Sunday July 5, 2009
No more pain
By DR YLM
Speculation mounts that Michael Jackson’s death was due to overdose of prescription drugs, namely painkillers. Can painkillers kill?
Michael Jackson died on June 25, 2009. He was 50. Michael Jackson’s death was a very sad occurrence. My family and I are among his greatest fans. We heard that he used painkillers very often. Can painkillers kill?
We will not know the results of Michael Jackson’s autopsy until much later, but as to the question whether painkillers can kill, well, I suppose the answer is yes. It depends on the type of painkiller. Some are more dangerous and addictive than others. It is a fair rule to say that any painkiller taken repeatedly and in great doses will exert unwanted effects on the one who takes it.
What are the types of painkillers?
Painkillers are also called analgesics. They are a class of drugs used to relieve pain by either blocking pain signals from going to your brain, or interfering with your brain’s interpretation of those pain signals.
Some people also include non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and its family (indomethacin, ibuprofen, naproxen, piroxicam, nabumetone) into the category of painkillers. Nevertheless, the aspirin family works against inflammation and can be used in many diseases for other purposes, rather than solely acting as a painkiller.
There are a newer type of anti-inflammatory drugs (also considered NSAIDs) which selectively block the COX-2 enzyme. They not only reduce pain, but also swelling. Drugs in this category include etoricoxib and celecoxib.
Analgesics are different from anaesthesia, which produces loss of consciousness. Usually when you go for a major surgery, you are given both anaesthesia and analgesics.
There are two major types of analgesics
·Non-narcotic – the most popular being paracetamol (acetaminophen), better known as Panadol.
·Narcotic – the opiates and the opioids (derivatives of opiates.) The opiates belong to the opium family.
Is paracetamol dangerous? But it’s sold over the counter without a prescription.
Any drug has its dangers if not taken properly as per prescription or instructions written on its leaflet. For paracematol, the instruction is usually written “Do not exceed eight tablets of 500mg per day”.
Narcotics sound addictive. Then why are they being used?
These are used for those who suffer from severe pain that cannot be managed by non-narcotic analgesics or NSAIDs. Pain of this category include cancer pain and childbirth. During major surgery, the painkiller most often used is morphine.
In the family of opioids are morphine, codeine, heroin, oxycodone, pethidine or Demerol, methadone, fentabyl, tramadol.
There is actually no upper limit dose for opioids, which is why the dose used varies from one patient to another. The only caveat is that you must increase it gradually to allow your body to develop tolerance to its side-effects.
Opioids, if taken long term, can be addictive. However, some experts believe that the good quality of life long-term pain sufferers get from opioids outweighs their addictiveness. In other words, if you are in chronic unbearable pain that can only be relieved by opioids, your doctor may prescribe them to you long-term.
Is ‘Demerol’ available in Malaysia? I have never seen it being sold anywhere.
Demerol is not an over-the-counter drug. None of the narcotics are. In Malaysia, it is known as pethidine. Its generic name is meperidine hydrocholoride.
You cannot take alcohol with meperidine as it can cause death. Meperidine and other opioids can also cause nausea, vomiting, dry mouth, contraction of your eye pupils, low blood pressure on sudden standing, urinary retention and constipation.
More seriously, they can also cause confusion, hallucinations, delirium, hypothermia, either fast or slow heartbeat, muscle rigidity and raised pressure in your brain.
At worst, they can cause respiratory depression, which can then lead to death. This happens most often in overdose.
Is painkiller abuse very common?
Yes. Apparently, statistics in the US show that over 15 million Americans admitted to abusing painkillers. Addictions rarely occur in people who take the drugs as prescribed. It’s when they start raising the intake by themselves the trouble starts.
A lot of people have blamed doctors and pharmacists for creating an epidemic of painkiller abuse, but the ethical dilemma for a doctor arises: “How much painkiller does this patient need? If he complains that he’s still suffering from pain, how much more painkiller should I give him?”
It will continue to be a debate, for sure, just as it is one for all the doctors who have ever treated Michael Jackson.
Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health advice, computers and entertainment. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information.
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