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“Then, the hell starts”: coroner’s findings spark medication warning

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SA Health is warning that the overuse of laxatives can cause horrific bowel conditions – and doesn’t reduce fat – fearing the release of a coroner’s report this week may encourage anorexia sufferers to stockpile the medication.

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State Coroner Mark Johns found that 28-year-old Newton woman Claudia La Bella died from a complication of laxative abuse in 2014, recommending that laxatives be made behind-the-counter, pharmacy-only medicines.

La Bella had been bulk-buying up to 30 boxes of laxatives from a chemist per week.

The head of SA’s Statewide Eating Disorder Service, Dr Randall Long, told InDaily he was concerned about the potential impact of media coverage of the coroner’s report this week.

He said 10 to 20 per cent of people with anorexia nervosa in South Australia abused laxatives in an effort to reduce their bodyweight – but the medication does not affect food absorption or reduce fat, and its overuse can cause excruciating and life-threatening bowel conditions.

“It’s pain and discomfort, bloating… then you become constipated, and then the hell starts,” said Long.

“I have seen patients who have been stuck using laxatives for many years, who need hospital admissions to manage their constipation.”

In the worst cases “they need surgery – they need bowel removal”.

Long said laxatives pass through the stomach and the small intestine where food is processed and only function in the large intestine, which is not involved in the absorption of calories.

An overuse of laxatives can cause a loss of bowel movement and, at worst, cause a “dead” bowel, where its nerves become totally desensitised and digestion stops, requiring emergency surgery to remove the organ, he said.

Long said he feared news coverage of the coroner’s findings may be misinterpreted by those with eating disorders and encourage them to stockpile the drug in case laxatives are made a prescription drug (which goes beyond the coroner’s recommendation that they be made pharmacy-only medicine).

He said laxatives were hard to stop taking after a certain period because of their counter-intuitive long-term effects on the gut.

“Maybe 10 to 20 per cent of our patients will struggle with (laxatives) and maybe will have to do some work to stop using them,” he said.

“These people are really, really, really trapped.”

State and Territory manager of the Pharmaceutical Society of Australia (SA/NT) Helen Stone told InDaily laxatives were among a number of medications sold in supermarkets that should only be offered in pharmacies.

She said her organisation provides a “mandatory text” to pharmacists around the country on the sale of laxatives that should prevent their abuse.

“There are a lot of things that are available in the supermarket that we would argue are best (made only available) at pharmacies,” said Stone.

“Laxatives are just one of them.

“A pharmacist should always be involved in their sale.”

Stone added that pharmacists needed to be “vigilant” to prevent harm.

Long agreed that a health professional should always be involved in the sale of laxatives and that pharmaceutical authorities should review their regulation.

“Maybe the pharmaceutical regulation authorities need to have another look at how this medication (is supplied and regulated),” he said.

“More control and more supervision by a pharmacist is probably the first step.

“If you need to use regular and large amounts of laxatives you have a health problem … you need to see a doctor.”

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