OPIUM OF THE MASSES


A RePORT ON THe MeDICINes We useD, MIsuseD OR ABuseD LAsT yeAR HAs JusT BeeN PuBLIsHeD AND IT MAkes FOR INTeResTING - IF NOT DePRessING - ReADING. IT WOuLD Be MORe ReAssuRING IF I COuLD CONFIDeNTLy sAy THAT THe £444 MILLION OuR HeALTH seRvICe sPeNT ON THe 43.1 MILLION PResCRIPTIONs DIsPeNseD LAsT yeAR RePReseNTeD vALue FOR MONey. THe DATA suGGesTs THIs MIGHT NOT Be THe CAse.


By Terry Maguire I


must firstly state that medicines are an extremely important aspect of modern healthcare and there is compelling evidence of the benefit to society from the availability of a range of safe and effective medicines.


The role of pharmacy, my profession - if anything - must be to support the proper use of medicines, ie, the right medicine for the right medical condition to achieve a definite outcome and, most importantly, to improve the patient’s quality of life.


This is the ideal, but for much of my professional work, the real world proves less than ideal.


In the fiscal year 2019-2020, we spent £229.83 per head of population on medicines, whereas the devolved Health services of Wales, scotland and england spent much less. england spent £161.29 per head of population and scotland £182.43.


Given that england has less social deprivation, scotland might be a better comparator for Northern Ireland, but I still struggle to find much evidence that the £50 more we spent on medicines per person compared to scotland delivered any additional health and well-being for our population.


8 - PHARMACy IN FOCus


This additional £85 million would, I suggest, be better invested in community development groups to support the significant social challenges and poorer health outcome of those in the lower socio- economic groups.


For too many years, the Health service has been starkly aware of the discrepancy between our medicine costs compared with other uk regions. Huge efforts have been made to reduce inappropriate medicine use and, whereas improvements were made, this report seems to suggest we are slipping backwards.


some 25 per cent of the medicines dispensed last year in Northern Ireland were classified as central nervous system medicines: a very broad category, which includes depression, anxiety, movement disorders, pain and much more.


We use many more antidepressant drugs than other uk regions and this use is more prevalent in areas of social deprivation.


I rather tire of the excuse that this is because of our ‘legacy of The Troubles’. That is much too lazy and politically expedient a conclusion. social deprivation drives poorer health outcomes including poorer mental


health, and antidepressants are certainly not a long-term solution.


We also seem to be in an epidemic of pain. A stand-out medicine in the report is co-codamol: a combination of paracetamol and codeine used for pain management, which is also highly addictive and it is this latter feature that might be the main driver for our excessive use of this medicine.


Codeine in the body is converted to morphine and at the higher doses of 60 milligrams of codeine this is equivalent to ten milligrams of morphine sulphate, which is a schedule 2 controlled drug under the Misuse of Drugs Act.


At the 60mg dose there is no doubt about an analgesic effect, but this is only a moderate effect and only for acute conditions. It is relatively ineffective in pain control when used chronically.


There is surprisingly little evidence for the effectiveness of the lowest doses of the codeine/paracetamol combination compared to


paracetamol alone. It is likely that the only additional benefits from two co- codamol 8/500 tablets over two paracetamol 1000mg are constipation and a ‘fuzzy’ feeling.


Co-codamol stands out as it is the only drug in the report that exists on


two key tables. It is listed number four in the ten most frequently- prescribed medicines, with 125,000 prescriptions last year. It is also listed in the top ten most expensive medicines.


Given the fact it is relatively poor in the management of chronic pain - with strong potential for addiction - this report might be highlighting the emergence of a significant public health problem.


Co-codamol, at the lowest codeine dose, is currently available over the counter, but it is likely that this supply will be blocked by the medicines regulator - the Medicines and Healthcare Regulatory Authority - in the next twelve to 18 months. It’s a fixed dose combination that predates the current rigorous assessment of medicines’ safety and efficacy.


It seems it only exists because of the legal requirement to keep the daily dose of codeine below the level which allows it to be supplied as a pharmacy medicine, rather than only being available on a doctor’s prescription.


Co-codamol is only one of a long list of medicines that require more rational use so that they really help patients and improve public health.


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