Bitter pill of assessing the gain/pain balance

It is now almost a week since some major changes to strong painkillers were introduced and there are still some highly polarised arguments about whether it is working or whether it was necessary at all.

In one sense this comes down to the different positions on regulation, whether we delegate some responsibility to those with more expertise than ourselves, trusting they are working for our own and the greater good or whether this is just one more instance of excessive control removing individual choice.

The disruption of these changes will affect individuals who sporadically or even more regularly like to have stronger pain relief on hand but there is a bigger picture of what was intended. First is the consideration having stronger pain killers freely available for common ailments creates a dangerous temptation to simply  pop a pill and ‘soldier on’. The problem with such masking agents is that they often fail to target the cause, while removing the pain that is the symptom equally discourages the patient to do something more substantial about it; namely consult a doctor as to its cause and if there is better treatment.  “If pain persists, see a doctor” runs the advice but how often is it easier to postpone it with one more pill.

Some, perhaps only a small number, have inadvertently become addicted to these low dose drugs but a much larger number may well use these drugs without full knowledge of their consequence. Codeine is just one drug that was probably once seen as a cure all but has now been discovered to have significant consequences and with this comes the inevitable updating of advice and restrictions.

It is worth recalling only a century ago drugs such as cocaine and powerful opiates were available across the counter, or on prescription, from pharmacies across the western world. Headache powders fortified with phenacitin, an addictive pain killer linked to an epidemic of kidney cancer, were freely sold in this country until 1977. Cold and flu tablets containing more than 800mg of pseudoephedrine, a precursor that could be used in the manufacture of amphetamine-like substances, were also freely available until 2006.

In all of these cases a growing awareness of their harmful side effects, which often included addiction and death, led to them being banned or heavily regulated. The complaints they were originally used to treat are now being dealt with by equally effective, and much safer, alternatives.