Co-proxamol

Part of the debate – in Westminster Hall at 4:27 pm on 17 January 2007.

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Photo of Anne Begg Anne Begg Labour, Aberdeen South 4:27, 17 January 2007

Thank you, Mr. Cummings—you did indeed pronounce co-proxamol correctly. I, too, hope to pronounce the various medical terms correctly.

I am delighted to have secured this debate. I am also delighted that my hon. Friend Dr. Stoate is here. I hope that he will catch your eye, Mr. Cummings, so that he, too, can contribute. I hope to speak from the perspective of a patient who has taken co-proxamol, but my hon. Friend is a doctor and knows all the fancy medical terms. I would also like to thank Arthritis Care and the British Society for Rheumatology for their help in preparing for this debate. Without their help and detailed knowledge of the subject, I would certainly not be as well informed as I am.

I am glad to see the Minister in her place. She has drawn the short straw, because she was also the Minister who deputised in a similar debate that I secured some 18 months ago, on 13 July 2005. At that time, we discussed the initial recommendation that co-proxamol should be withdrawn from use. I suspected that a follow-up debate such as this might be necessary. In summer 2005, GPs were just beginning to withdraw co-proxamol from their patients. Now, we can see the effect of that withdrawal, and I hope that we can evaluate whether patients have been able to find alternatives.

At the time of the last debate, the Minister and many in the medical profession assured those of us who were taking co-proxamol that equally effective alternatives would be found. For instance, I was told that full-strength paracetamol would be just as effective as an analgesic as co-proxamol. That is simply not true; when my GP contacted me to say that he would no longer repeat my co-proxamol prescription, I, like many, went along with his advice. I stopped taking it and have not gone back to it.

I have not secured this debate for my own sake; I have found alternatives, although the alternative of paracetamol supplemented with dihydrocodeine is probably more powerful than co-proxamol. If I had a free choice, I would go back to co-proxamol, but that obviously also depends on the outcome of today's debate.

Last summer, there were problems with the supply of the drug—probably because of confusion over its status, which meant that some pharmacists were not reordering it. Stocks diminished as a result. I understand that the problem has been sorted out, certainly in the short term. However, such problems will arise later this year and in the foreseeable future.

As things stand, prescriptions of co-proxamol under existing rules will end in December 2007. Thereafter, it will be prescribed to far fewer people, and only on a named-patient basis. Less of the drug will be required, and the manufacturers will take commercial decisions on that basis.

I have secured this debate to persuade Ministers at the Department of Health that their concerns about the high incidence of suicide among those using co-proxamol can be addressed without a full ban. The action taken during 2005-06 to reduce prescription of co-proxamol has been effective, so it will reduce the number of suicides. The statistic cited for the number of suicides per year among those using co-proxamol dates from 2001. I suspect that in the past two years that number has dropped as a result of the huge reduction in the prescriptions of the drug from 434,250—almost half a million—in January 2005 to just over 70,000 in August 2006. Only 1,350 of those were new prescriptions.

I have a copy of the paper considered by the Committee on Safety of Medicines in reaching its decision; an individual requested one under freedom of information legislation. That paper lists a complete ban as only one of five options. The Medicines and Healthcare products Regulatory Agency said that it decided in favour of a full ban because information and communication programmes had failed to alert prescribers and patients of the dangers of the drug. What the paper presented to the committee actually said was that the programmes had failed at national level as they had

"been piecemeal activities rather than a concerted campaign using several vehicles simultaneously."

The paper goes further in its conclusions, saying that

"it is possible on pharmacokinetic grounds that co-proxamol may only have a full therapeutic effect with chronic dosing. There may therefore be some justification for co-proxamol remaining a therapeutic option for the management of chronic pain."

Another conclusion in the paper, on the clinical effectiveness of co-proxamol, was based on the contention that there were no robust data to prove that. Co-proxamol is an old drug that has been around since the 1950s. It has never been subject to testing to find out exactly how it works, as is done on modern drugs. Such testing has not been carried out even today. There are no robust data, because there are no data.

The conclusion drawn could quite easily have been the opposite—that there were no robust data, and that that proved that the drug was not effective. There are no robust data proving that full-strength paracetamol is as effective as co-proxamol either. From my experience, it most certainly is not.

It is difficult for me, as a lay person looking at the papers on which the MHRA based its decision, to find the justification for a full ban. There were alternatives to that. However, it took that decision and created huge confusion. At the time, some GPs assumed that they had to get all their patients off co-proxamol as quickly as possible. Indeed, during my July 2005 debate, the Minister quoted an article in Pulse magazine from May 2005 about a GP who, concerned at the risks of co-proxamol, had managed to reduce the number of patients on the drug from 438 to 20.

However, an article in an issue of Pulse magazine from October last year—a copy of which was thrust under my nose by my brother, who happens to be a GP—had the headline "GPs demand U-turn on co-proxamol ban". The magazine reported its own survey, which showed that 70 per cent. of GPs and 94 per cent. of rheumatologists demanded that the MHRA revisit its decision. Although the spokesman for the MHRA accepted that there was

"a small group of patients with a clinical need for co-proxamol as alternatives appear not to be effective or suitable", he said that the licence for the drug would still be withdrawn in December 2007.

I have asked for this debate so that we can get a sensible solution for that small group of patients—the 20 to whom the GP in the Pulse article of May 2005 still prescribed co-proxamol even after he had tried to remove the drug from all his patients.

I certainly do not argue that we should return to the levels of co-proxamol prescription that preceded the original decision of the MHRA; the drug was too widely available then, and often prescribed for acute pain. My own experience was that it never worked for acute pain. If I had a headache, I always took paracetamol, which worked. Co-proxamol did not. However, co-proxamol has proved effective in dealing with chronic pain, and I can back that up from my own experience. It is not just that co-proxamol is effective; many patients claim that it actually works.

I have received a large number of e-mails supporting my position from all over the country, not only from my constituency. One came from Jonathan Russell, my constituent who instigated my original debate, as a result of which he was able to get his GP to re-prescribe co-proxamol. He writes explaining what a difference that has made. He has a full and active life despite having ankylosing spondylitis.

A correspondent from Ayrshire says that he is "getting a better understanding" of how and why co-proxamol works so well and why pain tests fail to identify that. He says:

"Co-proxamol enables me to cope with more pain but with far fewer side effects than anything else. So physically I am in much better shape and far less prone to despair or depression."

I have too many e-mails to read them all out, but another correspondent asked me to ask the Ministers concerned

"why they felt that they had to ruin all our lives by withdrawing the medication when they could have made a more humane decision to not prescribe to any new patients."

There are strong feelings among patients about the effectiveness of the drug.

To achieve an acceptable balance between a significant reduction and availability where there is a clear clinical need, Arthritis Care and the British Society for Rheumatology propose that co-proxamol be made a controlled drug under schedule 3 of the Misuse of Drugs Act 1971, which I hope my hon. Friend the Member for Dartford will explain; that co-proxamol prescriptions should be initiated at specialist level, but that GPs should be able to make repeat prescriptions; that the MHRA should conduct a co-ordinated and comprehensive education campaign, aimed at prescribers, about appropriate and inappropriate use of the drug; that prescriptions be restricted to second-line usage; and that prescriptions be restricted for chronic, rather than acute, pain.

I hope that the Minister has some good news for the hundreds of people who have found co-proxamol the most effective drug in dealing with their chronic pain. They are looking to her to remove worry and to ensure that they continue to have access to the one drug that has made their life bearable.

If only I could cross my fingers, I would. I hope that the Minister has heard my appeal and responds sympathetically.

Annotations

Jeffrey Coles
Posted on 21 Aug 2007 5:30 pm (Report this annotation)

I have to say how desperate I am after the withdrawl of the drug co-proxemol... my Mother, who is now 80yrs old as depended on, and successfully taken them for over 16 years to relieve the symtoms of arthritis.. with no ill effects.

Since being taken off the drug my mothers mobility has declined to the point that she is no longer able to move around... and spends most of every day in bed..this lack of excersise is probably a contributary factor in the developement of a thrombosis in her leg.

My mother now has deceased kidneys.. quite likely from the increase in the amount of paracetomol she now takes, in an hopeless attempt to relieve her pain.

Until 12 months ago, my mother was very active and although she was never pain free...co-proxemol gave her the relief she needed to get around.

The withdrawl of the drug as not only ruined my mothers life... it is now ruining mine... as I am unable to go anywhere and leave my mother I feel hopeless and trapped as I cannot help her with her pain.

I have to work full-time and before setting off to work I have to make sure my mother has a breakfast and then I prepare sandwiches for her until I arrive home from work.

The local surgery as promised allsorts of help... but 6 months later .... I am still waiting.

It is difficult to get an appointment outside of my working hours to discuss my mothers health.. I feel abandoned.

My mother has tried the alternative drugs...and apart from doing nothing for her pain the side effects are too unpleasent for her to manage.

It seems to me that thousand and thousand of people now have to suffer because of a few selfish people that chose to use the drug to commit suicide.

I feel sorry the country has got to a state where people want to commit suicide.

I have completely lost faith in the Health Service and its chiefs, as honest hard working people seem to have no place in the system.

Thousands of people have tried the alternatives and they do not work.

There is a good case for not prescribing co-proxemol at the drop of a hat.... but on the other hand if the precribing is well monitored.. there should not be a problem.

There is also a case for not prescribing the drug to vulnerable people.. such as the younger population who are less likely to be suffering the symtoms of arthritis.

We are now being "nannied" to much... but people need to be allowed to take responsibilty for themselves without the State intervening every time something goes wrong.

The biggest curse in this country at the moment is alcohol... it ruins the lives and kills more people than anything else I know..... I say ban alcohol.

Knee jerk re-action??? just look at the facts.

I beg the commitee that chose to ban this drug, to urgently re-consider their decision.. and take into account GP's and the public's views more throughly.

Regards,
JC

paul savage
Posted on 6 Oct 2007 12:11 am (Report this annotation)

HERE HERE i applause jc for telling the story of thousands not hundreds of people who are suffering from the withdraw of co-proxamol, i myself suffer real bad with arthritis and have taken co-proxamol since 1985,i was taken them from me in 2005 and given alternatives for which my health has got worse and im unable to walk due to the pain but was still working when they were taken off me in 2005. I would love to be able to be prescribed co-proxamol but the powers that be would rather let us genuine persons suffer and unable to work again. im 43 years old and virtually house bound due to the pain and my quality of life has nosed dived so bad over the past 2 years. oneday maybe we will get co-proxamol back so we can have some quality of life before i kick up the daisys.

Regards paul savage.

joanne ryles
Posted on 25 Jan 2008 1:50 pm (Report this annotation)

I also have been on co-proxamol with no problems for 10 years now. Now the drug has been withdrawn I have been given various alternitives which in their own way have made me very sick and just cannot take them. So what now, put up with the pain, quality of life limited, all because some people have died from co-proxamaol. Most pain releif drugs out there are a risk and in copious amounts will kill, not just co-proxamol. Surely it is a patients choice to be able to have the drug and be monitered. I have now been prescribed liquid morphine which in my opinion is much more dangerous and after having 4 dozes of only 2 and a half mls, I will not be taking any more. Many people's lifes have been taken by many other drugs, have they been taken off the market? I dont think so. I think there is more to taking them off the market than just people overdosing. I agree in begging some-one to re-consisder lifting this ban. Even my G.P. does not agree with it.