TikTok and Instagram influencers have been peddling the “Barbie drug” to help you tan.

But melanotan-II, as it’s called officially, is a solution that’s too good to be true. Just like tanning, this unapproved drug has a dark side.

Doctors, researchers and Australia’s drug regulator have been warning about its side effects – from nausea and vomiting to brain swelling and erection problems.

There are also safer ways of getting the tanned look, if that’s what you’re after.

What is melanotan-II?

No, it’s not a typo. Melanotan-II is very different from melatonin, which is a hormonal supplement used for insomnia and jet lag.

Melanotan-II is a synthetic version of the naturally ocurring hormone α-melanocyte stimulating hormone. This means the drug mimics the body’s hormone that stimulates production of the pigment melanin. This is what promotes skin darkening or tanning, even in people with little melanin.

Although the drug is promoted as a way of getting a “sunless tan”, it is usually promoted for use with UV exposure, to enhance the effect of UV and kickstart the tanning process.

Melanotan-II is related to, but different from, melanotan-I (afamelanotide), an approved drug used to treat the skin condition erythropoietic protoporphyria.

Melanotan-II is not registered for use with Australia’s Therapeutic Goods Administration (TGA). It is illegal to advertise it to the public or to provide it without a prescription.

However, social media has been driving unlicensed melanotan-II sales, a study published last year confirms.

There are many black market suppliers of melanotan-II injections, tablets and creams. More recently, nasal sprays have become more popular.

What are the risks?

Just like any drug, melanotan-II comes with the risk of side effects, many of which we’ve known about for more than a decade. These include changes in the size and pigmentation of moles, rapid appearance of new moles, flushing to the face, abdominal cramps, nausea, vomiting, chest pain and brain swelling.

It can also cause rhabdomyolysis, a dangerous syndrome where muscle breaks down and releases proteins into the bloodstream that damage the kidneys.

For men, the drug can cause priapism – a painful erection that does not go away and can damage the penis, requiring emergency treatment.

Its use has been linked with melanoma developing from existing moles either during or shortly after using the drug. This is thought to be due to stimulating pigment cells and causing the proliferation of abnormal cells.

Despite reports of melanoma, according to a study of social media posts the drug is often marketed as protecting against skin cancer. In fact, there’s no evidence to show it does this.

Social media posts about melanotan-II rarely mention health risks.

There are no studies on long-term safety of melanotan-II use.

Then there’s the issue of the drug not held to the high safety standards as TGA-approved products. This could result in variability in dose, undeclared ingredients and potential microbial contamination.

The TGA has previously warned consumers to steer clear of the drug due to its “serious side effects that can be very damaging to your health”.

According to an ABC article published earlier this week, the TGA is cracking down on the illegal promotion of the drug on various websites. However, we know banned sellers can pop back up under a different name.

TikTok has banned the hashtags #tanningnasalspray, #melanotan and #melanotan2, but these products continue to be promoted with more generic hashtags, such as #tanning.

Part of a wider trend

Australia has some of the highest rates of skin cancer in the world. The “slip, slop, slap” campaign is a public health success story, with increased awareness of sun safety, a cultural shift and a decline in melanoma in young people.

However, the image of a bronzed beach body remains a beauty standard, especially among some young people.

Disturbingly, tan lines are trending on TikTok as a sought after summer accessory and the hashtag #sunburnttanlines has millions of views. We’ve also seen a backlash against sunscreen among some young people, again promoted on TikTok.

The Cancer Council is so concerned about the trend towards normalising tanning it has launched the campaign End the Trend.

You have other options

There are options beyond spraying an illegal, unregulated product up your nose, or risking unprotected sun exposure: fake tan.

Fake tan tends to be much safer than melanotan-II and there’s more long-term safety data. It also comes with potential side effects, albeit rare ones, including breathing issues (with spray products) and skin inflammation in some people.

Better still, you can embrace your natural skin tone.

Rose Cairns, Senior Lecturer in Pharmacy, NHMRC Emerging Leadership Fellow, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

This week’s ABC Four Corners episode Pain Factory highlighted that our health system is failing Australians with chronic pain. Patients are receiving costly, ineffective and risky care instead of effective, low-risk treatments for chronic pain.

The challenge is considering how we might reimagine health-care delivery so the effective and safe treatments for chronic pain are available to millions of Australians who suffer from chronic pain.

One in five Australians aged 45 and over have chronic pain (pain lasting three or more months). This costs an estimated A$139 billion a year, including $12 billion in direct health-care costs.

The most common complaint among people with chronic pain is low back pain. So what treatments do – and don’t – work?

Opioids and invasive procedures

Treatments offered to people with chronic pain include strong pain medicines such as opioids and invasive procedures such as spinal cord stimulators or spinal fusion surgery. Unfortunately, these treatments have little if any benefit and are associated with a risk of significant harm.

Spinal fusion surgery and spinal cord stimulators are also extremely costly procedures, costing tens of thousands of dollars each to the health system as well as incurring costs to the individual.

Addressing the contributors to pain

Recommendations from the latest Australian and World Health Organization clinical guidelines for low back pain focus on alternatives to drug and surgical treatments such as:

• education
• advice
• structured exercise programs
• physical, psychological or multidisciplinary interventions that address the physical or psychological contributors to ongoing pain.

Two recent Australian trials support these recommendations and have found that interventions that address each person’s physical and psychological contributors to pain produce large and sustained improvements in pain and function in people with chronic low back pain.

The interventions have minimal side effects and are cost-effective.

In the RESOLVE trial, the intervention consists of pain education and graded sensory and movement “retraining” aimed to help people understand that it’s safe to move.

In the RESTORE trial, the intervention (cognitive functional therapy) involves assisting the person to understand the range of physical and psychological contributing factors related to their condition. It guides patients to relearn how to move and to build confidence in their back, without over-protecting it.

Why isn’t everyone with chronic pain getting this care?

While these trials provide new hope for people with chronic low back pain, and effective alternatives to spinal surgery and opioids, a barrier for implementation is the out-of-pocket costs. The interventions take up to 12 sessions, lasting up to 26 weeks. One physiotherapy session can cost $90–$150.

In contrast, Medicare provides rebates for just five allied health visits (such as physiotherapists or exercise physiologists) for eligible patients per year, to be used for all chronic conditions.

Private health insurers also limit access to reimbursement for these services by typically only covering a proportion of the cost and providing a cap on annual benefits. So even those with private health insurance would usually have substantial out-of-pocket costs.

Access to trained clinicians is another barrier. This problem is particularly evident in regional and rural Australia, where access to allied health services, pain specialists and multidisciplinary pain clinics is limited.

Higher costs and lack of access are associated with the increased use of available and subsidised treatments, such as pain medicines, even if they are ineffective and harmful. The rate of opioid use, for example, is higher in regional Australia and in areas of socioeconomic disadvantage than metropolitan centres and affluent areas.

So what can we do about it?

We need to reform Australia’s health system, private and public, to improve access to effective treatments for chronic pain, while removing access to ineffective, costly and high-risk treatments.

Better training of the clinical workforce, and using technology such as telehealth and artificial intelligence to train clinicians or deliver treatment may also improve access to effective treatments. A recent Australian trial, for example, found telehealth delivered via video conferencing was as effective as in-person physiotherapy consultations for improving pain and function in people with chronic knee pain.

Advocacy and improving the public’s understanding of effective treatments for chronic pain may also be helpful. Our hope is that coordinated efforts will promote the uptake of effective treatments and improve the care of patients with chronic pain.

Christine Lin, Professor, University of Sydney; Christopher Maher, Professor, Sydney School of Public Health, University of Sydney; Fiona Blyth, Professor, University of Sydney; James Mcauley, Professor of Psychology, UNSW Sydney, and Mark Hancock, Professor of Physiotherapy, Macquarie University

This article is republished from The Conversation under a Creative Commons license. Read the original article.