Many of us are responsible drug users. We see a doctor when necessary. We buy prescribed drugs from a pharmacy and we take the drugs as directed by the doctor or pharmacist. Many of our homes have over-the-counter and prescription drugs, in use or left overs, or even just stocked as handy drugs.

They are regarded as safe. They cure or at least relieve symptoms when we are sick. We call them good drugs because they are not like those bad drugs that are used socially and can cause a lot of trouble.

In this article, we consider how such good drugs can become disastrous. Sometimes we swallow our drugs with just any drink that is handy. This is risky. Drugs should be swallowed with water. Drugs are chemicals. Drinks are also chemicals.
Chemicals tend to react with one another and generate new products which changes the ability of the drug to affect the ailment it is being used for. It also produces other risks such as a wrong end product chemical that may be anything from inert to toxic, causing undesired and unexpected effects in the body.

Acetaminophen or paracetamol (Panadol®) is our common household pain killer. It is a useful and helpful drug for relieving pain and fever but one should not use it habitually. Taken according to the manufacturer’s indication, it is safe enough.
Any harmful effect of the drug is not lasting because the drug is soon enough transformed and excreted from the body and the body repair system mends any side effects. However, this drug taken in excess, routinely and chronically, or just a large dose once, causes acute or long term liver damage and death.

When drinking alcohol and one develops a headache, one may try to kill the pain with paracetamol. Paracetamol taken by alcoholics can cause deadly liver damage, especially in people who already have a compromised liver.

Other pain killers such as aspirin, ibuprofen, or naproxen taken with alcohol increase the risk of stomach irritation and bleeding. Damage to the stomach and ulceration may seem like a small ailment.

A man died recently and it was revealed that he had pain in his “stomach” a few days ago and his autopsy revealed he had ulcer and hernia.
When the gastrointestinal (stomach and intestine) wall is damaged to the extent that there is a hole through the wall, the contents which have food, bacteria and other microorganism, that were normally safely heading towards the anus, leak into the abdomen and cause sepsis and death.

The massive invasion of the clean abdomen by bacteria is a shock to the body. Thus perforated gastrointestinal ulcers are disastrous.

Many over the counter pain killers that we buy regularly without prescription can damage the gastrointestinal wall leading to ulcer especially in people who, for economic or other reasons, skip meals.
The group of drugs called non-steroidal anti-inflammatory drugs or NSAIDs are notorious for this. Aspirin, ibuprofen, naproxen, and indomethacin are all NSAIDs. They should not be taken on an empty stomach and they should not be taken with alcohol.

When we skip meals, the stomach becomes empty. If the stomach wall protective mechanisms are weak, the stomach is open to the action of the acid and enzyme secreted for the digestion of food. The acid and enzyme are free to digest the stomach rather than food (which is not available), causing ulcer. Add an NSAID pain killer, and this may be a recipe for disaster and death.

Prescription painkillers should not be used with alcohol because the combination worsens the NSAIDs’ ability to cause ulcers. Alcohol itself has damaging effect on an empty stomach, especially if the stomach lacks strong protection of mucus and other protective mechanisms.

A second group of painkillers, opioids, are use through prescription unlike NSAIDS that we buy freely. Opioid pain killers such as oxycodone are central nervous system depressants. Central nervous system depressants depress a part of the brain called the respiratory centre that controls respiration (breathing).
The dose of any opioid that we use for medication does not depress the respiration to a harmful level. Alcohols also depresses the central nervous system therefor both opioid and alcohol taken together can depress the nervous system to the point of sudden death.

We need pain killers and when we use them correctly we can enjoy their benefits. However, if we use NSAIDs when fasting or when skipping meals, or when on a poor diet, we run the risk of gastrointestinal damage and ulcer which can be fatal.
Low income level people who tend to skip meals and also use pain killers for headaches are at risk of unexpected fatality from ulcers.
High income people who enjoy alcohol and also take NSAIDs for headaches run the risk of ulcer and those who take alcohol and also take an opioid pain killer run the risk of sudden death from respiratory depression and sudden cessation of breathing.

Many people take these drugs on an empty stomach or with alcohol and the combination does not result in serious problems but we must understand the risk. Pain killers should not end up killing more than the pain.