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“Someone is trying to jump off a bridge and they give him ketamine in the ambulance to calm him down and 9 months later, he says, ‘I haven’t felt suicidal for 9 months.’ “When enough stories like that started to pile up, doctors said, ‘Maybe there’s something here,’” says Stewart, an emergency physician and founder of Insight Ketamine in Santa Fe, NM. Like the drug itself, Stewart got his start in combat medicine during the Vietnam War. Some doctors also use ketamine to treat suicidal thoughts.
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On its own, 500mg paracetamol has a success rate of around 43% meaning it only helps around 4 out of 10 people. In fact, researchers have found that, for every 3.5 people taking it, only one would experience good pain relief. Oddly, there is no evidence that higher doses (600mg to 1g) are more effective – in fact, they appear to be less effective than the 500mg dose! Products that combine paracetamol with ibuprofen work in up to 70% people, however, as mentioned above. A study published in the British Medical Journal, which looked at the results from 13 clinical trials, concluded that paracetamol is not effective for reducing back pain, and that it provides only minimal, short-term benefit for people with osteoarthritis of the hip or knee. The most likely explanation is that these conditions are associated with low-grade inflammation, and paracetamol lacks any anti-inflammatory action.
Tramadol should also be used cautiously in patients with impaired respiratory function, e.g. asthma, chronic obstructive pulmonary disease and sleep apnoea, and in patients with hypotension, shock, impaired consciousness or obstructive bowel disorders.5 If tramadol is prescribed to a patient taking warfarin, close monitoring of INR levels is recommended due to an increased risk of bleeding, particularly during the first week of treatment. Tramadol is contraindicated in children aged under two years due to the limited amount of safety and efficacy data.7 Liquid tramadol is sometimes given to children in a secondary care setting for post-operative pain; care is required to avoid over-dose as two strengths are available, i.e. 10 mg/mL and 100 mg/mL, however, these formulations are not subsidised for use in the community.
Most children in our survey who were taking medication for ADHD had tried methylphenidate (84 percent) or an amphetamine (51 percent) in the past three years. A smaller percentage (17 percent) had tried a nonstimulant medication. There were no differences in the type of medication children were prescribed either by age or length of time since they had been diagnosed. Most children taking these medications had been taking them for longer than two years (35 percent overall), while 22 percent had been taking them for one to two years. Our survey found there were no major differences in effectiveness between amphetamines and methylphenidates. But there were more reports of “irritability and anger” and “high mood/energy (manic behavior)” among children who used amphetamines.
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