Doctor shortage Health

How to boost sales of illegal painkillers

Predictably, the number of Nova Scotians in need of a family doctor hit a new high as of Nov. 1.

On the bright side, it’s “only” 1,179 more than the month before, and it’s the fourth number in a row suggesting some kind of moderating trend. So, fingers crossed, eh?

On the dark side, our 59,225 doctor-less citizens may lose access to a much-needed painkiller next year.

Health Canada is proposing to make low-dose codeine products available by  prescription-only. This would include Tylenol No. 1, which is an alternative for people who cannot tolerate a class of common painkillers called NSAIDs. It includes Aspirin, Ibuprofen, Alleve and many others.

I’m not saying Tylenol No.1 is risk-free. Regular Tylenol (and its generic versions) contains acetaminophen, which by itself can have serious side-effects when misused, but is safe when guidelines are followed.

However,  Tylenol No. 1 also contains codeine and caffeine, which are intended to boost the pain relief. Codeine is an opioid which, given the current paranoia over anything with that name, explains what’s going on here.

Health Canada has a stout defence of its proposal and I lack the science to debate the issue with them.

But I will say that even retail drugs can have unwanted side effects. The misuse of Aspirin and its cousins, for example, can cause stomach ulcers. The question is whether the benefits of a drug outweigh the risks.

If you have chronic pain, you might be willing to risk a lot for relief. (On the flip side, I know someone whose death likely began with a refusal to request opioids for severe pain.)

And I note Canadians take about 600 million doses per year of Tylenol No. 1, which pro-rates to about 15 million doses in Nova Scotia, the equivalent of 300,000 bottles containing 50 tablets. I don’t know how many prescriptions that will require, but the calculation starts at 300,000.

Whatever the final number is, it’s bound to be a burden for family doctors, some of whom have already endured oppressive and unnecessary prying by authorities waging a war on opioids.  Nonetheless, a doctor I know supports the management of opioids even in small doses, but feels other types of painkillers should be made more accessible and less expensive. Interestingly, this doctor suggests including opioids among the drugs pharmacists are permitted to prescribe.

And that brings us to the biggest problem here: if Health Canada makes this change, how will you get Tylenol No. 1 if you don’t have a family doctor? 

How many of our 59,225 doctor-less citizens will have go the infamous “street” for their pain relief? These folks are about six per cent of the province which, using my seat-of-the-pants calculation, equates to a potential market of about 18,000 bottles.

So that could be new biz for “the street” and its dangerous, unregulated products. That’s a lot of risk. I wonder if the benefits are worth it.

But I’m no expert. To quote the Great Ignoramus, I’m just sayin’, that’s all.

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0 comments on “How to boost sales of illegal painkillers

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