Misuse of pain killers
Incorrect use of analgesics or more commonly known as “painkillers” in public can lead to addiction and/or fatal consequences. This is a silent crisis that we are currently facing. I wanted to touch up on this topic because although it is extremely common, people are still very much unaware of this matter. Let’s first start off with exploring what a painkiller is and why we use it.
A painkiller is any medicine that is used to manage pain – it can range from over the counter medicines such as paracetamol and ibuprofen to prescription only non-steroidal anti-inflammatory drugs (NSAIDs) to opioids such as morphine and fentanyl; roughly speaking, these are the main groups of analgesics. Why we take them can range from a simple headache to palliative care pain management.
There are two common misconceptions:
- “If I can buy it over the counter, it must be safe” or
- “If my doctor is prescribing it to me, it must be safe”
If you fall into any of the two categories above then please read on, because this blog will help you identify the risks associated with painkillers. All medicines have side effects and analgesics are no exception. Below I have outlined the side effects and risks associated with misuse/overuse. It is important to note that analgesics are not dangerous when used correctly, I am outlining the dangers of overuse/misuse of painkillers.
Side effects with paracetamol are quite rare and it is tolerated well by many people therefore, it is usually a first line treatment in the UK. It is commonly used to treat pain and high temperature (fever). It is typically used to relieve mild or moderate pain, such as headaches, toothache or sprains, and reduce fevers caused by illnesses such as colds and flu.
Long term use – Daily high dose use of paracetamol can heighten the risk of side effects such as kidney/liver damage, cardiac problems and blood disorders. However, there are no concrete evidence based studies to support this theory.
Overdose – Taking more than the recommended daily allowance of paracetamol can be extremely dangerous. Overdose on paracetamol leads to irreversible liver damage that can be fatal.
- Non-steroidal anti-inflammatory medicines
These are widely used to relieve pain, reduce inflammation and bring down a fever. They're often used to relieve symptoms of headaches, painful periods, sprains and strains, colds and flu, arthritis and other causes of long-term pain. Examples includeibuprofen, naproxen, diclofenac, celecoxib, mefenamic acid, etoricoxib, indomethacin and high dose aspirin. Although some can be bought over the counter, they are not suitable for everyone and can have some unpleasant side effects.
Long term use – One of the main problems associated with NSAID use is GI (gastrointestinal) related side effects. In the short term, it can cause side effects such as indigestion, nausea and stomach pain, however, in long term use it can lead to stomach ulcers or a hole developing in the stomach lining. As a result of these conditions, it is sometimes possible to develop internal bleeding. The use of NSAIDs must therefore be used with caution in people who have a history of peptic ulcers and who are over 65 years of age due to their risk being higher. Generally, your doctor will prescribe a medicine that belongs to the group “proton pump inhibitors” to protect your stomach’s lining and minimize side effects.
NSAIDs are also linked to cardiac side effects with long term use increasing the risk of problems associated with the liver, kidneys, or heart and circulation, such as heart failure, heart attacks and strokes. It is important to note that these side effects are quite rare, but the use of NSAIDs must still be used with caution in people who have any problems with the heart, liver, kidneys, blood pressure, circulation or bowels.
Please always remember to take your NSAID on a full stomach directly after food to minimize side effects.
Overdose – It is important to take the recommended daily dose of any prescribed/over-the-counter NSAID to prevent any damage to the kidneys and the gastrointestinal system.
Opioids are probably the main cause of concern for overdose and misuse due to its addictive effects. Opioids are a class of drugs that include, but are not limited to, the illegal drug heroin, synthetic opioids such as fentanyl and other pain relievers such as oxycodone, codeine and morphine. Yes you heard it correctly, codeine. The drug that you can readily buy over-the-counter in a pharmacy in the form of co-codamol – a combination of paracetamol and codeine. The term “opioid” comes from the word “opium”, a chemical that comes from opium poppies. For thousands of years, opium has been used to treat pain. And through the years, people also have used and abused it for pleasure.
These medicines are extremely effective painkillers and are generally prescribed for moderate to severe pain such as post-surgery pain or end of life care. Although opioids are effective analgesics for acute pain and end of life care, they are of limited use for long term chronic pain. Side effects are very common and a lot of patients taking opioids long term have developed a dependence on them.
Long term - Dependence is a huge issue with this group of medicines – the term “the opioid crisis” describes exactly that. Many people will take codeine over the counter to manage pain or cough on a long term basis unknowingly developing dependence. Furthermore, many patients will take opioids prescribed by doctors incorrectly with the conception of it being “safe” - again resulting in drug dependence.
Opiates can give the sense of “euphoria”. However, with long term use, the body becomes tolerant to the drug and patients feel the need to keep upping their doses to get the same feeling which can lead to overdose.
Overdose – Overdosing on any opiate is extremely dangerous and fatal.
How to avoid dependence – Most people will take opioids and will be completely safe. It is important to remember that as long as you take your medicines as prescribed by your doctor or advised by your pharmacist and you do not share your medicines with anybody, your chances of developing long term complications are low.
It also helps to monitor your pain and to know when you can swap your opioid to a milder pain management regime. Finally, always know your risk factors! There are certain groups of patients that must use opioids with caution, such as previous history of drug use, patients with psychiatric problems, family history of drug abuse and alcohol abuse.
If you have any questions about pain management, drug dependence or psychiatric support, please contact our pharmacist for friendly and confidential advice on 0208 630 1244.