We often fail to realise the risk of painkillers

by Nicky Pellegrino / 20 December, 2016

Photo/Getty Images

We seem to be in a lot of pain, at least if our consumption of drugs designed to relieve it is anything to go by.

In the past decade, use of prescription and over-the-counter opioid painkillers such as codeine has quadrupled in this country. Now there is evidence many people don’t know the risks attached to painkilling drugs available without prescription at pharmacies, supermarkets and petrol stations.

Judy Mullan, a professor at the University of Wollongong’s School of Medicine with extensive experience as a pharmacist, knew anecdotally that people buying over-the-counter medicines rarely considered the side effects. She confirmed her suspicions by doing research with popular drug brand Nurofen, which contains the anti-inflammatory ibuprofen, as well as Nurofen Plus, which blends it with the analgesic codeine.

“Everyone who bought a pack in a pharmacy did a written survey,” she says. “We asked what the active ingredient was, and many respondents answered correctly, although a large proportion thought paracetamol was also in the product. We asked what was the safest maximum dose and a lot of people got that wrong. And we asked about potential side effects and less than half recognised that they had any side effects.”

Researcher Judy Mullan.

Mullan says the people surveyed were well educated and health-literate. She has since repeated the study with Panadol, which contains the active ingredient paracetamol. And she has collaborated with the University of Auckland to do Facebook-based research with Nurofen For Children. Again, half of consumers didn’t realise the drug had side effects.

“Even though all the information is on the packet, people will say, ‘No I’ve had this before, it’s fine.’”

In fact, NSAIDS (non-steroidal anti-inflammatory drugs) such as ibuprofen can worsen asthma symptoms and should be avoided by those with stomach ulcers and sufferers of gastric reflux. They may not be the best choice for patients with kidney disease, heart disease or high blood pressure. Meanwhile, codeine can result in drowsiness and, like other opioids, may be addictive, and too much paracetamol causes liver damage.

“When they are advertised, we’re told they help with headaches, period pain or back pain. None of the advertising suggests we should look out for side effects.”

Mullan found that almost one in five people weren’t sure if they should check with their doctor to find out whether over-the-counter drugs were safe to take alongside prescription medicines.

“The ones in trouble are those with osteoarthritis or chronic pain conditions who are taking their medication diligently as prescribed. Then a friend will recommend an over-the-counter medicine that worked for them and they’ll start taking it not realising it’s a similar class of drugs and it’s putting them over the recommended dose,” says Mullan.

It is particularly easy to overdo paracetamol since it is included in other products, such as cold and flu medicines, and people don’t realise they are doubling up.

“Often if they do get side effects, they don’t make the link with the over-the-counter drug they’re taking.”

There are many different brands of painkillers, and the elderly in particular can get confused. Mullan is collaborating with UK researchers in a study looking at people who inadvertently take a number of different products containing ­paracetamol and ibuprofen.

Some people swallow too many painkillers on purpose. Research at Wellington Hospital found that from 2007-2012, paracetamol accounted for nearly a quarter of overdoses, with most being deliberate self-harm and 8.6% accidental therapeutic overdose.

The answer isn’t to stop over-the-counter sales of painkillers altogether, because of the inconvenience of having to get a prescription for every headache or bout of period pain. Sales of medication containing the mild opiate codeine, such as Nurofen Plus, are already subject to controls, with pharmacists having to consult the buyer, and there have been calls in Australia and New Zealand to ban over-the-counter sales of codeine-containing drugs.

Making other painkillers less freely available is an option – in Sweden, paracetamol can’t be bought in supermarkets. Reducing the packet size and limiting the number of packets that can be sold in a single pharmacy visit have also been touted as solutions.

“I don’t think there is one simple answer,” says Mullan. “But the labelling on packets needs to be clearer and simpler to understand, advertising ought to address potential side effects as well as all the wonderful things these pills do, and doctors need to ask patients if they are taking anything other than their prescribed medication. If you target all these aspects, it might make a ­difference.”

This article was first published in the December 10, 2016 issue of the New Zealand Listener. Follow the Listener on Twitter, Facebook and sign up to the weekly newsletter.

Latest

Lecretia Seales' widower makes his case for death with dignity
103655 2019-03-20 00:00:00Z Health

Lecretia Seales' widower makes his case for death…

by Matt Vickers

Ahead of a report back on the End of Life Choice Bill, Matt Vickers, widower of assisted dying advocate Lecretia Seales makes his case.

Read more
Sid at the French Café to host a special lunch to support Christchurch victims
103751 2019-03-20 00:00:00Z Auckland Eats

Sid at the French Café to host a special lunch to…

by Metro

A special luncheon will be held to raise money in support of the victims and families affected by the Christchurch mosque shooting.

Read more
Tech giants accused of inciting violence for hosting mosque shooter's livestream
103603 2019-03-19 10:23:15Z Tech

Tech giants accused of inciting violence for hosti…

by Vomle Springford

Facebook, Google and other tech platforms are being condemned for hosting the Christchurch shooter's video.

Read more
'We've failed miserably': Critics condemn spy agencies' surveillance strategy
103607 2019-03-19 00:00:00Z Crime

'We've failed miserably': Critics condemn spy agen…

by Phil Pennington

Former Race Relations Commissioner Dame Susan Devoy said the response to Muslims over what they see as a growing threat to them was "diabolical".

Read more
Party leaders saying little on gun law reform
103601 2019-03-19 00:00:00Z Politics

Party leaders saying little on gun law reform

by Gia Garrick

Governing parties are giving no clues on how the country's gun laws will change following Friday's terror attack in Christchurch.

Read more
Test of faith: Does New Zealand have anything to fear from radical Islam?
70722 2019-03-19 00:00:00Z Social issues

Test of faith: Does New Zealand have anything to f…

by Joanna Wane

Almost three years ago, the Muslim community in Auckland welcomed me into their world with warmth, trust and open arms.

Read more
Saziah Bashir: 4 things you should do following the Christchurch terror attack
103634 2019-03-19 00:00:00Z Social issues

Saziah Bashir: 4 things you should do following th…

by Saziah Bashir

What can we do? Where to from here? People have to recognise the Muslim community is grieving.

Read more
Christchurch shooting: How the world is reacting to the terror attack
103651 2019-03-19 00:00:00Z World

Christchurch shooting: How the world is reacting t…

by Ryan J Holder

In the wake of the Christchurch terror attack, there is grief, despair, anger and a righteous sense that things need to change.

Read more