pharmaceutical opioid medications

are surpassing those from illicit drugs such as heroin. If you have a chronic pain condition, your use of opioids needs to be carefully managed with expert medical advice. Addiction

Opioid dependence and addiction can start innocently when an injury, a surgical procedure, a kidney stone or other condition leads to the prescription of opioid analgesics for relief of acute pain. They are very effective for relieving pain. However, after a time of continued use, you need more to manage your pain and then you develop distress if you do not take the medication. Later, there is a strong compulsion to get hold of the drug even if the initial cause of the pain has passed.

Non-fatal overdose

We hear the statistics about painkiller overdose deaths, but what about the overdoses that people survive? The damage can be catastrophic: hypoxic brain injury (lack of oxygen to the brain); coma; seizures or brain death; and persistent vegetative state.

Poisonings in children

A report came out in July 2016 that 37 per cent of poisonings in children and young people were caused by non-opioid analgesics, such as paracetamol.

Overdosing in children is a particular danger and this is usually because of confusion about the right dose or carelessness in measuring the exact dose for the child’s age and weight. AWW