‘Respectable Addiction’ - A qualitative study of over the counter medicine abuse

[chugs]

The actual study is too large quote but its quite interesting. Mods feel free to merge with the mega codeine thread if you feel its appropriate.

I like how the respectable addicts despite seeking help to manage their addiction all felt availability should be maintained. Its nice to see a study that doesn't demonise codeine as is the case in Australia and the recent scheduling changes.

‘Respectable Addiction’ - A qualitative study of over the counter medicine abuse in the UK

The majority of participants across all three groups were in favour of the continued availability of OTC codeine and
other medicine, ensuring the public had the ability to choose, as long as addiction risks were made clear. An
apparent tension exists between offering medicines that can potentially cause harm, whilst ensuring medicines are
available for those who wish to use them. Raising awareness of OTC medicine addiction is recommended, together
with improved treatment and support options

The study can be found here

 

[chugs]

lol, those damn kids. i guess its a perception that "drug abuse" is immature practice but each to their own bigotry.

In terms of the internet being a source of information, the main concern centred around the provision of information
either about products that could be abused, or more technical information about ways of extracting active ingredients
such as codeine, from co-ingredients such as paracetamol. As one stakeholder noted:

“Now if you go on the websites you’ll find kids putting up on, I don’t know if it’s called Facebook or
some of those social chatrooms, you will find that they advise you to crush them, several tablets
probably in a pestle and mortar. Grind them as fine as possible into a powder. Shake the powder
with moderately hot water, the codeine preferentially dissolves the Ibuprofen preferentially
precipitates. Filter it through a handkerchief and drink the residue which is predominantly codeine.
It’s there on the internet. So the street abuse is already well known.”

 

[DeathDomokun]

Thanks for the link

 

[Sustanon]

Great link but man I really hope it doesnt get too much attention. Its great to have an OTC pain reliever and on the occasion a bit of recreational use within moderation. Im just imagining the poor people who suffer from a great deal of pain constantly and how much hassle itd be to go to the doctors just for a script. I mean im sure there are heaps of people who have long term pain on and off even where the doctors recommend buying your usual pain killers and for them not having to prescribe something like 30mg fortes. On the side note saw a huge pack of fortes at my grandparents place, was quite tempted but then realized whats the point of risking when a whole box of otc would yield the same as taking a blister pack LOL I really think the government should focus all its attention on illicit drugs mainly heroin and ice. Those two are the ultimate destruction substances and sometimes more easier to get than your otc at pharmacies. Can buy drugs 24/7 pretty much anytime with one phone call. At least the otc meds are controlled and wont have people OD-ing or getting ill from a bad batch or something even worse.

 

[Crankinit]

Interesting to finally see CWE's pop up in research.

“Now if you go on the websites you’ll find kids putting up on, I don’t know if it’s called Facebook or
some of those social chatrooms,

lol I bet he wakes up at 4:30am, wears his pants over his nipples and yells at kids to get off his lawn too.

 

[Busty St Clare]

Im just imagining the poor people who suffer from a great deal of pain constantly and how much hassle itd be to go to the doctors just for a script.

As you all probably realise I couldn't give a shit about availability for addicts to this product, but from a professional point of view it would be tragic if we lose codeine as an otc product. Having patients fill up your book simply for a script is ridiculous and simply hurts the rest of the practices patients who need that appointment. I have a flat $60 consult fee partially to cover costs but also to discourage script shoppers.

 

[chugs]

Great link but man I really hope it doesnt get too much attention.

not sure I get you there Sustanon.

interesting article though especially where they talk about how much these people were using. Seriously I calculated one women was eating 32grams of ibuprofen a day for several years! I can't believe she's still alive.

 

[Sustanon]

not sure I get you there Sustanon.

Yeah your right, most people know about it anyway, I just wish all this talk about it in forums and other place wouldnt happen so often = less likely to get attention and then you know what happens.

 

[Mr Blonde]

Interesting to finally see CWE's pop up in research.



lol I bet he wakes up at 4:30am, wears his pants over his nipples and yells at kids to get off his lawn too.

Yeah that's the same thing that instantly popped into my head!

Chugs: Thanks for posting this up, I'm going to bookmark to read later for now. :D

Yeah your right, most people know about it anyway, I just wish all this talk about it in forums and other place wouldnt happen so often = less likely to get attention and then you know what happens.

Pharmacists would be devastated if OTC codeine were banned, community pharmacy is an industry on it's knees as it is and you can stand in a pharmacy and watch all day and see that usually quite a large number of their customers come in for these OTC codeine products. I've talked to a few pharmacists about their views on the issue, they all recognize the potential for abuse but almost all of them did not want to see a ban.

 

[Sustanon]

Pharmacists would be devastated if OTC codeine were banned, community pharmacy is an industry on it's knees as it is and you can stand in a pharmacy and watch all day and see that usually quite a large number of their customers come in for these OTC codeine products. I've talked to a few pharmacists about their views on the issue, they all recognize the potential for abuse but almost all of them did not want to see a ban.

The problem is the pharmacists will have no control over the ban, no matter how many people protest against it. It kind of sucks, no democracy in said situation.

 

[Mr Blonde]

^ The Pharmacy Guild of Australia has a relatively large degree of autonomy, thanks to how they negotiate and work with the government with the 5 year agreements they make. When we had the schedule change a couple of years back, that was largely due to the Pharmacy Guild pushing for the products to be made Schedule III. They don't get to make the final decisions but they do have a large say in how things should happen. They also help to keep pharmacies out of supermarkets, which would be the final blow for the community pharmacy industry in my opinion. Plus, I think that if we already had pharmacies in supermarkets then there would be less resistance from pharmacists to keep codeine as it is scheduled now.

 

[chugs]

i wish pharmacies would talk up about interactions. for example i never knew that with APAP alcohol made it far more toxic to your liver. Sure it says not to mix alcohol but not because of toxicity but rather due to drowsiness. from the study I read none of the respondents knew that eating several grams of ifburophen

i'm surprised that the drug company doesn't have to note this effect.

For example I've never heard a chemist tell me not to drink grape fruit juice when i'm eating my codeine forte tablets for my headaches.

 

[Dr Phibes]

for example i never knew that with APAP alcohol made it far more toxic to your liver. Sure it says not to mix alcohol but not because of toxicity but rather due to drowsiness.

When I heard this recently I was really surprised. Taking Panadol the morning after a big night on the booze should be warned against. "not to be taken for hangovers" printed on the pack.

 

[Sustanon]

For example I've never heard a chemist tell me not to drink grape fruit juice when i'm eating my codeine forte tablets for my headaches.

I doubt they would want to give you ideas on how to potentiate it.

 

[Halif]

community pharmacy is an industry on it's knees as it is and you can stand in a pharmacy and watch all day and see that usually quite a large number of their customers come in for these OTC codeine products.

I like it when I find a pharmacy which does away with pretenses: I order a pack of codeine, I automatically get given a large box. I pay for it and leave. No token questions or recording of details.

It's just a business transaction like any other product, where we both get what we want, the way it should be.

 

[KillCops]

does this make sence to anyone else: i think they put the codiene cintaining pills out OTC actualy expecting people to do CWEs if they are buying them for the codeine and not the ibeprofen or acetaminophen. because the recomended dose it says to take on the box does not contain enough codeine to do anything recreationaly OR for pain relief. the companies know this and they use there product as an excuse to sell codeine legaly knowing that the people that know what there doing will do a CWE and the people that dont will take the recomended dose and get the pain relief from the ibeprofen and assume the codiene must be helping too.

and then theres to people like the lady that took 32 grams of ibeprofen a day because she wasnt aware of CWEs wich did alot of harm to her body.

 

[L3inad]

does this make sence to anyone else: i think they put the codiene cintaining pills out OTC actualy expecting people to do CWEs if they are buying them for the codeine and not the ibeprofen or acetaminophen. because the recomended dose it says to take on the box does not contain enough codeine to do anything recreationaly OR for pain relief. the companies know this and they use there product as an excuse to sell codeine legaly knowing that the people that know what there doing will do a CWE and the people that dont will take the recomended dose and get the pain relief from the ibeprofen and assume the codiene must be helping too.

and then theres to people like the lady that took 32 grams of ibeprofen a day because she wasnt aware of CWEs wich did alot of harm to her body.

I'm not sure if the relative ineffectiveness of low dose codeine formulations is really that well known to professionals. Pharmacists seem pretty oblivious to this, so do my pharmacology lecturers.

I've only seen the one study that indicates that OTC doses are more placebo than anything else. But really the manufactures SHOULD be very aware as at some point in time they would have had to of done Phase III clincal trials for efficacy and came to this conclusion. But manufactures are out to make money, and if the government is happy keeping these products OTC then they'll keep selling them knowing fully what they're used for.

 

[Mr Blonde]

i wish pharmacies would talk up about interactions. for example i never knew that with APAP alcohol made it far more toxic to your liver. Sure it says not to mix alcohol but not because of toxicity but rather due to drowsiness. from the study I read none of the respondents knew that eating several grams of ifburophen

i'm surprised that the drug company doesn't have to note this effect.

For example I've never heard a chemist tell me not to drink grape fruit juice when i'm eating my codeine forte tablets for my headaches.

Several grams of ibuprofen... what?

The reason they don't warn you about grapefruit and codeine is because, when taken as directed, it is not a real danger at all. There are some medications were there can be a significant due to grapefruit consumption, some that spring to mind are certain statins, anti-arrhythmic drugs and calcium channel blockers. Pharmacies have stickers warning against grapefruit consumption for drugs where there have been serious adverse affects.

I agree though that perhaps there needs to be a warning on the packet about combining alcohol with paracetamol.

I like it when I find a pharmacy which does away with pretenses: I order a pack of codeine, I automatically get given a large box. I pay for it and leave. No token questions or recording of details.

It's just a business transaction like any other product, where we both get what we want, the way it should be.

That's the way many of us would like it, I'm sure, but most of this over-zealousness comes down to how people are trained regarding these transactions. Some pharmacy assistants will be trained to treat codeine buyers the same as people asking for pseudoephedrine, others are a lot more relaxed.

Some questioning is also necessary; for example, to detect drug interactions which could potentially be serious. For a while I was taking ibuprofen alongside my propranolol until a pharmacist, after asking me if I took any other medications, warned me that doing so could have adverse effects on my serum potassium levels.

We have all been in situations where the questioning and treatment is out of line though, and it annoys the hell out of me as well.

 

[Sustanon]

Yeah thats the way we all prefer it, I sometimes get pretty annoyed with them asking the same questions over and over again, some places know me all to well and dont even bother asking. My tiny favorite little chemist not far from me automatically reaches for the 2 large boxes without me saying anything LOL at the end of the day if people are sensible about it and are well educated then its our responsibility. I think most of us are way more educated regarding codeine than most pharmacy worker. One day my favorite brand sold out and the lady recommended me something else saying its the same thing. I had to explain to her the difference between ibuprofen and paracetamol. She didnt have much clue about.

 

[tyrael]

^ The Pharmacy Guild of Australia has a relatively large degree of autonomy, thanks to how they negotiate and work with the government with the 5 year agreements they make.....

Interesting M_B. I'm interested to know, even with how much negotiation there may be between The Guild and Government, how much weight/power does the The Guild in fact have? You can see it all the time in terms of Government areas employing the help of experts and still not actually take said advice on hand! (*cough cough, Conroy, filter, cough* 8) ).

Tbh, and this is imo, I personally wouldn't be surprised if the OTC codeine accessibility was reduce, put up a schedule, or something of the like.

.....
I agree though that perhaps there needs to be a warning on the packet about combining alcohol with paracetamol.
....

Umm, explain?! There is absolutely no drug interactions with paracetamol and alcohol. Unless you mean in terms of how doctors/pharmacists say don't drink and take antibiotics - again there is no drug interaction between (most/majority of) antibiotics, it's said purely on the fact that, in order to be taking AB's in the first place the PT's immune system must already be compromised, that then coupled with ingesting another drug (alcohol), going out to night clubs, etc, etc.

Yeah thats the way we all prefer it, I sometimes get pretty annoyed with them asking the same questions over and over again.....

Haha, agreed. I reckon we should be given the option of taking a test which in the end gives us a coloured card which signifies our level of med/pharma/etc knowledge. So for instance, if you're at level yellow, you're not asked those annoying basic questions about ibuprofen and such. lol