Doctors warn of codeine dangers after occurrence of acute confusion in daughter, 14

Lack of efficacy and risk of poisoning and craving suggest use of over-the-counter codeine narcotics may be unwarranted, says report

Doctors have issued a warning about the use of over-the-counter medications containing codeine following what is believed to be the first published lawsuit of acute disarray in a 14 -year-old girl.

The dangers associated with codeine in cough remedies, both prescribes and otherwise, are highly unnecessary because of the lack of evidence that they actually work, the experts said.

Many mothers still dedicate codeine products to their children, despite regulators fears. This may be because of what they perceive as its strength, and its analgesic impacts, medical professionals from Ireland say in an article in the publication BMJ Case Reports.

The girl was assured at a hospital A& E department after five days of fluctuating confusion and amnesia, according to the report. She had been sleeping up to 20 hours a day, had a decreased attention span and suffered from intermittent headaches.

She had falsely reported having completed tasks, such as having showered, her mothers told physicians, and she also switched speeches while doing her homework. The girl had flu-like symptoms over 15 days, during which she missed school, and had been taking two to three spoonfuls a day of oral codeine phosphate over this time.

Although the girl had not exceeded the recommended daily dosage of three to six spoonfuls, she had outstripped the maximum recommended duration of three days. In all, she was thought to have devoured 450 -6 75 mg of codeine, instead of the maximum of 270 mg over any course of treatment.

The symptoms abated five days after the girl was admitted to hospital. There was also no codeine in her urine. A clinical review 2 week after she was discharged proved she was well and free of symptoms.

Confusion is a relatively unusual complaint in codeine intoxication, say the doctors, highlighting the necessity of thorough investigations. Codeine does however often affect the central nervous system and breathing and can cause severe rub of the scalp and flushes.

In April, the European Medicines Agency warned physicians against giving codeine to children and adolescents. It reviewed international data relating to coughs and other respiratory infections, including four demises, arising from codeine poisoning in children aged between 17 days and six years.

For coughings and colds in under-1 2s, it should only be used in special circumstances, relevant agencies said. Older children and adolescents with breathing problems should also not use codeine , nor should patients of any age who were known to convert codeine into morphine at a faster rate than normal.

The authors of the BMJ article say that although there was no evidence of codeine craving in this case, other studies had raised questions over codeine dependence in adolescents and vulnerable adults.

The combination of lack of efficacy, danger of acute intoxication and dependency, suggests the use of over-the-counter codeine preparations may be unwarranted, they said.

The UKs Medicines and Healthcare Products Regulatory Agency said: Codeine is a strong medication authorised for pain relief. It is not recommended for use in children or adolescents for the symptoms of coughing and cold as it is associated with a risk of respiratory side-effects.

If anyone has any questions, they should speak to their GP or pharmacist who can best advise on alternative treatments.

Professor Nigel Mathers, honorary secretary of the Royal College of General Practitioners, said: GPs are aware of the risks links with prescribing codeine and, in line with current guidelines, as a general rule we would not recommend medications containing codeine for children unless other alternatives have been explored and only when it is really necessary.

We would certainly not recommend these drugs for patients who have other conditions, such as asthma. But codeine is an effective cough suppressant and widely accessible without a prescription, so if patients do choose to take medications that contain codeine, we would urge them to read the label carefully and stick to the recommended dose.

Neal Patel, a pharmacist and the head of corporate communications at the Royal Pharmaceutical Society, said: The UK Commission on Human Medicines advises that over-the-counter liquid medications that contain codeine should not be used for coughing suppression in people under 18.

There is only limited evidence that codeine is effective for treating cough and cold symptoms in children. The hazards outweigh the benefits for treating the symptoms of cough in this age group.

Codeine-containing medications are unsuitable for treating pain or coughing in children under the age of 12 due to the potential seriousnes of side-effects.

Pharmacists advise that, when used, codeine-containing medications should only be taken for three days and only at the recommended dosage, as it can cause addiction. People with coughings that last for more than two weeks should seek advice about the cause from a pharmacist or GP.

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Irish people have dared to speak on abortion. Our government must listen | Grainne Maguire

The story was that abortion could be tolerated in only the most limited of circumstances. Then 99 members of the public were asked what they thought

In 1916, when revolutionaries were putting the final touches to the proclamation of independence, the manifesto of the Irish state, there was one phrase that maintained holding everything up: should it be addressed to the men of Ireland as Pdraig Pearse insisted, or the men and women, as James Connelly argued? Connelly won, but whose revolution it actually was is still up for debate 101 years later.

Last weekend, a national assembly set up by the taoiseach, Enda Kenny, to debate access to abortion in Ireland announced its results. Abortion is still illegal in Ireland( as was the case in Northern Ireland) and Kenny, in the dying days of his leadership, is reticent to lead on the issue. So instead 99 members of the public the Citizens Assembly picked to represent the hearts, intellects and conscience of middle Ireland, were sent away to consider the facts and present their results. Contrary to everyones expectations they voted overwhelmingly not only to recommend legalising abortion but under circumstances more liberal than anyone guessed possible.

The narrative up until now has been that abortion in Ireland could be tolerated in only the most limited of circumstances. There are good abortions: fatal foetal abnormalities, rape, incest. And then there are bad abortions: women who for whatever personal reason no longer want to be pregnant. The spectre of British-style abortion loomed in the public conscious, the worry that unrestricted access would result in feckless women discontinuing pregnancies on caprices, giddy on cosmopolitans during Sex and the City binge-watches.

It seemed to become socially acceptable to casually dismiss the two sides of the abortion debate as being as bad and as extreme as each other. That the anti-choice side groups that regularly display gruesome images of late-term abortions outside public builds, set up fake counselling services to frighten pregnant teens into continuing their pregnancies, and claim abortion leads to infertility are in their style, just as extreme as the pro-choice side. Theyre the ones that argue its a matter best left between a woman and her doctor.

Ireland is still a very conservative country. News organisations sent their religion affairs reporter to cover the assemblys seeing , not their health correspondent. The Irish prime minister casually uses the phrase abortion on demand in interviews. Images of heavily pregnant women and newborns illustrate abortion news tales. There was even the jaw-dropping audacity of Sinn Fin until very recently bragging it was a pro-life party.

I grew up in a typical midlands household in Ireland, and like most Irish people I went to a Catholic primary and secondary school. Up until my early 20 s, when abortion became more real and less philosophical, I was unthinkingly anti-abortion. I remember the day we encompassed it in religion class. There was one chapter on it in our book, and at the end 10 reasons set out above it was wrong and two why some people thought it was OK. There was little deliberation. A room full of curious, intelligent, ambitious young lady, and our minds were as certain, closed and stupid as an unread book.

There was a really lovely young geography educator at our school. A few years after I left school, she got pregnant and then found out she had cancer. She decided to stop the treatment because it would set her pregnancy at risk. She miscarried, then slipped into a coma and died. Its not my place to even imagine the hopeless loneliness of her selection, but in a culture that told her motherhood mattered above all else, I wonder how much choice she truly had. Or was what she felt she had to do so obvious, she merely couldnt find her way out of it? I wish she had been more selfish. I wish she had insisted her own life was worth fighting for.

Centuries of colonisation do strange things to a nations male psyche. For a long time, females were daughters or mothers but never comrades, never equals: loved but never really liked. Those who didnt play by the rules could be sent away to laundries and never seen again. The classmate that never came back to school, the sister that couldnt be mentioned again, all those empty chairs a warning to the women left behind. Play by the rules or the bogeyman will come and get you.

The assemblys recommendations are just that, recommendations. They are not legally binding. We now have to wait for government to discuss and decide on the wording of any referendum that might take place. It is unlikely to be as liberal as I would like, or as the recommendations themselves. Despite all this, I still have hope because, just as with the recent referendum to legalise same-sex matrimony, I eventually heard the voice of the kind, sensible, compassionate Irish people I know and love. I have hope that we might eventually have a country worthy of the women and men that live there. Until that happens, its not my revolution.

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Ireland general election: referendums cast as hung parliament predicted

Calls for Fine Gael and Fianna Fil to create a grand coalition and govern together for the first time amid signs of no clear winner

Voters in Ireland are going to the polls to elect a new government, amid pressure on the two biggest parties born out of the Irish civil war to bury their historic hatred and govern together for the first time.

More than 3 million people are eligible to vote in 40 constituencies, and there are 552 candidates contesting 157 seats in the Dil, the Irish parliament. Polls close at 10 pm on Friday night, and counting will start on Saturday.

Given that most opinion polls have predicted a hung parliament, which could lead to days maybe weeks of horse-trading between the main parties and a slew of unaligned independent nominees, some commentators have called on Fine Gael and Fianna Fil to create a grand coalition, on the same lines as the Christian Democrats and Social Democrat when they came together to govern Germany.

However, resulting figures in ruling party Fine Gael, including health minister Leo Varadkar, have described such a coalition as a nightmare. Fine Gael and its Labour coalition partners have instead appealed to voters to return them to power in the name of stable government.

The prime minister, Enda Kenny, returned to his native County Mayo on Friday and cast his election at a polling station in Castlebar. He would make history if he is re-elected, as since the state was created in 1921 no Fine Gael taoiseach has been returned for a second term of office.

Speaking after casting his vote, Kenny said: I only hope that everybody around the country accepts their responsibility today and that people go out and election and do their constitutional duty.

The Fianna Fil leader, Michel Martin, cast his referendum with his family in Ballinlough, Cork, refusing to talk about any potential electoral outcomes but predicting a good result for his party.

Sister Anastasia of the Franciscan order casts her referendum at Knock national school, Mayo. Photo: Brian Lawless/ PA

Fourteen years of continuous Fianna Fil rule brought to an end when the party was trounced at the 2011 election, returning to parliament with merely 20 seats its worst electoral showing in the republics history. The party took a hammering from an electorate that blamed it for the collapse of the Celtic Tiger and the loss of fiscal sovereignty to the International Monetary Fund.

This time around, all opinion polls have forecast that Fine Gael will retain its No 1 spot and that their constituencies will penalise Labour for the coalitions austerity programme, which has caused widespread anger, particularly over the imposition of water rates for the first time in the countrys history.

Sinn Fin is expected to capitalise on much of this anger, as will a number of leftist parties and an amalgam of independents. The Labour leader and deputy prime minister, Joan Burton, is in danger of losing her Dublin West seat.

Any coalition needs at least 79 seats to form a government. A Fine Gael-Fianna Fil link-up would render a huge working majority.

Although Northern Ireland has not been a major issue in this election, the spectre of the Troubles created its head again on Friday morning at a polling station in the village of Hackballscross in County Louth.

Photographers who had arrived from Dublin to take pictures of former IRA Thomas Slab Murphy after he voted were cautioned not to by a Murphy associate. Hours afterward Murphy was sentenced in Dublin to 18 months in jail over tax evasion.

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