Analgesics abuse

The analgesic sy 07AbuseANALGESICS ndrome accounts for widespread morbidity and mortality. It comprises renal disease, hypertension, peptic ulcer, anemia, and recurrent headache. Epidemiological and clinical evidence gathered from many Western societies display unsupervised consumption of compound analgesic preparations, particularly those containing phenacetin, in the causation of the majority of cases. Laboratory experiments so far have ailed to produce an entirely satisfactory model of clinical analgesic nephropathy (damage within the internal structures of the kidney. It is caused by long-term use of analgesics (pain medicines), especially over-the-counter (OTC) drugs that contain phenacetin or acetaminophen, and nonsteroidal anti-inflammatory drugs such as aspirin or ibuprofen). In small animals, papillary necrosis (a disorder of the kidneys in which all or part of the renal papillae die. The renal papillae are the areas where the openings of the collecting ducts enter the kidney and where urine flows into the ureters) results from prolonged feeding with large doses of aspirin and a number of other anti-

inflammatory agents more readily than when phenacetin, paracetamol or phenazone is given alone. The apparently conflicting deductive and experimental data may be reconciled if, as indicated by preliminary observations, salicylates enhance the toxicity of phenacetin derivatives. In planning a program of prevention for the analgesic syndrome, the central aetiological role of nonnarcotic drug dependency must be recognized. As the analgesics to which addiction commonly occurs are the compound powders and tablets, or those containing a stimulant, these preparations should be available only in circumstances where their use can be monitored. Suspected unsupervised and unwarranted consumption of analgesics should be checked by urinary testing for drug metabolites. Because the underlying problem of analgesic dependency is behavioral and environmental in origin rather than medical, the physician must combine forces with the social engineer to devise a definitive solution for this condition. Three important issues must be addressed in any attempt to determine whether combination

painkillers play a role in analgesic

nephropathy. The first issue, namely that of a causal link between the combination itself and nephrotoxicity (rapid deterioration in the kidney function due to toxic effects of medications and chemicals), has never been adequately documented. On the contrary, there is much evidence that the combination as such has no influence whatsoever. The cause of the nephrotoxicity is most likely the painkilling mechanism, i.e. the antagonism to prostaglandins; the most potent prostaglandin-antagonists, the nonsteroidal anti-inflammatory drugs, whether used in combination or singly, also most frequently cause renal pathology. The second issue, is the safety of combination painkilling drugs in comparison with that of single substances, is intimately bound up with the advantages of the former with respect to both activity and the ratio of the activity-side effect. The third issue, abuse, should be recast in a broader context. The central element here is not the painkilling drug but rather the labile personality of the user in conjunction with a more or less stressful environment in which a wide variety of drugs and stimulants are available and taken for better "coping" . Finally, To a great extent analgesics, abuse can be prevented by information (i.e. social medicine). In a broader perspective, man experiences considerable difficulty adapting to the sweeping social, technological and ideological changes of recent decades, and this transition contributes in no small measure to the analgesics problem. It should be a priority of the government to find remedies for this state of affairs.