Tag Archives: drugs

Man found dead in bed by his mother was in ‘constant pain’ before he died

A MAN found dead in bed by his mother on December 5 last year was in constant pain due to health problems, an inquest was told.

Jeffrey Lloyd, 59, of Pontypool, lived with his mother, Margaret, and took medication including morphine to ease the pain of spinal stenosis. He suffered from asthma and bronchitis, smoked cannabis for pain relief, and was dependant on alcohol, said Mrs Lloyd in a statement.

She had checked him and found him asleep at around 3am that morning, but he was not breathing when she checked again at 5.10am

A post mortem examination determined the cause of death as acute exacerbation of chronic obstructive pulmonary disease (COPD) – though Mrs Lloyd said he had not been diagnosed with it – and alcohol and drugs intake. Several prescribed drugs were detected in his system, in therapeutic doses.

Senior coroner for Gwent Wendy James said that together these produced a “cocktail”. She recorded a narrative conclusion, that Mr Lloyd died of natural causes, exacerbated by alcohol and drugs intake.

Full article: http://www.southwalesargus.co.uk/news/16397839.man-found-dead-in-bed-by-his-mother-was-in-constant-pain-before-he-died/

Revealed: loopholes that let addicts buy hundreds of opioid pills online

People with addiction problems are able to order hundreds of powerful opioid painkillers by taking advantage of a lack of proper checks with registered online pharmacies, the Guardian can reveal.

A number of online pharmacies that are regulated and operating legally have no alert system in place to identify when someone makes multiple orders to the same address.

The safeguarding loophole means people can order hundreds of tablets a month.

The online pharmacy regulator, the General Pharmaceutical Council (GPhC), is calling for stricter measures to be introduced and says it is consulting on whether online pharmacies should stop supplying opiates unless further checks are carried out.

David (not his real name) told the Guardian that his wife, who had an addiction, this year made four orders in a month for the strong opioid dihydrocodeine from the website Doctor-4-u after setting up multiple accounts. Hundreds of pills were delivered to the same address, but the unusual activity was not flagged on its system.

“Why do online pharmacies not have the capability to check various accounts linked to the same addresses?” he said. “This happens with insurance and many other industries.”

Doctor-4-u said it carried out thorough ID checks, but multiple orders to the same address were possible if someone used a different family member’s ID and credit card. It said this would not be flagged up on its system.

After the Guardian raised the issue, the company said it would put safeguarding measures in place to protect against this problem, “to demonstrate our commitment to making our online pharmacy as safe as possible”.

John Elliott, the IT director at Doctor-4-u’s owner Med Connections, said: “We are constantly investing in our systems to detect this kind of fraudulent activity.”

The GPhC said it was not aware of a study that showed the numbers using online pharmacies, but it is likely to be in the thousands. Last year, Pharmacy2U, which claims it is the UK’s largest online pharmacy, said it dispensed more than 200,000 items to patients in a month.

The Guardian has also discovered that Doctor-4-u and another leading online pharmacy, UK Meds, are being investigated by the GPhC, which regulates pharmacies operating online, although details of what concerns had been raised – even whether they related to multiple ordering – about them could not be revealed.

A UK Meds spokesperson said: “[We are] a regulated and responsibly run online healthcare portal, which is actively lobbying for the highest safety standards to be introduced across the industry. Patient care and safety is at the core of our business.”

The news comes as concerns grow about the rising number of people seeking help over prescription pills bought online. The Guardian reported this month that a clinic set up to help teenagers addicted to Xanax and other prescription drugs is being sought out by adults who use pills purchased online.

Yasir Abbasi, the clinical director for addiction services at Mersey Care NHS foundation trust, said: “If you are getting multiple prescriptions from one address in the UK, there should be an alert system to make it hard for this to go ahead, just as there are regulation[s] to make sure you cannot buy two boxes of paracetamol at one supermarket …

“If you buy something online you should have to go through one central system, regardless of which online pharmacy you visit online, so what you buy can be monitored.”

The GPhC said it investigated 17 cases involving online pharmacies in the year to June. Its main concerns were about how patients accessed medications online that may be subject to abuse and about the safety of the processes in place.

Duncan Rudkin, the chief executive of the GPhC, said: “We have set out actions we’re proposing that online pharmacy owners would be expected to take to meet our standards and make sure that people obtain medicines safely online. This includes identifying multiple orders to the same address or using the same payment details.”

The watchdog is holding a public consultation on proposed new safeguards, including whether online pharmacies should stop supplying certain drugs, such as opiates and opioids, unless further checks are carried out.

There are currently 445 pharmacies that bear the council’s logo. They can sell opiates and opioids medicines such as tramadol, co-codamol, codeine and dihydrocodeine, which if abused can lead to severe addictions.

David said his wife was able to order hundreds of pills using his credit card. She started doing so in 2016 after becoming addicted to the opioid hydrocodone, which she was given for a slipped disc.

She was able order medicines while she was pregnant by clicking a question on a form to say she was not pregnant, although in this instance the pills were not obtained from Doctor-4-u and David could not recall which website they came from.

“This meant when my son was born, he rated high on the Finnegan scale – basically children born who show signs of opiate addiction – but it did pass,” he said.

He added that addiction had had a huge impact on his family. “The checks are simply not good enough for medication issuing. I cannot go to doctor and say, ‘I want this medication’ – I tell them my symptoms and the doctor prescribes medication, but it’s the opposite way around with online pharmacies. You say ‘I want this’ and the doctors look at it,” he said.

Concerns have also been raised about websites allowing people to select medicines including opiates and opioids before a consultation. The GPhC said: “There are additional risks to patient safety when prescription-only medicines can be chosen before having an appropriate consultation with a prescriber.

“For example, if a patient simply has to answer questions before the healthcare professional makes their prescribing decision, they might fill in a number of questionnaires, learning what answers to give so they can get the medicine in question.”

Speaking anonymously, a former online pharmacy worker who left his employer recently due to concerns about safeguarding said that “even though there are procedures and safeguards put in place, customers are still able to make multiple orders using different email addresses and accounts”.

He added: “It’s not such a problem with some products, but for opioids it can be very dangerous.”

Abbasi said: “We are seeing an increase in drug-related deaths, and prescription drugs are playing a role more and more. Things are almost at a crisis point.”

Full article: https://www.theguardian.com/society/2018/jul/25/online-pharmacies-fail-spot-multiple-opiate-orders-addiction

Babies die after mums given Viagra in Dutch trial

A Viagra in pregnancy trial has been urgently stopped after 11 newborn babies died.

Women taking part in the Dutch study had been given the anti-impotence tablets to improve growth of their unborn children because they had poorly developed placentas.

It appears the drug, which promotes blood flow, may have caused lethal damage to the babies’ lungs.

Experts say a full investigation is needed to understand what happened.

There is no suggestion that there was any wrong-doing.

Sick babies

Earlier trials in the UK and Australia and New Zealand did not find any evidence of potential harm from the intervention. But they also found no benefit.

At that time, in 2010, researchers said the treatment should be used only in trials.

Foetal growth restriction caused by an underdeveloped placenta is a serious condition that currently has no treatment.

It can mean babies are born prematurely, with a very low birth weight and poor chances of survival.

A medication that could improve weight or prolong the time to delivery could have significant advantages for these very sick babies.

Dummy drug

The latest Dutch study, which was due to run until 2020, was being carried out across 11 hospitals in the Netherlands, including the Amsterdam University Medical Centre.

In total, 93 women were given sildenafil (the non-brand name for Viagra) while the remaining 90 were given a dummy drug or placebo.

Twenty babies developed lung problems after birth – three in the placebo group and the rest in the treatment group.

Eleven in the sildenafil group died from lung complications.

Prof Zarcko Alfirevic, from the University of Liverpool, who led part of the UK research into sildenafil in pregnancy that found no benefit in terms of improving baby growth, said: “This finding in the Dutch study is unexpected.

“We need to be careful at this point to find out more.

“It needs a thorough investigation because the complications were not seen in the two other, similar trials that have already been done in the UK and Australia and New Zealand

Full article https://www.bbc.co.uk/news/health-44942302

Scots drug deaths hit new record high

Drug deaths in Scotland hit a new record high in 2017, having more than doubled in a decade.

New figures from the National Records of Scotland showed that 934 drug-related deaths were recorded in 2017.

This is the largest number since the figures started being collated in 1996, and more than double the 2007 total.

The Scottish government is drawing up a new drugs strategy, saying that “each of these untimely deaths is a tragedy”.

The newly released figures show a steady rise in deaths since 2013, with the rate of deaths now “very roughly two and a half times that of the UK as a whole” and “higher than those reported for all the EU countries”.

‘Drugs landscape’

The 2017 figure is up by 8% on that for the previous year, and more than double the 2007 total of 455.

Males accounted for 70% of the deaths, while 39% were of people aged 35 to 44 – compared to 29% being in the 45 to 54 age group and 20% in the 25 to 34 cohort.

Broken down by area, 30% of the deaths occurred in the Greater Glasgow and Clyde health board area, while 15% were in Lothian, 11% in Lanarkshire and 10% in Tayside.

Opiods such as heroin, morphine and methadone were linked to 87% of the deaths, while benzodiazepines like diazepam were linked to 59% – reflecting that multiple substances were implicated in many cases.

Misuse of opioids such as tramadol and fentanyl is ‘global epidemic’, report finds

The misuse of pharmaceutical opioids is fast becoming a “global epidemic”, with the largest quantities being seized in African countries for the second year in a row, according to a UN report.

While huge attention has been paid to the opioid crisis in the US – where the misuse of prescription drugs like fentanyl dominates – figures released by the United Nations Office on Drugs and Crime has revealed seizures in Africa of opioids now account for 87% of the global total.

Unlike in the US, the seizures – concentrated in west, central and north Africa – have largely consisted of the drug tramadol, followed by codeine.

The figures were disclosed in the latest UN world drug report, which noted that opioids were the most harmful global drug trend, accounting for 76% of deaths where drug-use disorders were implicated.The report said that while fentanyl and its analogues remain a problem in North America, tramadol – used to treat moderate and moderate-to-severe pain – has become a growing concern in parts of Africa and Asia.

The report added that the global seizure of pharmaceutical opioids in 2016 was 87 tonnes, roughly the same as the quantities of heroin impounded that year.

The figures on pharmaceutical opioids were rivalled by global cocaine manufacture, which the agency said had reached the highest level ever reported in 2016, with an estimated 1,410 tonnes produced.

Most of the world’s cocaine comes from Colombia, but the report also showed Africa and Asia emerging as cocaine trafficking and consumption hubs.

From 2016-17, global opium production also jumped by 65% to 10,500 tonnes, the highest estimate recorded by the agency since it started monitoring global opium production nearly 20 years ago.

“The findings of this year’s world drug report show that drug markets are expanding, with cocaine and opium production hitting absolute record highs, presenting multiple challenges on multiple fronts,” said the UNODC’s executive director, Yury Fedotov.

“Non-medical use of prescription drugs has reached epidemic proportions in parts of the world,” he added. “The opioid crisis in North America is rightly getting attention, and the international community has taken action.

“However … the problems go far beyond the headlines. We need to raise the alarm about addiction to tramadol, rates of which are soaring in parts of Africa. Non-medical use of this opioid painkiller, which is not under international control, is also expanding in Asia. The impact on vulnerable populations is cause for serious concern, putting pressure on already strained healthcare systems.”

Despite the increase in availability and production, the report disclosed that the number of people worldwide using drugs at least once a year remained stable in 2016 at around 275 million people – or roughly 5.6% of the global population aged 15-64 years. Drug use among the older generation (aged 40 years and above) has been increasing at a faster rate than among those who are younger.

Despite that, global deaths directly caused by drugs use increased by 60% from 2000 to 2015, with mortality among people over the age of 50 increasing from 27% of these deaths in 2000 to 39% in 2015. About three-quarters of deaths from drug-use disorders among those aged 50 and older were among opioid users.

Read full article here: https://www.theguardian.com/global-development/2018/jun/27/misuse-opioids-tramadol-fentanyl-global-epidemic

Adverse drug reactions – (NICE)

Assessment

  • Assess the nature and severity of the reaction.
  • This will determine whether urgent action is required or whether the person can be managed in primary care. For example, a cough due to an angiotensin-converting enzyme inhibitor can be troublesome but not life threatening, but an anaphylactic reaction is a medical emergency.
  • The nature of the presenting condition may strongly suggest that it is an adverse drug reaction (ADR). For example, the following conditions are often ADRs:
  • Acute dystonias
  • Blood dyscrasias
  • Skin reactions, such as Stevens–Johnson syndrome and toxic epidermal necrolysis
  • Neuroleptic malignant syndrome
  • Take a history of the presenting symptoms, including:
  • When it started:
  • The time from when use of the drug was started to when the reaction develops may be characteristic of the reaction (for example anaphylaxis usually develops within a few minutes of parenteral drug administration).
  • If the drug was stopped, the time it took for the reaction to abate will often be related to the known duration of action of the drug.
  • Relationship to dose:
  • ADRs are often dose related and may be minimized by reducing the dose of the drug.
  • If the symptoms resolve when the drug is withdrawn, they may have been associated with the drug, although it could still have been coincidental.
  • If a drug is reintroduced and symptoms recur, the drug is most probably responsible for the adverse reaction. However, deliberate re-challenge is only very rarely justified (clinically and ethically) after serious ADRs, because of the risks involved.
  • Other possible causes:
  • The symptoms may be a manifestation of the person’s underlying illness or another disease.
  • Other medications (including self-medication and herbal remedies) could be responsible.
  • Consider the possibility of drug interactions (including with food and drinks).
  • Consider the drug history, and review any history of allergy or previous ADRs.
  • Take a complete drug history, including when the drug was started, what dose is being taken, what other drugs are being taken, and whether the person is also taking over-the-counter (OTC) or herbal medicines.
  • Check whether the person has ever had similar symptoms or presentation in the past with other drugs (from the same or a different drug class) or has a history of atopy or of ADRs with different presentation(s).
  • Be aware that even if a drug was stopped some time before the ADR, it may have been responsible if it has a very long duration of action (for example amiodarone).
  • Review the adverse effect profile of the drug and consider:
  • Whether the signs and symptoms are in keeping with the documented adverse effect profile of the drug.
  • Whether the ADR been reported before. This can be checked in the readily available sources of information, including:
  • The British National Formulary (BNF).
  • The electronic Medicines Compendium (www.medicines.org.uk).
  • Interactive Drug Analysis Profiles(iDAPs) — a complete listing of suspected ADRs for individual drugs that have been reported to the Medicines and Healthcare products Regulatory Agency (MHRA) through the Yellow Card scheme by health care professionals, members of the public, and pharmaceutical companies.
  • Regional and district medicine information services. Details of regional centres and other useful contacts can be found in the front of the BNF and BNF for Children (or online). Local services can found by contacting the medicines information department or the hospital pharmacy in major hospitals.
  • How common the suspected adverse reaction is.

More

WEDINOS SERVICE

WEDINOS tests substances to give individual users and others rapid
and accurate information to reduce harms.
WEDINOS is a harm reduction project, and reflects trends in substance use. It is therefore important that samples are submitted with a completed ‘Effects Record’ and correct postcode information, including samples from outside of Wales. This does not affect your anonymity.

Wedinos website

Antidepressant Seroxat tops table of UK drug withdrawal symptoms

Seroxat, the British-made antidepressant which outsells Prozac, causes more people distressing withdrawal problems when they try to stop taking it than any other drug in the UK.

Paroxetine, also known by trade names including Paxil and Seroxat among others, is an antidepressant of the selective serotonin reuptake inhibitor class.

Formula: C19H20FNO3
Trade names: Paxil, Pexeva, Seroxat, others

The committee on the safety of medicines, which receives reports of drug side-effects from doctors and pharmacists, has received an avalanche of complaints about Seroxat, one of the class of drugs known as SSRIs (selective serotonin reuptake inhibitors). The SSRIs, including Prozac, have always been marketed as safe medicines which are supposed not to cause the dependence problems that emerged with older drugs such as Valium and Ativan.
Seroxat – known generically as paroxetine – leads the top 20 table of drugs causing withdrawal problems, with 1,281 complaints from doctors under the “yellow card” scheme set up for the reporting of medicines’ side-effects. More reports have been filed about Seroxat than about the rest of the top 20 put together.

Full story – https://www.theguardian.com/news/2002/jul/27/uknews

The Doctor Who Gave Up Drugs

Two years ago, Dr Chris van Tulleken discovered we are taking more prescription drugs than ever before – a billion prescriptions a year in the UK. He worked with a GP surgery to get patients to try drug-free alternatives – with amazing results.

Now he is on a new mission – to understand why we are giving British kids over three times more medication than we were 40 years ago. As a new dad, Chris has a very personal motivation to explore the reasons behind this explosion in medication. In the series he sets about finding alternatives which might be just as, or even more, effective than drugs. He tackles the shocking rise in teens taking anti-depressants by testing if wilderness therapy can work where the drugs are failing. He investigates why parents are giving out so many over-the-counter meds when they may not be always necessary, and he helps hyperactive kids replace their drugs with mindful meditation.

He also digs deeper into the forces driving the over-medication of UK children and asks whether the drug industry itself could be playing a part in the rise. In 2016 we spent a staggering £64 million on one brand of children’s liquid paracetamol. Chris meets a self-confessed fan who reveals she has bought over 25 bottles in less than two years! As a new dad, Chris doesn’t blame vulnerable parents. His research reveals a pharmaceutical industry that helps create a culture which, he believes, encourages parents to unnecessarily use liquid paracetamol. At a family fair in Bristol, Chris creates a surprising stunt to show Britain’s parents when not to give liquid paracetamol and make sure they don’t waste their hard-earned money giving children drugs they don’t need.

One of the other areas where medication rates have increased the most is treating kids’ behavioural problems – prescription meds for ADHD have increased by 800 per cent since 2000. These drugs do help some symptoms of ADHD in the short-term, but side effects can include loss of hunger, changes in personality and stunted growth. Chris joins a group of hyperactive children as they attempt the impossible – an intense course of stillness and mindful meditation as an alternative to the meds. As the families go on transformative and emotional journeys, they discover, with poignant results, that ADHD remedies do not always have to come in a pill.

https://www.bbc.co.uk/programmes/b0b4jjq3

Drugs and driving: the law

It’s illegal to drive if either:

  • you’re unfit to do so because you’re on legal or illegal drugs
  • you have certain levels of illegal drugs in your blood (even if they haven’t affected your driving)

Legal drugs are prescription or over-the-counter medicines. If you’re taking them and not sure if you should drive, talk to your doctor, pharmacist or healthcare professional.

The police can stop you and make you do a ‘field impairment assessment’ if they think you’re on drugs. This is a series of tests, eg asking you to walk in a straight line. They can also use a roadside drug kit to screen for cannabis and cocaine.

If they think you’re unfit to drive because of taking drugs, you’ll be arrested and will have to take a blood or urine test at a police station.

You could be charged with a crime if the test shows you’ve taken drugs.

Prescription medicines

It’s illegal in England and Wales to drive with legal drugs in your body if it impairs your driving.

It’s an offence to drive if you have over the specified limits of certain drugs in your blood and you haven’t been prescribed them.

Talk to your doctor about whether you should drive if you’ve been prescribed any of the following drugs:

  • amphetamine, eg dexamphetamine or selegiline
  • clonazepam
  • diazepam
  • flunitrazepam
  • lorazepam
  • methadone
  • morphine or opiate and opioid-based drugs, eg codeine, tramadol or fentanyl
  • oxazepam
  • temazepam

You can drive after taking these drugs if:

  • you’ve been prescribed them and followed advice on how to take them by a healthcare professional
  • they aren’t causing you to be unfit to drive even if you’re above the specified limits

You could be prosecuted if you drive with certain levels of these drugs in your body and you haven’t been prescribed them.

The law doesn’t cover Northern Ireland and Scotland but you could still be arrested if you’re unfit to drive.

Penalties for drug driving

If you’re convicted of drug driving you’ll get:

  • a minimum 1 year driving ban
  • an unlimited fine
  • up to 6 months in prison
  • a criminal record

Your driving licence will also show you’ve been convicted for drug driving. This will last for 11 years.

The penalty for causing death by dangerous driving under the influence of drugs is a prison sentence of up to 14 years.

Other problems you could face

A conviction for drug driving also means:

  • your car insurance costs will increase significantly
  • if you drive for work, your employer will see your conviction on your licence
  • you may have trouble travelling to countries like the USA

( source: https://www.gov.uk/drug-driving-law )