Painkillers and Me

This morning I saw this article from Sophia Irvine, apparently a freelance writer who managed to get this nonsense published by IA.

https://independentaustralia.net/life/life-display/pharmacists-are-overstepping-moral-boundaries,13151

I don’t pay much attention to IA, the articles are mostly poorly researched and there is never any real “news”, just opinion pieces run days after a newsworthy event has taken place.

This article was just more of the same. I found it absolute nonsense.

I have long experience in painkillers containing codeine.

Here goes.

In my younger days, like most young women I knew, I used Panadeine for period pain. I suffered badly from that, ordinary paracetamol or aspirin did nothing, I needed codeine as well.

I never took much, usually two tablets taken together would sort me out and by next day I’d be fine. I didn’t use painkillers much, apart from that, except for very rare tension headaches. A packet of 24 tablets would last me months, maybe a year.

Years later I began to experience severe back pain with accompanying pain down the back of my right leg. My GP and I both knew the likely cause – the return of cancer of the cervix we both thought I had beaten five years earlier. (Note – I had always had regular Pap tests, they had always been clear, but it’s not uncommon for these tests to return a false result). My GP sent me off for scans and tests, my gynaecologist told me my pain was due to me stopping HRT. He was no help at all

None of the scans or smear tests returned a positive result. As it turned out the new tumour was tiny, higher up, wrapped around my spine and nowhere near where anyone was looking.

During the year it took to finally get a diagnosis I took aspirin and codeine for pain relief. I took the strongest tablets I could buy without a prescription – 30 mg of codeine. I used about 6 every 24 hours. My GP prescribed Endone, it was useless. He sent me to a pain clinic, where I was given Epilim (sodium valproate) an epilepsy drug which was supposed to control my pain, plus uppers for daytime and downers for night. None of those helped either.

Eventually I swapped to paracetamol and codeine tablets, still with 30 mg of codeine. This is the same level as Panadeine Forte, back them you could just buy them off the shelf in the chemist – walk in, grab a packet or a bottle of “strong pain” tablets and head for the checkout. In January 1990 I went to hospital for a biopsy and a final diagnosis. They put me back on Endone, saying it was best for “your kind of pain”. When, again, it did nothing the specialist said it was either Endone or morphine, there was nothing else. He assured me morphine was not addictive, but five years earlier I’d spent a few days in a hospital room next to a man who was withdrawing from morphine. He was off his face with withdrawal symptoms. I knew the stuff was addictive and refused it. I had my mum smuggle me in some Pandeine and pretended to take the Endone until they started my chemo. The chemo, meant only as palliative care because they told me I had only weeks to live, months if I was lucky, killed the pain immediately. I went home with a prescription for Endone, in case I needed it.  I never did. I endured four more chemo treatments, one every month, and recovered.

But – there were side effects of that tumour. It had pretty much killed the sciatic nerve in my right leg. Every so often the nerve would try to spring into action and I would suffer random bouts of neuropathic pain. It’s hard to describe. Let’s just say it’s like an electric shock. It comes, it stabs and goes away, only to keep returning every few minutes. It can be excruciating. Your whole body feels the spasm.

This random pain is why I have been relying on painkillers with codeine for almost 30 years. I don’t need them often, can go months without a bad attack, can usually manage mild ones with plain ibuprofen, but sometimes they can last for a few days, or keep me awake at night, and for that only codeine works.

For years I kept buying my paracetamol/codeine tablets off the shelf at the chemist, still using the 500 mg/30 mg mix. Then a government decided the 30 mg variety would no longer be available without a prescription. I started asking my GP to prescribe them but found I rarely used them at all. Just this week I found a box unopened, prescribed in 2014 and past their use-by date. Must have been the last time I asked for a prescription. I chucked them out.  I still bought painkillers over the counter, ones containing 10 mg of codeine, and coped with a lower dose. However to get the same effect as one tablet I used to take I now needed two, so I was taking more paracetamol than I had before.

Then a government decided that painkillers containing codeine would not be sold off the shelf, you had to ask for them and have a chat with the pharmacist before you were allowed to buy them. This new regulation meant I started buying the biggest pack I could – 40 tablets – instead of the smaller packs I used to buy, just to avoid the embarrassment of being asked questions – “Does your doctor know you take these?” “Do you know they are addictive/can increase your blood pressure?” “Do you know you have to stay well hydrated when you take these”. “Have you tried other kinds of pain relief?” Yes was the answer to all those. The interrogation was even worse if I tried to but an ibuprofen/codeine mix, which was actually better for my issue. I stopped trying to buy those, it just wasn’t worth the fuss.

So now I was taking twice as much paracetamol as I once used to take and was buying bigger packs of pain killers. So were many others.

Then about three years ago a government decided that all codeine users were addicts and a register was set up. This meant every time I wanted to buy painkillers with codeine I had to produce photo ID, even though I had been using the same pharmacy for years and was on first name terms with the pharmacists and the staff. I had to wait while the online register was checked, to make sure I had not been shopping around for extra codeine. This meant I held up the line of people waiting to pick up prescriptions, it also made me feel like a criminal. I kept on buying the biggest packs I could, to avoid this process as much as possible.

Then at the beginning of 2018 a government decided codeine was prescription-only. I now ask my GP for a prescription every six months, when I renew my prescription for blood pressure drugs.

There is no requirement for any doctor to write a reason for prescribing codeine on prescriptions, so Ms Irvine is either making up crap when she makes this claim or needs to find a new doctor. I’ve checked the guidelines and while a doctor is supposed to advise on alternate forms of managing pain there is nothing about giving reasons on a prescription

I’m not put through the third degree every time I buy painkillers now. All pharmacy staff have ever said is “I’ll just check we have that in stock” because these days pharmacies tend not to carry big stocks of painkillers containing codeine, and because I am prescribed an unusual dose.

That dose is my doing. When I first asked my GP for a prescription he asked only what strength I needed. I had a bit of a brainsnap and said 15 mg of codeine, so that’s what I get. My new GP just kept on prescribing the same thing when my former GP retired. Both understood why I need to take these painkillers. We have tried other things, like Lyrica, the standard treatment for neuropathic pain, but it did not suit me or my needs. I’m experimenting with folate supplements. Folic acid is said to be excellent for neuropathic pain, but I can’t take it. I have a genetic mutation that means my body can’t process folic acid, instead it builds up and causes an increase in homocysteine levels, very bad for someone with a family history of cardiovascular problems. I take folate instead, but it’s too early to tell if it is helping. I considered other over-the-counter products offered as alternatives to codeine,  like Voltaren (diclofenac) and decided they were not for me because they clash with existing health problems. So it has to be either ibuprofen (I’m aware of the risks) or paracetamol with codeine.

I don’t like taking pain killers. I rely on a magic oil called Be Relieved that is wonderful for muscle pain, headaches and does help with some of the neuropathic issue, but cannot completely kill the pain. I’m a firm believer in the therapeutic benefits of a good cup of tea and a rest. I do not like the drowsiness that codeine causes and will hold off taking it even when I know I need it.

So there you are – I need painkillers with codeine, and thanks to increasing government regulation I now take more paracetamol than I used to and buy bigger packs of painkillers. I don’t think that is what the government had in mind when they started down this road of regulation.

Update – 18 February 2020.

The ABC just had an item on their midday news about Lyrica. As I mentioned, I tried it – took just one pill, it turned me into a zombie, it did not help with the pain and I decided it was not for me. It was prescribed by a GP (not my usual GP) because he said it was better than codeine for neuropathic pain.

Apparently doctors have been prescribing Lyrica – handing it out like packets of Smarties by the sound of things – because it was thought to be non-addictive. That despite its well-known side effects of suicidal thoughts, depression, blurred vision, drowsiness and more.

Well, guess what! Turns out the vile stuff is addictive as hell.

https://www.abc.net.au/news/2020-02-18/lyrica-pbs-drug-linked-to-depression-anxiety/11921882

Just as well I decided to stick with codeine, to which I have never become addicted, despite a few years when I took it twice a day, every day. When that particular health issue was fixed I just stopped taking it, no problems at all.

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