Misuse of pharmaceuticals
Pharmaceutical drugs provide many benefits including increasing our quality of life. Most people use these drugs appropriately, following the guidance provided by a medical practitioner, pharmacist or instructions on the packet. However, the misuse of pharmaceuticals—in particular opioids, including over-the-counter codeine, and benzodiazepines—has been reported to be increasing and is emerging as an issue of concern.
Use of pharmaceuticals in Australia
The 2010 National Drug Strategy Household Survey found that 4.2% of the Australian population reported non-medical use of pharmaceuticals in the previous 12 months. The number of Australians who recently used pharmaceuticals for non-medical purposes increased by more than 100,000 between 2007 and 2010 (from 640,000 to 770,000).
According to the not-for-profit organisation, Reconnexion, in Australia there are approximately 10 million scripts written for benzodiazepines each year. Rates of prescribing have remained fairly consistent with a small increase in the past few years.
It is estimated that one in 50 Australians are currently taking a benzodiazepine and have been taking the drug for longer than six months.
People over 65 have the most scripts written for benzodiazepines, most commonly for sleeping problems. Women are prescribed benzodiazepines at twice the rate of men. Temazepam, Diazepam, Alprazolam and Oxazepam are the most common benzodiazepines prescribed in Australia.
Effects of common pharmaceuticals
Benzodiazepines have a range of effects including:
- relief from anxiety.
Even when benzodiazepines are used as prescribed, they can cause a range of harms including:
- depressed mood
- cognitive impairment.
Opioids have a range of effects including:
- pain relief
- respiratory depression.
Medically, opioids are used to treat pain, as cough suppressants and substitution treatment for opioid dependence. In Australia, the most commonly used opioids used to treat pain include: codeine, morphine and oxycodone. Methadone and buprenorphine are the two main pharmacotherapies used to treat opioid dependence.
Even when opioids are used as prescribed, they can cause a range of harms including:
- dependence (dependence can occur quite rapidly)
- reduced fertility
- low sex drive
- irregular periods in women
- erectile dysfunction in men (the inability to keep an erection)
- reduced ability to fight infection
- increased levels of pain.
Over the counter medicines
The harms associated with pharmaceuticals are not just related to prescription drugs. Over the counter drugs such as analgesics that contain codeine are emerging as a problem. The drugs that cause the most problems are combinations of codeine with paracetamol or ibuprofen, which can contain up to 15 mg of codeine.
Codeine belongs to the opioid group of drugs. Other opioids include opium, heroin, oxycodone and methadone. Codeine is used to provide relief from a number of conditions including:
- mild to moderate pain
- severe pain (when combined with aspirin or paracetamol)
- dry irritating cough
- cold and flu (when combined with antihistamines and decongestants).
Misusing codeine, including taking more codeine than recommended on the packet, increases the risk of side effects and puts a person at risk of an overdose. Some of the mild side effects that may be experienced include:
- confusion, difficulty concentrating
- euphoria, restlessness
- blurred vision
- dry mouth.
More serious side effects and complications can occur, especially when codeine is taken with other drugs—particularly paracetamol and ibuprofen.
In late 2007, it became evident that a number of Victorians were being hospitalised with life-threatening complications due to taking very high doses of ibuprofen. Complications included:
- gastro-intestinal bleeding and/or perforation
- renal failure
- low potassium levels
- opioid dependence
These clinical presentations result from the consumption of large amounts of ibuprofen-codeine combination drugs.
The high levels of codeine available in non-prescription analgesics contribute to their misuse and health prevention agencies such as the Australian Medical Association have called for tighter controls on them.
Using pharmaceuticals without a prescription from a doctor, or selling or giving them to someone else, is illegal. There are also laws against forging or altering a prescription or making false representation to obtain pharmaceuticals or a prescription for them.
Preventing and reducing harms
- Talk to your health professional before taking prescription medicine or if advised to do so on the drug packet.
- Take medicines according to the instructions.
- Be aware of potential interactions between different drugs including alcohol.
- Store medicines according to the instructions on the packet.
- Make sure the medicine is not damaged (seal broken) or past its expiry date.
- Regularly review your medicines with your health professional.
- Do not share medicines.
- Be aware of the effects on driving ability and work.
Contact your health professional if you are concerned about the side effects of any drugs including over-the-counter medicines.
There are also telephone lines that you can call for advice and to report problems (they are not emergency services):
Medicines Line T: 1300 633 424
Adverse Medicines Events Line T: 1300 134 237
If you experience a serious negative reaction to any drug, call an ambulance immediately by dialling 000. If possible, have the medicine with you so the ambulance officers know what you have taken.