Should codeine be prescription-only?

Joe Boswell writes: Re. “The unaccountable pencil-pushers who want you to suffer more pain” (Friday). Bernard Keane makes several good points about the potentially costly and undesirable consequences of the decision to ban over-the-counter codeine, but there is more. The article quotes AMA vice-president Stephen Parnis claiming the ban is justified because it would prevent “the loss of a young life from the misuse of an addictive medication like codeine”. Oh yes, as ever, won’t somebody think of the children.

Anyway I’m not sure why it’s only young lives that matter, but as the article also points out, people will resort to paracetamol as one of the few relevant over-the-counter medicines left, even though it is not very effective. In recently reported trials it was wholly ineffective and performed no better than a placebo. This encourages users to take more frequent or higher doses in the hope of getting some effect although it is easy to overdose and horribly dangerous. A paracetamol overdose can cause irreversible liver damage and a lingering ghastly death within a week or two. Are deaths from paracetamol more acceptable than deaths from codeine?

Helen Robertson writes: While I think the codeine combination drugs are mostly used responsibly by people and I’m not keen to see them as prescription only, the issues with codeine are wider than just addiction. First, a bit about codeine — it gives pain relief by being metabolised into morphine and people vary (genetically) as to what extent their body does that. In about 10% of the general Australian population the process doesn’t occur at all and they get no pain relief from it (but also are unlikely to over-use it as they perceive no benefit). The percentage of non-metabolisers is a lot higher in those of Chinese background.  This means that, at a population level, the drug can both be addictive and not much use.

Some people do over-use codeine (whether or not they get addicted to it).  An important issue with over-use is the drugs codeine is combined with. Too much Paracetamol (in the Panadeine  tablets) is toxic to the liver, sometimes irreversibly. Too much Ibuprofen (a non-steroidal anti-inflammatory agent) is toxic to kidneys, sometimes irreversibly. People on certain types of blood pressure or heart medication (particularly the classes ACE inhibitors and ARBs) are particularly susceptible. The Ibuprofen type of drug can also cause ulcers and severe bleeding. So the person seeking more effect from Codeine (either because they are addicted or because they have uncontrolled pain) get dangerous side effects from the second component in the over the counter drug.

I think the warnings on the boxes should be much more explicit about these risks, because some people get into strife from simply not realising the risks.

What planet are you on?

Roy Ramage writes: Re. “The 6 ways Australia is lagging behind the global economic recovery” (Friday). If Alan Austin thinks the global economic outlook is so good why are there so many interest rate cuts and why are Europe and America operating on zero interest rates? It is not a matter of what planet Austin is on – he is off-planet!

On gun culture

Geoff Heard writes: Re. “Rundle: John Howard, unlikely American saviour” (Friday). John Howard saving Americans from themselves? Subtle thinking on Guy Rundle’s part.

I am not sure about his suggested evolution of Canadian culture, however. He might be right but hen he might not be.

Worth looking at in respect of the American gun culture is (the sadly late) Joe Bageant, Deer Hunting with Jesus, etc. He wrote strong stuff on this subject. A much reduced and far too simplified notion of what he argues is that at bottom you have the Borderers, the fightin’ Scots brought in from Scotland and Ulster by the likes of Fairfax and Washington et al. Their culture of gun ownership and use has been taken totally out of context and blown out of all proportion.

Well worth the read — and oddly, published in Australia. A lot of his work is still on the internet.

No place for Newman

Jock Webb writes: Re. “Let Troy Newman in” (Friday). Dearie me, John Richardson. There are obviously too many of these idiots here already as you list so elegantly proves. Sorry, mate. I’ll allow the odd dope smoker, reformed heroin user (go Keef Richards) and so on, but those who preach harassment and execution of women, those who bash them up and those who preach hate and violence can get nicked. If Newman were a Muslim he would never have been allowed on the plane. That is enough.

Peter Fray

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