Analgesics AUSTRALIAN DRUG FOUNDATION
13 HOW DRUGS AFFECT YOU
This pamphlet is part of the “How Drugs Affect You” series. It aims to provide the facts about analgesics for anyone interested in understanding more about this drug. It has been written for the general public, including employees, employers, health professionals and their clients.
Other titles in this series include alcohol, amphetamines, benzodiazepines, cannabis, cocaine, drugs and their effects, ecstasy, GHB, hallucinogens, heroin, ice, inhalants, ketamine and tobacco.
What are analgesics? Analgesics, also known as “painkillers”, are used medically to relieve pain. Most analgesics are relatively safe to use when taken » as prescribed or instructed by a doctor or pharmacist » and in conjunction with the manufacturer’s instructions » on the packaging. This brochure outlines some commonly used over-the-» counter analgesics, including what they are used for, possible effects of misuse and risks associated with using them outside » the recommended doses. The painkillers covered are:
»» aspirin »» codeine »
(in combination products)
13 HOW DRUGS AFFECT YOU
»» ibuprofen »» paracetamol.
What they look like Analgesics are available in many forms. These include tablets, capsules, suppositories, soluble powders and liquids.
How and why are they used? Analgesics are generally swallowed and their intended purpose is to relieve pain. Some can also be used to reduce fever, to help relieve the symptoms of cold and flu, reduce inflammation and swelling, control diarrhoea, and as a cough suppressant. Some people misuse analgesics by intentionally taking more than the recommended dose, in a mistaken attempt to “get high”, or as an act of self-harm.
Non-medical analgesic use in Australia According to the National Drug Strategy Household Survey1, in 2010, 3.0 per cent of the Australian population aged 14 years and older had used analgesics for non-medical purposes in the previous 12 months. Australian Institute of Health and Welfare (AIHW) 2011 » 2010 National Drug Strategy Household Survey: Report, » Canberra: Australian Institute of Health and Welfare.
Chemical and brand names Analgesics are known by their chemical (generic) names and their brand or trade names. Some common examples include:» Generic name
Aspro Clear®, Disprin®
Aspirin and codeine
Aspalgin®, Codral Cold & Flu Original®
Ibuprofen and codeine
Dymadon®, Lemsip®, Panadol®, Panamax®, Tylenol®
Paracetamol and codeine
Dymadon Co® and Dymadon Forte®, Panadeine Forte®, Panamax Co®
Paracetamol, codeine » and doxylamine
Mersyndol® and Mersyndol » Forte®, Panalgesic®
Aspirin What is aspirin? Aspirin (acetylsalicylic acid) is used to reduce » pain and/or inflammation. It can be used to treat:
»» mild to moderate pain »» fever »» swollen, red »
»» rheumatioid arthritis »» rheumatic fever
and tender tissues
It is also used in the prevention of heart attacks, » strokes and bowel cancer. Side effects of aspirin Misusing aspirin increases the risk of side effects and puts » a person at risk of an overdose. Overdose means that a person » has taken more aspirin than their body can cope with.
Body » sweating » fever
Stomach » nausea » vomiting
Lungs » rapid and shallow breathing » respiratory failure
Ears » ringing in ears » deafness
Brain » headaches » dizziness » confusion » drowsiness
» thirst » seizures » coma
Effects of aspirin misuse and overdose
Long-term effects If people take high doses of aspirin over a long period, » they may experience long-term side effects. More serious long-term effects can include:
»» anaemia (low red »
blood cell count) »» easy bruising or » abnormal bleeding »» peptic ulcers, inflamed stomach lining, stomach bleeding »» vomiting blood that may look like coffee grounds » and bowel motions that » look like black-tar
»» an allergic-type reaction,
wheezy breathing and a tightness in the chest in adults, hives in children, » or in some rare cases swelling of the face, lips, tongue or around the eyes »» reduced kidney or » liver function.
Codeine What is codeine? Codeine belongs to a group of drugs known as “opioids”. » Other opioids include opium, heroin, morphine, pethidine, oxycodone, buprenorphine 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 »» diarrhoea »» cold and ‘flu (when combined with » antihistamines and decongestants).
Side effects of codeine Misusing codeine increases the risk of side effects and puts » a person at risk of an overdose. This means that a person has taken more codeine than their body can cope with. If someone has overdosed on codeine it is important that they receive emergency care immediately so they can be given an antidote. The effects of codeine misuse and overdose include:
See diagram Long-term effects If people take high doses of codeine over a long period, » they may experience long-term side effects. More serious» long-term effects can include:
»» constipation »» reduced sex drive
»» menstrual problems.
» More serious side effects and complications can occur » when codeine is taken with other drugs.
Skin » mild allergic rash, itching or hives
Stomach » stomach ache » nausea » vomiting
Lungs » very slow, shallow breathing
Mouth » dry mouth
Eyes » blurred vision
Psychological » agitation » euphoria, restlessness
Body » weakness » sweating » cold clammy skin that has a bluish tinge
Bladder » difficulty urinating
Heart » decreased heart rate, palpitations
Muscles » limbs feel heavy » slack muscles
Brain » dizziness, lethargy » confusion, difficulty concentrating » stupor, coma » seizures
Effects of codeine misuse and overdose
Ibuprofen What is ibuprofen? Ibuprofen is a non-steroidal anti-inflammatory » drug and can be used to provide relief from:
»» mild to moderate pain »» severe pain (when combined with codeine) »» fever »» swollen, red and tender tissues »» rheumatoid arthritis, back pain and gout » (in conjunction with physical therapy).
Side effects of ibuprofen Misusing ibuprofen increases the risk of side effects » and puts a person at risk of an overdose. This means » that a person has taken more ibuprofen than their body » can cope with. If someone has overdosed on ibuprofen » it is important they receive urgent medical attention. The effects of ibuprofen misuse and overdose include:
See diagram More serious side effects and complications can include:
»» anaemia (low red »
blood cell count) »» peptic ulcers, » inflamed stomach » lining, or heartburn »» vomiting blood that may look like coffee grounds » and bowel motions that » look like black-tar
»» severe allergic-type
reaction, or in rare cases swelling of the face »» impairment of kidney » or liver function »» confusion or disorientation, mental depression, feelings of unreality, anxiety, paranoia.
Long-term effects If people take high doses of ibuprofen over a long period, » they may experience long-term side effects. More serious long-term effects can include:
»» kidney damage »» gastrointestinal bleeding »» increased risk of heart attack.
Bladder and bowel » bladder irritation and pain, frequent urination » diarrhoea » constipation Body » thirst, sweating » fluid retention » ankle swelling » allergic reaction » tingling or numbness in hands and feet » problems sleeping.
Ears » ringing in the ears
Psychological » agitation » confusion
Stomach » abdominal pain » nausea » vomiting » heartburn
Eyes » blurred vision » eye irritation
Brain » headaches » dizziness » confusion » drowsiness » seizures » coma
Effects of ibuprofen misuse and overdose
Paracetamol What is paracetamol? Paracetamol is used to relieve mild pain and to reduce fever. It can be combined with other drugs such as codeine and used for stronger pain relief. It is also combined with antihistamines and decongestants to help relieve the symptoms of colds and the ’flu. Side effects from paracetamol Misusing paracetamol increases the risk of serious side effects and puts a person at risk of an overdose. If someone has overdosed on paracetamol it is important that they receive emergency care immediately so they can be given an antidote as soon as possible.
Children may occasionally experience low blood sugar » and tremors, or feel hungry, faint or confused.
Skin » rashes or itching
Stomach » abdominal pain » nausea » vomiting
Brain » drowsiness and fatigue » coma » seizures
The effects of paracetamol misuse and overdose include
Long-term effects If people take paracetamol over a long period, they may experience long-term side effects. More serious long-term effects can include:
»» liver damage »» bluish tinge to »
fingers and lips
»» breathlessness »» anaemia (low red » blood cell count).
Tolerance and dependence Long-term use of analgesics can lead to a psychological dependence. People who are dependent on analgesics find that using the drug becomes far more important than other activities in their life. They crave the drug and find it very difficult to stop using it. Codeine tolerance, dependence and withdrawal There is evidence that people who use codeine regularly can develop dependence and tolerance to it. Tolerance means they need to take larger amounts of codeine to get the same effect. Dependence on codeine can be psychological, physical, or both. People who are dependent on codeine crave the drug and find » it very difficult to stop using it. People who are psychologically dependent on codeine may find they feel an urge to use it when they are in specific surroundings or socialising with friends. Physical dependence occurs when a person’s body adapts to codeine and gets used to functioning with the codeine present.
Some common withdrawal symptoms include:
»» goose bumps, fever, »
chills, sweating »» runny nose, sneezing »» abdominal cramps, diarrhoea, nausea, vomiting »» lack of appetite
»» dilated pupils »» trembling, aching »
muscles and joints
»» restlessness, irritability, nervousness
Pregnancy and breastfeeding There is generally no increased risk of birth defects if taking over-the counter analgesics while pregnant. However, there are some risks including:
»» premature closing of the heart duct through which »
blood bypasses the lungs of the baby in the womb, » if aspirin and ibuprofen are taken late in the pregnancy. »» prolonged labour and bleeding difficulties if aspirin » and ibuprofen are taken close to the birth. »» withdrawal symptoms after the birth if the mother » has taken large doses of codeine late in the pregnancy. Check with your doctor or other health professional » if you are using or planning to use analgesics or any » other drugs during pregnancy or while breastfeeding.
Analgesics and other drugs The effects of mixing analgesics with other drugs, including alcohol, prescription medications and other over-the-counter medicines, are often unpredictable. Some examples of these are:
»» drinking alcohol while taking aspirin and ibuprofen can increase the risk of stomach irritation and discomfort
»» aspirin and ibuprofen can alter the effects of some blood
pressure medicines and may increase the risk of bleeding » if taken with medicines such as warfarin »» taking codeine with other drugs such as benzodiazepines, certain antidepressants and certain antihistamines, can increase the depressive effects and reduce the breathing rate »» naltrexone blocks the effects of codeine » and other opioids. Check with your doctor or pharmacist for more information.
Analgesics and social problems All areas of a person’s life can be affected by drug use.
»» Disagreements and frustration over drug use can cause » family arguments and affect personal relationships.
»» Legal and health problems can also add to the strain » on personal, financial and work relationships.
Treatment options In Australia, there are many different treatment options for drug problems. Some aim to help a person to stop using a drug, while others» aim to reduce the risks and harm related to their drug use. Treatment is more effective if adapted to suit each person’s situation. Some of the different options include individual counselling, group therapy, medication (pharmacotherapy), residential therapy and supervised/home withdrawal.
Preventing and reducing harms »
All drugs have the potential to cause harm. As use increases, so does the potential for harm. Australia’s national drug policy is based on harm » minimisation. Strategies to minimise harm include encouraging people to avoid using a drug through to helping people to reduce the risk of harm if they do use a drug. It aims to reduce all types of drug-related harm to both the individual and the community.
There is no safe level of drug use Use of any drug always carries some risk—even medications can produce unwanted side effects. It is important to be careful when taking any type of drug.
What to do if you are concerned about someone’s drug use If you are concerned about someone’s drug use, there is confidential help available. Contact the alcohol and drug information service in your state or territory. The telephone numbers are listed on the back of » this pamphlet.
What to do in a crisis If someone overdoses or has an adverse reaction while using analgesics, it is very important that they receive professional help as soon as possible. A quick response can save their life.
»» Call an ambulance. Dial 000. Ambulance officers are not obliged to involve the police.
»» Stay with the person until the ambulance arrives. Find out if
anyone at the scene knows cardiopulmonary resuscitation (CPR).
»» Ensure that the person has adequate air by keeping crowds back and opening windows. Loosen tight clothing.
»» If the person is unconscious, don’t leave them on their back—they
could choke. Turn them on their side and into the recovery position. Gently tilt their head back so their tongue does not block the airway. »» If breathing has stopped, apply CPR. »» Provide the ambulance officers with as much information as you can—such as how many analgesics were taken, how long ago and any pre-existing medical conditions. For further tips on how to reduce the risks of using analgesics, » talk to your doctor, pharmacist or health professional, or » call the alcohol and drug information service in your state » or territory. The telephone numbers for these services are » listed below.
ACT (02) 6207 9977
Tas. 1800 811 994
NSW (02) 9361 8000 (Sydney)» 1800 422 599 (NSW)
Vic. 1300 85 85 84 (information)»
NT 1800 131 350
QLD 1800 177 833 SA
1300 131 340
1800 888 236 (counselling)
WA (08) 9442 5000 (Perth)» 1800 198 024 (WA)
Produced by the Australian Drug Foundation © 2011. Celebrating more than 50 years of service to the community, » the Australian Drug Foundation is Australia’s leading body committed to preventing alcohol and other drug problems » in communities around the nation. www.adf.org.au For further copies of this pamphlet: Post: PO Box 818 North Melbourne Vic 3051» Street: 409 King Street West Melbourne Vic 3003» Email: firstname.lastname@example.org» Web: www.druginfo.adf.org.au
Developed in response to demand from our customers, this pamphlet discusses the consequences of deliberate or accidental misuse of common pa...