Drink and Drugs News October 2016 | Page 9

‘... bouts of low mood and panic attacks had eased since starting her painkillers.’

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POST-ITS FROM PRACTICE

HEALING THE HURT

Taking painkillers can mask issues that are nothing to do with physical pain, says Dr Steve Brinksman
‘... bouts of low mood and panic attacks had eased since starting her painkillers.’
LIKE MANY MODERN GP GROUP PRACTICES, ours has GPs with specialist interests. One of mine is rheumatology and it was in this role that I met Maria. She was 43 and had been diagnosed with rheumatoid arthritis four years ago. She had a lot of joint pain and was started on co-codamol 30 / 500( 30mg codeine and 500mg paracetamol in each tablet) She was taking these regularly, so slow release dihydrocodeine was added in and titrated up to 120mg twice a day with Oramorph( liquid morphine) for breakthrough pain.
After seeing a consultant rheumatologist she was started on methotrexate, a disease modifying anti rheumatoid drug( DMARD), and was being seen in our clinic so that this could be monitored.
On examination I could find no signs of active joint inflammation and noted this had been the same the last couple of times she had been seen. When the possibility of reducing her analgesia had been suggested before, she said she still needed it. When I asked her about this, she told me that she felt much better in herself when she took her medication and worried that she would be‘ bad’ if she didn’ t. She explained that she had previously had bouts of low mood and panic attacks, which had eased since starting her painkillers, and that the Oramorph was now mainly used when she was anxious.
There wasn’ t time to explore this further, but she agreed that I could book her another appointment to follow this up.
A week later she told me about growing up in a home where her father had been very controlling and frequently demeaned and verbally abused her mother, and to a lesser extent her. Her panic attacks had significantly worsened after the death of her mother eight years ago and she agreed that the opioids were not really being used for her RA pain now but to deal with her mental health issues.
A referral for CBT was arranged and we discussed how best to deal with her medication. She felt it would be difficult to slowly reduce what she was currently taking as she felt out of control with the Oramorph, and the decision was made to start her on buprenorphine. This has been titrated and she has stabilised on 6mg, which we are going to start slowly reducing while continuing her CBT.
Maria is a reminder that opioids are not only good painkillers but have psychological effects as well, and life events that can increase the risk of illicit drug use can also make dependence on prescribed medication more likely. The key is assessing these at the outset and using ongoing monitoring to try to avoid strong opioids from readily ending up on repeat prescriptions.
Steve Brinksman is a GP in Birmingham, clinical lead of SMMGP, and a member of the Opioid Painkiller Dependence Alliance, www. opdalliance. org

MEDIA SAVVY

The news, and the skews, in the national media
THE LAWFUL PHARMACEUTICAL INDUSTRY in the United States is the most insidious, vile and addictionprovoking monster of its type on the planet. Until it is properly confronted and curtailed, the migration of addicts from legal highs to heroin hell will continue at its fast and furious rate. My
real wrath [ is ] aimed squarely at every politician and doctor who has enabled this horrendous scourge on society by encouraging Americans to medicate themselves in such a disastrously excessive and unnecessary manner. They’ ve created a real life Walking Dead. Piers Morgan, Mail, 9 September
THE NHS HAS NEVER BEEN GOOD at engaging with excluded populations and delivering services to challenging individuals. Offenders, the homeless and people with fragile mental health, as well as drug users, often have no GPs, make themselves unwelcome at A & E departments, and miss appointments, and the complexity of
their health needs is ill-matched to a system structured around specialities. Too often the very people who need the NHS most are those least able to navigate its various pathways. Paul Hayes, Guardian, 9 September
WHILE [ RODRIGO ] DUTERTE’ S OBSESSIVE WAR on narcotics may be horrifying to an international audience, for many Filipinos – even those ambivalent to his presidency – a‘ some action is better than no action’ stance has made a welcome change of pace … Duterte’ s victory came as the Philippines’ drug problem was becoming so endemic that a firebrand, cartoon character of a president taking a sledgehammer to the issue became a reasonable gamble … Duterte’ s mass execution of the low hanging fruit in
the Philippines drug trade will serve only to highlight how drugs have filled the vacuum created by successive governments. Filipinos did not vote for Duterte; they voted for a jab at the establishment that has, for the past five decades, consistently let them down. Joanna Fuertes-Knight, Guardian, 16 September
WHY DO SUCKERS ALWAYS FALL for the claims of ' medical cannabis '? Its advocates are invariably mixed up with the lobby for general legalisation … Cannabis may make some people feel better, but so did Thalidomide. A drug correlated with severe mental illness may just not be the ideal miracle cure. Peter Hitchens, Mail on Sunday, 18 September
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