Analgesics abuse: theoretical and practical considerations.

Three important issues must be addressed in any attempt to determine whether combination painkillers play a role in analgesic nephropathy. The first issue, namely that of a causal link between the combination itself and nephrotoxicity, has never been adequately documented. On the contrary, there is much evidence that the combination as such has no influence whatsoever. The cause of the nephrotoxicity is most likely the painkilling mechanism, i.e. the antagonism to prostaglandins; the most potent prostaglandin-antagonists, the non-steroidal anti-inflammatory drugs, whether used in combination or singly, also most frequently cause renal pathology. The second issue, i.e. the safety of combination painkilling drugs in comparison with that of single substances, is intimately bound up with the advantages of the former with respect to both activity and the activity-side-effects ratio. The third issue, abuse, should be recast in a broader context. The central element here is not the painkilling drug but rather the labile personality of the user in conjunction with a more or less stressful environment in which a wide variety of drugs and stimulants are available and taken for better 'coping'. To a great extent analgesics abuse can be prevented by information (i.e. social medicine). In a broader perspective, man experiences considerable difficulty adapting to the sweeping social, technological and ideological changes of recent decades, and this transition contributes in no small measure to the analgesics problem. It should be a priority of government to find remedies for this state of affairs.