by Jeanne Hambleton © 2008 – NFA Leader Against Pain-Advocate
The coproxamol debate has apparently been ‘pushed under the carpet’ and seems to have lost its momentum with GPs disgruntled but still wanting to prescribe the 50-year-old safe painkiller. Meanwhile the Government and the Medicines and Healthcare Products Regulatory Agency dig their heels in and refuses to consider a review of the whole sorry situation and ‘bungled withdrawal’. One man is so angry as he lives with unmanaged pain, he is seriously considering spending £20,000 of his hard earned cash on a Judicial Review and another angry coproxamol patient has launched an e-petition for the attention of the Prime Minister.
Russ Mclean, making a comment on the Pulse Today website (owned by and for GPs) expressed his concern for some 60,000 patients being exposed to the possibility of life in untreated pain. As someone in pain, he had pleaded with the MHRA to sort out the failure of the “Named Patient” issue, but they had refused to reconsider the coproxamol withdrawal. Russ McLean now felt he had put up some £20,000 for legal fees to require the MHRA to be subject to a Judicial Review. Russ McLean claims he should be investing this money in helping creating much needed jobs.
P. E. G. Cope, the e-petitioner, urging everyone who has become a ‘coproxamol refugee’ to sign up and give their support to his message to Gordon Brown, writes, ‘We, the undersigned, petition the Prime Minister to allow patients to indemnify their GPs to continue prescribing coproxamol, for pity’s sake.’
Of course I have rushed to sign it myself and congratulate this person – Mr. Cope – for taking this initiative.
Mr. Cope – please excuse me if I am wrong – also writes, “The Government has now withdrawn the analgesic coproxamol except for special named patients (for whom nothing else works) at their GP’s risk. It is NOW clear GPs will NOT take this risk. Tens of thousands of patients are now left in unnecessary pain. DoH should be as good as their word, in Hansard, and issue a Patient Indemnity Form transferring the GP’s risk to the patient, as with anesthetics. This can be done overnight. Please let it be, and end our agony. Pulse magazine found that 94% of rheumatologists favoured retention.
To sign the petition please log on to this link.
I could not agree more but the burning question is, will a letter offering to indemnify our GP, if he prescribes coproxamol, be valid in a court of law? It takes less than five minutes to sign the e-petition. Please keep the debate going.
My own GP, who is not prescribing, thinks a letter of indemnity will not hold good in a court of law. He is adamant that the responsibility lies with the prescriber and that any letter written by a patient accepting responsibility, would be invalid.
There is also the question of cost. While coproxamol was a legal category drug, it was available to pharmacists at £2.79 for 100 tablets – a cheap painkiller meeting the needs of thousands of NHS patients. Once it became illegal or de-classified on January 1 2008 the price rose to £20.39 for the same quantity of tablets. How can you justify a seven-fold increase?
This, of course, must be another turn off for our GPs. Not only are they walking a legal tight rope and putting their career on the line, but they would be also pushing up the medication costs within the practice by prescribing coproxamol, not to mention the agro the PCTs are giving the doctors.
WRITE TO THE HEALTH MINISTER AND YOUR MP
It is the Government’s fault and our only chance is to write to Alan Johnson, Minister for Health, and his new health team in the hope he will right the wrongs of the past. Send your emails with a list of all your symptoms, aches and unmanaged pain to
and plead for a review of the coproxamol withdrawal. Copy your letter to MP Anne Begg who has been doing sterling work for coproxamol but she does need some help from her us. Send a copy of your letters to your own MP. You can log on to theyworkforus.com, insert your postcode and you are presented with a message box.
We are counting on all you UK-iers living abroad to give us your support. Talking about Uk-iers I understand there are unlimited supplies of coproxamol in Spain – no problems.
With GPs facing possible litigation, and increased costs, it becomes painfully obvious that less and less doctors will be prepared to take the risk of prescribing coproxamol however much they know the patient cannot find an alternative and is in desperate need of this tried and tested painkiller.
CHECK MATE AND DISASTER
Unless we take some action ourselves and put pressure on the MPs and the Government, we may be faced with a ‘check-mate’ situation. Although one coproxamol manufacturer has pledged to continue providing the painkiller for ‘named patient’, if so few GPs prescribe coproxamol, this could mean that manufacturing becomes uneconomical, and it ceases. What about all the Government promises to help those who really need coproxamol – patient’s responsibility – all hot air – Government spin.
Facing pressure from the MHRA and the PCTs, the GPs facing patients who cannot find an alterative to coproxamol, are finding themselves between a rock and a hard place.
Writing on behalf of the CMP Medica in Pulse Today D. Cressey said as far back as November 2006, the UK drug regulator was passing the buck and telling patients to talk to their GPs if they wanted to continue taking coproxamol.
HYPOCRITICAL TO WITHDRAW COPROXAMOL AND RECOMMEND IT
But MHRA insisted providing individual patients prescriptions were not unusual. But GPs suggested it was ‘hypocritical to withdraw the drug yet still recommend its use.’
Following a survey of GPs and rheumatologists it was revealed that a large percentage wanted to retain the drug said Pulse.
But the Medicines and Healthcare Products Regulatory Agency had already made up its mind and dug its heels in. The agency was warning doctors of the legal risks of prescribing this painkiller. Coproxamol was withdrawn at the end of December 2007 and all pharmacies and warehouses were advised to return unused stocks.
Today I heard from a GP that an Alliance pharmacist, part of the Boots group, had said that coproxamol is no longer available not even for named patients. So who is pulling whose strings? They cannot even get their stories right. Even the pharmacists have no idea what is going on.
In 2007 it is claimed some 75,000 patients were still taking coproxamol. I doubt this is the case now. In November 2006 Pulse revealed the decision to withdraw coproxamol had split the medical profession with 70% reporting they were totally opposed to the withdrawal.
Almost a year later Dr Howard Stoate, an MP and medical practitioner, asked if the Government was so keen on patient choice and empowerment why is coproxamol, which so many people rely upon, being withdrawn?
He quoted Patricia Hewitt, who was then the Health Secretary, as saying the NHS is moving way from the old monolithic, monopoly NHS to a self improving system with more choice for people about the services they use and more freedom and responsibility for GPs to get the best service for people with long term conditions.
Dr Stoate described coproxamol as the only efficient painkiller that people with chronic rheumatic pain, had at their disposal. He said there are risks associated with coproxamol but he suggested there was a strong case for this painkiller to be made a Scheduled 3 controlled drug. With rescheduling the risk would be highlighted and extra safeguards would be introduced.
More importantly it would ensure that coproxamol would remain available to named patients.
Dr Stoate suggested the MHRA had lost its nerve and taken a decision that makes it impossible, in the practical sense of the word, to prescribe coproxamol in 2008, even to named patients. Dr Stoate suggested it is patently obvious that making coproxamol a Schedule 3 Controlled Drug remains the only viable option.
He suggested that perhaps Alan Johnson and his new health team may have learned some lessons from the coproxamol issue and should initiate a full review.
Nigel Praities writing on Pulse Today (www.pulsetoday.co.uk) in December 2007 advised GPs would receive further warnings about the legal implications if they continued to prescribe coproxamol after January 1 2008.
He reported that by October 2007 60,000 patients were still taking coproxamol, a fall of only one fifth as revealed by Cegedim Strategic Data. It was also noted that more than half of the patients who have changed to alternative treatments had lost pain control. The MHRA agency has been urging GPs to switch patients to paracetamol or ibuprofen. With my supply of coproxamol no longer available I have today been recommended to take co-codamol.
It was reported that the coproxamol withdrawal had completely divided GPs. Whatever the personal views they may have Nigel Praities on January 14 2008 reported GPs were under increased pressure following the huge seven fold price increase although in December some 60% were still prescribing coproxamol.
But it was reported by Pulse that almost 40 % of GPs had said they would continue prescribing it on a named-patient basis. Pulse Today have said this ‘bungled withdrawal’ is not working for patients or doctors.
ONE MAN’S VIEW
On 14 January 2008 Nigel Praities reported when coproxamol moved from a Category M drug to a Category C on January 1 2008, coproxamol had a reimbursement price, which was paid to chemists, of £2.79 for 100 tablets. This rocketed to £20.36 for 100 tablets, which brought more warnings from the PCTs. One doctor pointed out that there is nothing like a price hike to concentrate the mind.
In a comment to the Pulse Today website Russ McLean wrote, on January 15 2008
Dear Doctor, I read the Pulse article about legal exposure if you continue to prescribe coproxamol to patients presenting a “clinical need” on the unlicensed “named patient” basis. Whilst the MHRA are to be commended for their original aim in reducing suicides and accidental death from coproxamol, it seems the endeavour has gone too far in the ban direction, and resulted from what is written above, in some 60,000 patients being exposed to the possibility of life in untreated pain.
The purpose of my comment here is to advise, as one now in unmanaged pain, that having pleaded to the MHRA to sort the failure of the “named patient” issue out and had replies from the MHRA declining to revisit the coproxamol issue, I am now having to ante up some £20,000 for legal fees.
Not for any GP, but to require the MHRA to be subject to a Judicial Review. I should be investing this money in helping creating jobs. However, stubborn intransigence from the MHRA is meaning chronic pain, and a big pain in the wallet.
For my tuppenceworth, well done by the doctors who are honouring their commitment to the Hippocratic Oath and continuing, where clinical need presents, to prescribe coproxamol to their patients.
On the same day under another article Russ McLean wrote January15 2008
I am appalled. Sir Alasdair Breckenridge, chair of the MHRA promised a safety net for the 70,000 UK patients* such as myself that present a clinical need for coproxamol after MA withdrawal on 31st December 2007.
For the past two years, I have had the full range of experimental alternate analgesia and been hospitalised twice. All alternates proving either too strong, too weak or with intolerable side effects.
Even more frustrating, is that following spinal surgery in 1994, I was able to sign off of Higher Rate Disability Benefit and resume a meaningful working life (creating 70 jobs over ten years). Now through this MHRA mess, I am faced with unmanaged chronic pain and workless disablement because the MHRA “named patient” system is being shunned by doctors, my own included.
Today in Pulse, we have what seems like MHRA “spin” through cost rather than patient care, in another effort to again screw up the lives of thousands of patients who had effective pain management through coproxamol.
Shame on those in the MHRA who have ignored not one but two House of Commons debates and hundreds of letters of concern from senior surgeons, doctors, heads of pain management clinics, charities etc. * 70,000 as per House of Commons Debate – http://www.theyworkforyou.com/whall/?id=2007-01-17b.340.0
- January 2005 – MHRA announces withdrawal of coproxamol
- October 2006 – A Pulse survey reveals 70% of GPs demand the MHRA review its decision
- January 2007 – MPs demand u-turn on withdrawal at special House of Commons debate
- October 2007 – 60,000 patients remain on coproxamol
- December 2007 – Final withdrawal of coproxamol
- January 2008 – PCTs panic as price of coproxamol soars