h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

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Write to your MP, and check out if there are any groups getting together to campaign against it's withdrawal. Based on the justifiable anger with which you wrote this, it's likely that you are not the only person in this situation.

taking the drug off the market because people used it for suicide seems exceedingly odd. If, on the other hand, there were clear evidence that the drug induced suicidal depression a withdrawal would be worthy of consideration.

Is it truly a case of it just being a drug of choice for suicides? If so, what will become of razor blades in Britain?

The Doctor, I'm only a final year medical student, so I'm not going to offer advice, but *please* go and see your doctor, and discuss your options for pain relief.. there may well be something available that you haven't tried yet.

If you're prescribing drugs for pain then you keep trying new drugs until you find one that works, once you find one that works you don't keep trying new ones.

Co proxamol isn't the strongest drug available and it isn't the last resort, so there *must* be some that you haven't tried that.



Z

This is drug is one of the most effectively, but also widely prescribed, painkillers.

It stands to reason that people will use a strong 'fairly' easily available painkiller to do the job.

http://news.bbc.co.uk/1/hi/health/4221829.stm

"The risk of death associated with co-proxamol overdose seems to be higher than for either tricyclic antidepressants or paracetamol."

- tricyclics are less prescribed in favour of SSRIs these days and education about paracetamol dose has moved people to look for a quicker way to OD.

"Data shows fatal overdoses due to co-proxamol are the second most frequent means of suicide with prescribed drugs in England and Wales, accounting for up to 400 deaths each year." - 400 is a low number really.

I agree that it is an odd decision, but it has made for a reason.

You say you have been on it for many years and it was the only thing that helps your arthritis. When was the last time you tried something new? There are new meds available and if your GP is 'senior' it might be worth seeing a 'fresher' one that has experience of some of the newer drugs. (I am in no way meaning to patronise you)

I have had it prescribed for me for a vertebral problem which is agonising and it was indeed very effective unlike paracetamol which didnt touch it.


"As for the people who have committed suicide with this drug? Firstly, I am glad you wasters are dead. Your insane acts have ended with this, and even though I never knew you, your act is directly impacting me. I would like to say that I hope you died violently you inconsiderate pathetic losers, but as you are already dead there seems little point."

Angry as you may be - you out of order making comments like this.
As someone who obviously suffers constantly with arthritis, I would have thought you might have had some understanding on how being in permanant pain feels. Mental pain is just as unbearable as physical pain so don't make such nasty comments please.

As I said, I agree with you that it does seem a strange decision but take it out on your MP. That's what they get paid for.

From the following address: http://medicines.mhra.gov.uk/aboutagency/regframework/csm/csmhome.htm

More information. It appears that on the basis of 52 (Yes, JUST 52)responses, they are banning the drug I use. Only 3 patients appear to have been asked.


Following a 12-week exercise to gather further information on the risks and benefits of the painkiller co-proxamol UK Ministers have decided to accept the advice of the Committee on Safety of Medicines (CSM) that co-proxamol should be withdrawn from the market over a period of time. A letter was issued on 30 June 2004 with a deadline for comments of 22 September 2004. It was circulated within the health services, to interested organisations and officials in the Scottish Executive, Welsh Assembly and Northern Ireland (devolved administrations). A copy of the letter appeared on the MHRA’s website. The MHRA has received a total of 52 responses, which can be broadly categorised as follows:

Royal Colleges 7
Pharmacy interest 4
Replies from specialist pain bodies 3
Medical interest 9
Patients 3
NHS 12
Other bodies 6
No comment 8
TOTAL 52

The information gathered during this exercise provided no new objective evidence concerning the risk:benefit of co-proxamol, and opinion was broadly divided between prescribing advisers and front line clinicians, mainly GPs, rheumatologists and pain or palliative care specialists together with patients currently using co-proxamol. The Royal Colleges and other prescribing advisers were unanimously in favour of withdrawing co-proxamol, whilst current prescribers and patients tended to favour its continued availability. All respondents recommended that there should not be immediate cessation of the product on the market, as controlled management and patient care would be necessary. To help informed debate on the issues raised by this consultation exercise, and within the terms of the code of Practice on Access to Government Information (‘Open Government’), the Agency makes copies of comments received publicly available.

From the article:
>>"Measures have already been taken to address concerns about the medicine, including making advice more prominent on the packaging.
But they have failed to reduce the number of fatalities, according to experts."

Well, if the fatalities were due to suicide rather than accidental overdose, what did people actually expect new labelling to achieve?

It does seem the 400/year esitmate for suicide deaths using co-proxamol is very high, compared to the national total of 4-6000 recorded suicides from all causes, even trying to allow for the fact that people suffering chronic pain are presumably among one of the high-risk groups for suicide.

I can see that if some people can be treated adequately with other medications, then reducing national use of co-proxamol seems an understandable aim. However, if there are some people for whom it's the best treatment, it does seem unfortunate if it is completely withdrawn. The problem is, below a certain level of demand, who is going to bother producing it.

Mort

I have tried other drugs, and everytime I have done so in the past the simple act of walking and driving became agony. I am 47, have had four total hip replacements and discovered two weeks ago that the last one (done in 2001) is gradually pushing down in the femur and is fracturing the bone. I have been walking aroun on a broken leg in essence for the last six months apparently.

Without pain relief, I cannot describe the accute pain that I get in every single joint in my body, 24 hours, seven days a week. My life is only ever under my control when I take these drugs and I do feel very violent when somebody who I have never known kills themselves and then it impacts on me. I did not ask for this vile disease, and you may have guessed that coupled with the news that I have to have yet another total hip replacement and then finding that the pain killer is about to be banned is really putting me out on the edge.
Try being in pain for the vast majority of your life and see if you manage to stay rational at all times............

"Following a 12-week exercise to gather further information on the risks and benefits of the painkiller co-proxamol UK Ministers have decided to accept the advice of the Committee on Safety of Medicines (CSM) that co-proxamol should be withdrawn "

My interpretation is that the CSM had recommended its withdrawal and then they did the feedback survey with 52 replies. This survey was info gathering and not instrumental in the original recommendation

I am furious too, its the best thing for my back pain. I don't take it every day, but when things get worse, its always there, not for much longer though.

As an asthmatic who is meant to avoid all aspirin and ibuprofen based drugs, this doesn't leave me with a lot of options.

I know it react very badly with alcohol, which is their main concern. So to pander to people who can't tone down the drink, or even stop drinking for a while, we all have to lose out.

I can't quite figure out what the equivalent of this drug is here in the US -- is this something like percocet? Part narcotic, part acetaminophen/paracetamol?

There have been talks about pulling percocet off the market here -- not because of suicides (although it is used for that), but because there has been a susbtantial illegal market for it, and it's now used as a chaser for heroin or cocaine or something.

They decided not to, though, although recent court cases against doctors for giving out inappropriate prescriptions for it have made docs a little more wary -- my doc goes through all sorts of stuff with me about not leaving it where anyone else could take or steal it, etc.

I'm also allergic to all of the aspirin/NSAID-derivatives (including the COX-2-inhibitors, ibuprofen, naproxen, etc) -- but I've certainly never run out of pain medications here in the US that I'm not allergic to. Are there fewer options available in the UK, or is it more that people get very emotionally wedded to the option they are using?

I know I'd be peeved if they suddenly took tramadol off the market, and would be calling my representatives and whatnot, but I know there would still be lots of options out there to try.

I've been a bit worried about posting to this because I don't want to give medical advice.

Co-proxamol is a combination of week opiod codine and paracetamol, there are *lots* of other simalar preparations that aren't banned (including Tramadol).

There are lots of other drugs to try, even if you are allergic to the asprin/ibuprofen class. If it really is the only drug that works there's nothing to stop your GP prescribing the codine and paracetamol in two seperate tablets.

The thing about co-proxamal is that it's ing deadly if you over dose! Hear in the UK it's one of the most popular drugs used by doctors when they want to end it all.

*Declaration of competing intrests one of my tutors is on the CSM.

I can understand why people are upset and worried, but *please* please please talk to your GP before you panic or get upset. I'm 100& sure there are other drugs out there that you could use.

If you think about it when you are trying painkillers, you try all of them until you find one that works, if you find that drugs X and Y don't work, but drug Z does, you aren't going to try drug V to see if that works.

I'm concerned about the principle here. The problem appears to be deliberate suicides, not accidental ones. So which drug is the no. two favourite? Will that be banned next?
We already have over the counter sales of aspirin & the like restricted to make it more difficult to accumulate the necessary quantity to do oneself harm.
As someone has already said, what else will be banned to prevent people harming themselves? If someone is really wanting to end their life, they'll find a way to do it & wouldn't it be better for everyone concerned that it is not too messy?

If someone is really wanting to end their life, they'll find a way to do it

That's what I thought, but it seems that if you take away a means to kill yourself in the comfort of your own home less people will kill themselves *overall*.

For most people who take overdoses it's an impulsive action, if you take away the means to overdose less people will over dose.

Sucides fell when you stopped being able to buy paracetmol and asprin in large quanity packets.

Sucides fell when natural gas replaced coal gas and it became impossible to put your head in a gas oven.

The problem with doctors and pain medications is that far too many don't understand the relationship between pain, the amount of medication required for someone experiencing extreme pain as opposed to someone experiencing mild pain, and the relationship between unsolved pain problems and addiction/side effects.

When my ex was in the military, he had knee surgery which left him in agonizing pain. Instead of appropriately medicating him for the amount of pain he had, the response was "If we gave him any more he'd be all "hopped up"!" The better solution, as they saw it was that he experienced incapacitating pain than that he was "comfortable".

What they didn't understand was that people in extreme pain have a higher tolerance for pain medication, and require more, in order to end the pain than the person who has mild pain.

I was listening to an interview with a doctor who has made it his career to study pain and pain medication in order to help those who have chronic and/or debilitatin pain. He said that his "wake-up" came many years before when he had a patient who was suffering from severe pain after surgery, for a condition which had been causing years of pain. He prescribed morphine in the normal, "recommended" dosage. A few minutes after the nurse administering it, she suddenly realized that she had, in fact, given the patient what should have been a lethal dose. They grabbed a crash cart and ran into the room to find the patient sitting up and reading a magazine. When the situation was explained, he said "I have never felt better in my life."

He said that that was when he realized that dosages needed to be geared to the amount of pain, not to an abstract, pre-determined limit.

He also had conducted studies which found that addiction occurred overwhelmingly in patients for whom pain was not sufficiently reduced or eliminated.

Another aspect is the idea that people who are dying, in chrionic situations where pain is so debilitating that it affects their psychological well-being, and/or for whom there is no other satisfactory solution should not be denied the medication solely on the basis that they "could become addicted", that the medication might have undesirable side-effects, or that they could become "depressed". In fact, patients for whom pain medication is either denied completely or adequate amounts are not prescribed are more likely to become suicidal.

Clearly, in this case, the fac that the medication could cause someone to become depresssed or suicidal needs to be of concern. However, if there is no other alternative available and the patient is in danger of becoming depressed and/or suicidal as a result of the pain, surely it should be considered more important to use the medication in concert with monitoring of the patient's mental health (which, in situations of chronic and debilitating pain, should be monitored, anyway). This is, of course, aside from the fact that AIDS and other patients with terminal illnesses should not be denied "experimental" medication on the grounds that "it could kill them".

>>"So which drug is the no. two favourite? Will that be banned next?"

Co-proxamol is the number two favourite:
http://bmj.bmjjournals.com/cgi/reprint/326/7397/1006.pdf

There was an article in last week's New Scientist (unfortunately not available online) regarding pain relief and opiates, giving the opinion that much of the anti-opiate feeling is political rather than medical, with the US being possibly one of the most restrictive countries.

Even for people taking opiates for reasons other than pain relief, actual addiction was reckoned to be rather less common than most people would think, but anything (even the medical truth) seen to dampen down the "Drugs hook everyone instantly" message isn't considered acceptable in some government circles.

There is a difference between dependancy on a medication for pain relief and hopes for a life in which you can participate more fully.

An addiction that is evolving into an increasing psycological and physical problem is quite another topic and problem.

Without help, severe pain is quicker at making you sucidal, driving off help and creating depressions by not participating in life with a relatively predictable day of semi- comfort.

If a person is suicidal they will find a way.
It does not require narcotics to do so either.
Many a person has combined alcohol or used it alone to destroy themselves. Never has there been a suggestion to take alcohol off the market or subscribe by prescription. It is recommended as a healthy thing to do in moderation. How many doctors can take the time and monitor it or mixing it with medications. They are going to start screening for alchohol in the US during routime exams because of the complications.

There is no reason to be cruel to those having severe daily pain because a few patients chose this exit method. Far more people are given some of their life back by relief of pain than lose it trying to relieve pain.

If a medication is likely to cause an overdose it should be and IS carefully explained and monitored. Anybody that abuses attempts at relief is quickly eliminated as a candidate for these medications. In the US the doctors and patients are carefully monitored.

Just as many people kill themselves off my not taking prescribed medications. They are not prosecuting the doctors for what they do not do or witholding life insurance money for not following directions. The same should go for what a patient may do if all the rules were followed by the doctor.

It is often said the drug war in the US has adversely affected patients and doctors more than the criminal element it is intended to stop.

I can accept that Z, but I'm still dubious about where you draw the line between helping people with an effective drug & stopping people abusing its use.

On the question of pain relief, professional opinion seems to be that pain is better relieved if you can stop it being established. That's perhaps not so easy with a chronic condition, but it does bear out the previous posts about suitable dosage.
Prevention rather than cure as it were.

as always to abbi.

Here's my ten pennorth, for what it's worth.

I get pretty severe pain quite often, i can only take paracetomol, luckily this takes the edge off enough to allow me to either carry on or give up, retire to bed and hopefully sleep for a couple of hours. BUT the second method only works if i also combine it with , so in effect, i am self-medicating with alcohol in combination.

In the past, i have been prescribed anti-depressants and anti-anxiety stuff, ONLY when i was on these did i attempt suicide; though in fairness, i have been known to threaten it at other times...but yes, realising that taking an OD of beta blockers won't work, and that paracetomol is just plain stupid, means that maybe *not* having a handy handful of pills may make you stop and think long enough to not actually go ahead.

If we really and truly want to cut down the number of suicides, we should seriously consider the gun ban thing, 'cos that is such an instant thing, with no possiblity of saying " oh hell, maybe i made a mistake, better get the ambulance!"

*sigh* RIP Kurt Cobain et al.

zdt