They're cheap, widespread and billed as safe - but headache tablets from supermarkets and shops can carry big risks, especially for Indigenous Australians.
(Transcript from World News Australia Radio)
Now researchers in Adelaide want new national standards to ensure people are more aware of the potential dangers of over-the-counter medications.
As Karen Ashford reports, there are concerns that inadequate information, poor cultural competency by health professionals, and slick marketing by drug companies could be costing Indigenous lives.
Lola Kropinyeri is seeing her podiatrist.
It's one of many regular health checks she has to manage her various ailments.
"Diabetic, asthmatic - everything that goes with the body... I've got arthritis."
Prescription medicine keeps her well, but if she gets a cold or a headache she has to be careful about taking other tablets as they could interfere with the drugs her doctor's given her.
That includes tablets that friends think are effective.
"I was given a tablet and it sent my whole , what you call it, I wasn't allowed to leave my house on my own, had to wait 'til my daughter took me out, you know, because it stuffed my chemicals up."
Aboriginal people have a greater rate of chronic illnesses than the rest of the population, and that means they're at higher risk of complications from using multiple medications.
It's not just medicine prescribed by doctors that is of concern - even seemingly safe tablets like paracetamol and ibuprofen can have nasty side effects if taken with other medications or in the wrong doses.
Adelaide University researcher Charlotte De Crespigny says it's an easy mistake for people with several ailments to make.
"What if I'm taking Panadol Osteo because I've got arthritis, and I've got a headache as well and I might take my Herron or my Paralgin paracetamol because I didn't know it was the same drug. And there we have the problem, we're getting too much too often. And it's uncontrolled."
Charlotte De Crespigny says drugs such as anti-inflammatories that are advertised as being safe can cause serious problems.
"And now we've got babies, it's being advertised as safe for babies. So we've got a whole market out there of people who are taking non-steroidal anti-inflammatories, which has yes, good potential for pain relief, it reduces inflammation, again there are good reasons to take it in very short bursts at very low doses, under supervision if possible, and yet young women and vulnerable people are turning up in emergency departments haemorrhaging, and having to have blood transfusions because it's bleeding through the lining of the gut."
Liver failure, kidney failure, stomach corrosion, and internal bleeding are amongst the potentially fatal problems that can arise from medications found by the dozens in supermarkets and other shops.
Given their ready availability and slick promotion it's not surprising many people would be unaware of their risks.
Ms de Crespigny and respected elder Coral Wilson undertook to study about 30 Aboriginal people on multiple medications.
When those involved came to understand the risks they were shocked.
"The more we explained it, and showed it, with real packets and real pictures, the more angry they got, because they were saying but we have to take lots of medicines and nobody has told us this. And I thought they were safe, we thought they were… and they were talking to each other and then talking to us and they were asking lots and lots of questions about this, and then becoming quite frightened, well maybe I shouldn't ever take it and what do I do now, because I've got this disease, or I've got back pain, or I've had cancer or I've got arthritis. So then we had to say well look, the important thing is that you're talking with your doctor, talking with your health worker, you're talking with the pharmacist. It's really important to go to the chemist shop, the pharmacist."
Aunty Coral Wilson says there's a big communication gap.
"I think it's really important that people need to know about the effects of different medications and I think that should be taught more so in Aboriginal communities."
Aunty Coral thinks at the very least, clear information with large print and pictures should be placed alongside medications - to cater for people who may have limited understand of English, or poor eyesight.
But what she'd really like to see is analgesics taken out of supermarkets and restricted to chemists where people can get advice.
"Hello, can I help you there?"
"Yes you can, I was looking at those Voltaren tablets down there - what are they good for?"
"They're an anti inflammatory, very good for inflammation, joint pain, any sort of back pain, however they're not good for all people… "
Unlike a supermarket, a pharmacy is a place Aunty Coral can get information about the big range of tablets that are on the market.
"You've really got to make sure you know your medications, know what you're on and know the names of your medications and then we can advise you as to whether they're suitable or not..."
"That's actually what I wanted to know..."
Pharmacist Jacqueline Tsimbinos ensures analgesics found on open shelves elsewhere are kept behind the counter in her chemist shop, so that professionals can check customers' health needs.
"It's something that they need to get advice, first, so it's always a good idea to have them restricted I think, rather than just open to anyone to buy."
It's especially important for people like Aunty Coral, who has a heart condition that's managed with a blood thinner called Warfarin.
It's a drug that reacts badly to other medications and even some vitamins, and taking the wrong tablets with it could be fatal.
But Aunty Coral fears too few people are seeking that kind of detail.
The research she did with Charlotte De Crespigny showed many feel shame about asking doctors for information.
Instead they take what their friends give them, or what they see advertised.
"There are so many and there's more and more coming, you see them on telly (television), you know, fast relief and all of this business and you think well, I'll have to try that. And then for a month or so you think now I wonder where I can get those tablets. Now we're taking notice of what they're saying on telly and we want to try it, and we don't think, no I've got enough - I've got panadeine there, codeine there, osteo panadeine, you know, why should I try that one?"
Experts aren't just concerned about how widely they're available, but how many people can buy.
Charlotte de Crespigny says some medications come in packets of 100, and there are no limits on how many can be purchased.
"I could go to a chemist superstore and walk out with 1,000 paracetamol tomorrow for less than $15. It's cheap. Sometimes you get 100 for a dollar, because they're sucking you in like, the soft drink is on special today, come in and buy the rest of my products. So paracetamol in its various names is used like that."
It's prompted Alwin Chong, of the Yaitya Purruna indigenous health unit to call for changes to packaging.
Mr Chong says jumbo sized packages give the impression that the medications aren't dangerous, compared to smaller packages which imply drugs should be used sparingly.
"What we're trying to do is get people to think about it. In Britain they actually reduced the package size because…you know, they would buy these packages of over the counter medication, take big mob of them, nothing happens, then about 3 days later they have liver failure and die from it. Once you get liver failure from taking these over-the-counter medications there's nothing they can do for you then, once you turn up in hospital with this liver failure."
Nunkuwarrin Yunti Aboriginal Health Service is one of those at the front line in trying to raise awareness of the dangers.
Senior Aboriginal Health Practitioner Celia Harnas has developed a health guide to help both patients and professionals.
"It's got the brand name, the drug names as well, so you know what this thing is, then it says what it's used for, and it's done all in simple terms so that the client can understand it very easily, there's no big words, it shows how it works, it has a diagram of the body, and which parts are affected with the medication, it has the side effects, had the warnings, what interacts with the drug, what to tell the patients and what checks to come back for."
Originally developed as a flip chart, it's now been condensed into book form making it easier to distribute - and they'd like to see it used more widely.
Ms Harnas says so far it's being used by clinics in Central and South Australia, but she thinks it would be useful for patients to have copies too.
"I've gone through the book with them and stuff and they seem to then have much more of an understanding and they're always saying where can I get a book like this, so that if I forget what that medication's for again and why I need to take it all the time and what it's doing for my body, for my health, then I can go back and look at it again."
Services like Nunkuwarrin Yunti work differently from standard medical clinics.
Aboriginal Health Practitioner Shaun Jacobsen says instead of 15 minute appointments, patients each get 45 minutes or longer, so that staff have the time to build a relationship with patients, earn their trust, and better understand their complex health needs.
Mr Jacobsen thinks it's important that medicos outside the indigenous health system are taught a better awareness of the challenges faced by Aboriginal and Torres Strait Islander patients.
He says doctors and health professionals shouldn't assume their patients understand all aspects of their treatment.
"Because of their lack of education, knowledge on how various medications react with other medications, they can start feeling quite ill suddenly and have no idea what's going on and think it's something else that's far from the correct truth, and it can lead to death, or who knows, other complications down the road."
It coincides with a push by Yaita Purunna Aboriginal Health Unit to raise cultural awareness amongst medical students at the University of Adelaide, in a move Alwin Chong hopes will produce doctors more tuned in to indigenous needs.
"I was brought on board to try and make sure there was more Aboriginal content in Aboriginal studies. So this year we've just developed a workshop, a cultural workshop, that's compulsory for every student doing their medical studies, so from this point on for the next five years there will get some element of Aboriginal culture over the next 4 or 5 years before they go out in the field."
Mr Chong says the aim is to help doctors understand that many Aboriginal and Torres Strait islander patients feel reticent when dealing with medical authorities, and are unlikely to ask questions about their treatment or offer information which might be important.
He says improving communications by doctors and other health professionals is critical because it's unclear how widespread problems with over-the-counter medications might be due to a lack of data.
Charlotte De Crespigny says authorities keep records of overdoses or complications with prescription medicines, but not for over-the-counter drugs, leaving only sketchy information like inquiries to telephone help lines.
Ms De Crespigny wants to conduct research that would produce such data, but has found she has to show evidence of the problem before she can qualify for funding.
"There is the national poisons line, where anybody can ring up and ask about a medicine, and what it's side effects are et cetera, what are the risks. Paracetamol is the most inquired about medicine out of all medicines to that line, and yet we don't have real data about what's going on, who's using it, how much they're using and what problems there are, and we cannot find the data. We did put in for a research grant, but were told how do you know it's a problem, how do you know it's a problem if you haven't got hard data? So it's a catch 22."
Without the data Ms de Crespigny thinks she faces a difficult battle convincing authorities to boost safety around the use of non-prescription medications, be it through community education, clearer, culturally appropriate warnings, and restrictions on supply and advertising.
"The first people of our nation, who are the sickest of our nation, are least able to make wise decisions about their medicines, amongst other things, because they're not well informed. They're not unintelligent people, they want to have good information, they want to make good decisions for themselves and their families and particularly their young ones and their children. Why aren't we giving them that opportunity? It's going under the radar, and yet it has a huge potential I believe to actually exacerbate poor health. Obviously it can help - medicines help to stay well, medicines help to manage symptoms including these medicines. I'm not saying for a minute they shouldn't be available to people but they need to be available in a controlled, well informed supported way."
Ms de Crespigny says it's unclear how many lives might have already been lost due to such medications, or how many might be lost in future because of poor regulation and unawareness of the risks.