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Bad medicine: co-codamol

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f1821 (Published 20 March 2013) Cite this as: BMJ 2013;346:f1821

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Re: Bad medicine: co-codamol

Des Spence's article raises an issue of huge importance, which at present is not being addressed in the UK. As a GP for more than twenty years, I feel I was surprisingly naive about the addictive potential and use of the drugs I was issuing.

Now as a GP in Holloway prison, the abuse of prescription drugs is all too obvious and shocking.

Most of Holloway's inmates are young women. Yet they frequently come in on a cocktail of prescribed analgesics - usually for chronic back pain - as well as mind altering drugs of many types. Some of the analgesics have been prescribed by pain clinics - and as Des mentions - presumably justified as not being addictive as used for pain. The fact that most of the women also have fairly obvious poly drug abuse of illegal drugs seems to be passed over or not picked up, and this also applies to many women with very dubious diagnoses of epilepsy, for whom only Clonazepam seems to work....

It is interesting to talk to women about why they like certain drugs and what currently has street value. It may come as a surprise to some doctors - but current favourites are Quetiapine, Mirtazepine, Carbamezepine, Gabapentin and Pregabalin - as well as the more obvious opioid analgesics and benzodiazepines. All these are enjoyed for their mind altering qualities but are (presumably) prescribed for "diagnosed" conditions. Illegal drug users recognise that moving to prescribed drugs represents an easier and legal way of obtaining pleasure. We, as the medical profession, need to recognise this too - and decide on a strategy to manage the fall out.

Competing interests: No competing interests

01 April 2013
Rhiannon England
GP
HMP Holloway
Pentonville Rd London N7