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Co-proxamol ban makes a mockery of patient choice

If the Government is so keen on patient choice and empowerment, why is it taking away the option of a drug so many rely on, asks Dr Howard Stoate

If the Government is so keen on patient choice and empowerment, why is it taking away the option of a drug so many rely on, asks Dr Howard Stoate

The NHS is ‘moving away 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 services for people with long-term conditions'.

These aren't my words, but those of recently departed health secretary Patricia Hewitt.

Sadly, although ministers and senior officials often talk a good game as far as patient empowerment is concerned, the reality is sometimes rather different, as patients who depend on co-proxamol for pain relief will no doubt attest.

Here we have a drug that even many of its critics will admit is – and is likely to continue to be – the only effective means many people have at their disposal to control chronic rheumatic pain.

Yes, there are risks associated with its use and yes, the Medicines and Healthcare Products Regulatory Agency is right to flag up the serious potential consequences if its prescribed dosage is exceeded.

It would be wrong for us to ignore this, and there is now a strong case for co-proxamol to be made a schedule 3 controlled drug. This would highlight the risks involved in its use and introduce extra safeguards into the prescribing process.

Crucially, however, it would also ensure the drug remains available to patients. I take the view that as long as a doctor is satisfied that co-proxamol is the most suitable drug for a particular patient, and is confident the patient is fully aware of the potential risks involved and will follow the advice on how to take it, then the doctor should be free to prescribe it.

Instead the MHRA has lost its nerve and chosen to pursue a course of action that will make it impossible, in all practical senses, for doctors to prescribe co-proxamol after the end of this year – even when it is patently clear that it remains the only viable option.

It is a decision that begins to appear even more perverse when you consider the long list of side-effects associated with the main alternatives to co-proxamol.

NSAIDs carry a risk of gastrointestinal bleeds, cox-2s are prescribed only with reluctance by doctors because of the cardiovascular risk, codeine compounds can cause severe colic and constipation, and dyhydrocodeine can lead to dysphoria.

There is also some evidence to suggest that patients are choosing to exceed the recommended maximum doses for alternative, less obviously effective analgesics in a bid to relieve their discomfort.

Losing faith

Patients and doctors have every right to feel let down by this decision. It undermines at a stroke departmental promises to put patients with long-term conditions in control of their treatment options.

You can choose how your care is planned and managed, it seems to be saying, as long as we can retain strict control over what these care options actually are. Patients are free to choose, but only if it is on our terms.

Is it any surprise with decisions like this that patients and GPs appear to be losing faith in policymakers and health regulators?

Saying to doctors that you can't trust them to weigh up the pros and cons of prescribing a well-established analgesic – the job that they are trained and paid to perform – is no way to build bridges between Whitehall and professionals.

Perhaps Alan Johnson and his new health team will have learned some lessons from the way in which the co-proxamol issue has been handled in the past couple of years, and will initiate a full review.

For the sake of the many patients still reliant on co-proxamol, I certainly hope so.

Dr Howard Stoate is Labour MP for Dartford, Kent, and continues to work as a part-time GP

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