Otherside; the NSAID/Codeine addict
Monday, November 23, 2009
I've previously posted about my dislike of Ibuprofen & Codeine combination products. A few weeks ago met an example of my 'doom and gloom' ministrations, Corey.
Corey is thirty and has an addictive personality type. He's loved and kicked amphetamines, marijuana and benzos. He has been employed fulltime in a mid-level job throughout. He started taking Nurofen Plus(R) two years ago, and just over a year ago first nailed a 24-pack in a day. About January, he stepped up to 96 tablets a day, every day.
It was an eye-opening interview; I've only seen this kind of patient through Pharmacist's eyes. After a few minutes of talking with Corey, I asked a whole raft of questions about how many pharmacies he went to, what his usual 'symptoms' were, why he thought he needed so much and what happened when he was denied supply.
The money was never a factor, he said. It was about 'pain' and 'feeling normal'. He visited over forty pharmacies within a fifty kilometre area. If he got denied, he'd just go aroung the corner, returning to the first pharmacy a few weeks later. Corey said that he was rarely questioned about his use; he got denied or lectured a few times and copped more dirty looks than he'd care to remember. But, he said, without the pain killers he'd be in pain. He felt energised when taking them; during our interview, he expressed a desire to take more.
Corey doesn't have good insight, and I'd be pretty guarded about his prognosis. Why'd he even present to the GP? Five nights as an inpatient with Acute Analgesic Nephropathy and NSAID-induced gastritis.
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The Australian Prescriber Magazine produced this well-written article article on Drug-induced Kidney Disease.
Most importantly, if you are concerned about your use of NSAIDs or NSAID/opioid combination products, or if you regularly take greater than the maximum recommended dosage, please see your doctor.
Corey is thirty and has an addictive personality type. He's loved and kicked amphetamines, marijuana and benzos. He has been employed fulltime in a mid-level job throughout. He started taking Nurofen Plus(R) two years ago, and just over a year ago first nailed a 24-pack in a day. About January, he stepped up to 96 tablets a day, every day.
It was an eye-opening interview; I've only seen this kind of patient through Pharmacist's eyes. After a few minutes of talking with Corey, I asked a whole raft of questions about how many pharmacies he went to, what his usual 'symptoms' were, why he thought he needed so much and what happened when he was denied supply.
The money was never a factor, he said. It was about 'pain' and 'feeling normal'. He visited over forty pharmacies within a fifty kilometre area. If he got denied, he'd just go aroung the corner, returning to the first pharmacy a few weeks later. Corey said that he was rarely questioned about his use; he got denied or lectured a few times and copped more dirty looks than he'd care to remember. But, he said, without the pain killers he'd be in pain. He felt energised when taking them; during our interview, he expressed a desire to take more.
Corey doesn't have good insight, and I'd be pretty guarded about his prognosis. Why'd he even present to the GP? Five nights as an inpatient with Acute Analgesic Nephropathy and NSAID-induced gastritis.
---
The Australian Prescriber Magazine produced this well-written article article on Drug-induced Kidney Disease.
Most importantly, if you are concerned about your use of NSAIDs or NSAID/opioid combination products, or if you regularly take greater than the maximum recommended dosage, please see your doctor.
How long would it take to obtain all those meds on a daily basis? Seems like a huge hassle.
Oh btw, our blog adddress changed. It's now http://iddxblog.blogspot.com
you write:
"It was an eye-opening interview; I've only seen this kind of patient through Pharmacist's eyes....
That sort of discussion should be occurring with the patient at the pharmacy when it is noticed he is buying them regularly. There are many reasons for this. One is pharmacists are remunerated only for selling drugs, not keeping people well
Robbo,
I absolutely agree; as you know, this is one of the ongoing dilemmas from a pharmacy perspective; the patients will doubtless seek medication from other locations.
For owners, it's even more of a conundrum; do you turn away your most regular customers, turn a blind eye, or find a safe, happy (and profitable) medium?
Often a policy of 'drip feeds' is often negotiated, in order to establish some sort of trust and a therapeutic relationship with the patient, whilst enabling them to return to the pharmacy frequently, but appropriately.
I'm an advocate of this strategy, and of the opinion that a patient will take help when they're ready to receive it. That being said, I've also been in the position of labelling 24-packs for patients whom are trying to monitor their usage.
This interview completely put paid to the 'drip feeding' idea as a way of reducing overuse; 'Corey' had such a deal at several pharmacies, used different names, addresses, the works.
I'm certain that this isn't a unique occurrence; it opened my eyes all the wider to the frank and misguided deception that patients are willing to engage in to obtain the Codeine/Ibuprofen combination.
It appears that there's little way, irrespective of how much questioning occurs, that pharmacists can adequately restrict large, dangerous amounts of Nurofen Plus being purchased or consumed.
Through diligent practice, Pharmacists can make some difference, but legislative changes must be at the core of any ongoing safety measures; the harder Codeine is to obtain, the harder it is to abuse.
More importantly, I believe that reducing ease of access will reduce new addictions, c.f pseudoephedrine/Project Stop.
Pharmacists, owners and pharma-companies all have a role to play in preventing poor outcomes such as Corey above.