The silent addiction to everyday painkillers

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Forget cannabis and heroin. Thousands of utterly respectable Britons are in the

grip of an insidious and deadly drug addiction - to everyday painkillers, such

as Nurofen. Here one victim tells his terrifying story:

 

Lying awake, staring into the pitch darkness, computer consultant Mark Edwards

tried desperately to relax and go back to sleep. As his wife Julie slept beside

him, Mark fought to ignore the dull ache that was beginning to creep into his

joints, and the pounding headache that was adding to his insomnia.

 

Finally, he could bear it no longer. Mark, then 39, got quietly out of bed and

went downstairs to rummage in his work briefcase. There he found what he was

looking for - packets of Nurofen Plus and Panadol Ultra, and for the third time

that night he gulped down six tablets in one go.

 

Back in bed, he waited for the familiar feeling of calm and contentment to wash

over him, and within 15 minutes was sound asleep.

 

That night, like so many other nights before, Mark had taken 24 tablets over an

eight-hour period. With his four-hourly habit during the day, he was getting

through 30 tablets a day - five times the recommended safe limit.

 

Mark was in the grip of what is dubbed in pharmaceutical circles the 'silent

addiction'. He wasn't drowning his sorrows in booze, or blowing the family

income on shooting up drugs in dark alleys.

 

Instead, his addiction was more insidious, harder to pinpoint and easy to

ignore. Like thousands of other unregistered and unrecorded addicts up and down

the country, Mark was abusing over-the-counter painkillers. The comedian Mel

Smith has admitted he had an addiction to Nurofen Plus.

 

In doing so he was putting himself at risk of - among other things - liver

failure, serious stomach damage, gall bladder problems, Irritable Bowel Syndrome

and respiratory problems - yet ironically he had no idea he was an addict.

 

'It all started in 1993 when I was hospitalised for a collapsed lung. A chest

drain was inserted, which became infected,' says Mark.

 

'I contracted MRSA and ended up with a huge scar on my left chest where the lung

had been expelling all the infected tissue. I was in dreadful pain.

 

'For a few months I took the basic paracetamol but that hardly touched the pain.

Then three months later I remember pleading with a chemist for some pain relief.

He gave me a box of Panadol Ultra. I took it home, tried two, and not only did

the pain subside but I felt relaxed.'

 

From then on, Mark was never without his box of Panadol Ultra or Nurofen Plus.

 

'I took Panadol Ultra and Nurofen Plus every day for 13 years, and for most of

that time I had no idea that I was doing myself any harm, let alone displaying

the classic signs of addiction,' says Mark, from Derbyshire.

 

'It wasn't until 2005, when my addiction started to spiral quickly out of

control, that I began to have an inkling I might be in trouble.

 

But by then it was too late, because I felt I couldn't function without my

pills,' he explains. 'Every day I took more to combat bad headaches and joint

aches, and I was becoming irritable and lethargic.'

 

Codeine, the crucial ingredient in extra-strength painkillers, is a member of

the opiate family of drugs - which includes morphine and heroin.

 

Opiates have long been used as painkillers, and codeine is an effective pain

receptor inhibitor, enhancing the action of standard painkillers such as

ibrobrufen.

 

Like all opiates, codeine induces a feeling of calm and well-being - but if

taken in big enough doses, for some people it can be addictive, with significant

side effects if they try to stop.

 

In addition, says neurologist Michael Gross, who runs clinics for people

addicted to over-the-counter (OTC) medication, the painkillers themselves can be

the cause of headaches and back pains.

 

'OTC medication abuse is a widespread problem,' he says. 'Mark's case is extreme

- although I wouldn't say rare - and most people seek help before things get

that bad.

 

'You get a migraine or back pain and initially the painkiller works. But for

some reason the effect starts to lessen over time.

 

'We know that the brain learns to have headaches and possibly neck and shoulder

pain. Once the pain pathways are opened up the headaches become more common, and

this process is exacerbated by any painkiller, not just codeine.

 

'Some experts believe this can happen if you only take around six painkillers a

week, but certainly if you are taking the full recommended dose every day you

may get this effect.

 

'It's called medication overuse syndrome, it is medically recognised and it is

happening to around 100,000 people in this country.'

 

According to Dr Gross, even the basic painkillers can have this effect, but

because the codeine-based products are stronger, the effect of addiction is much

quicker.

 

'With the codeine products you have the extra problem of the opiate addiction,'

he explains. 'People become hooked on the feeling of well-being, but of course,

as with heroin, eventually you need the opiate just to feel normal.

 

'So when someone tries to stop taking OTC painkillers, not only do they have to

contend with the blinding " learned " headaches, but with the opiate withdrawal

symptoms which can include shivers, aching joints, agitation and insomnia.

 

'Most people can cut down by themselves but occasionally I will end up admitting

some of my patients to hospital where they have to undergo cold turkey - and

sadly it's not very pleasant for them.'

 

Mark knows this from bitter experience. 'I did try to give them up,' he recalls,

'but I had some dreadful physical and psychological side-effects which came on

within a couple of hours. My joints would ache, I felt fluey and craved the

tablets.'

 

But it wasn't just the codeine cravings that were putting Mark in danger. Both

ibrobrufen and paracetamol, if taken beyond the recommended safe dose, can cause

serious and life -threatening illnesses, and Mark - who was exceeding the dose

several times over - was dicing with death.

 

'I knew from the packets that paracetamol can seriously damage your liver, and

that ibruprofen can cause the stomach lining to be destroyed,' he explains.

 

'What I didn't find out until later was that people regularly overdose and die

from their addiction and many end up having parts of their stomach chopped out

where the ibruprofen has caused massive damage.'

 

Although no official statistics exist to document the extent of the problem,

addiction to the codeine in OCT painkillers has long been recognised within the

medical and pharmaceutical industry.

 

In 2005, the Medicines and Healthcare products Regulatory Agency (MHRA) and the

Proprietary Association of Great Britain, the UK trade and standards association

for the manufactures of OTC drugs, investigated the problem.

 

'The investigation found that although misuse was significantly under-reported,

it was exceedingly small compared to the amount of daily sales,' says a

spokesman.

 

'However, that data came from healthcare professionals - pharmacists who had

reported misuse via our yellow card system. For obvious reasons that can't

include all the people who don't admit to - or even know they are - misusing.'

 

Simon Greasley is a clinical nurse specialist in drug dependency who has

extensive knowledge of codeine addiction. He helps run the Codeine-Free website

and believes one of the reasons codeine dependency goes unreported is because it

is hard for misusers to see themselves as addicts.

 

Mark agrees: 'Although I knew in the back of my mind that I shouldn't be taking

that many pills, somehow, because I could buy them over the counter and they

came in a pharmaceutical package, it felt respectable.

 

'I wasn't a big drinker blowing a small fortune in the pub. I was just spending

£20 a week in the chemist.'

 

Simon Greasley believes there are a variety of abusers - including a few hard-

core drug addicts who take codeine alongside other drugs. He says: 'The majority

are like Mark and are everyday respectable people who have no idea they can be

addicted to something legally on sale in this country.

 

'Most of them start off by taking painkillers to treat an existing real pain,

but then, once the original pain is gone, the need for the pills is still there.

It's not surprising when you consider each plus-strength tablet contains around

12mg of codeine.'

 

For a while, it was easy for Mark to deny to himself that he had any kind of

problem. But when, in 2003, the management team changed at work, he began to

feel stressed and his tablet intake quickly got out of control.

 

'I begin to get nasty migraines,' he says. 'I was having trouble relaxing my

mind enough to go to sleep and started to take Panadol Ultra at bedtime.

 

'At first they worked brilliantly, but then I began waking up a few hours later,

so I would take another couple, then I started taking two Nurofen Plus with two

Panadol Ultra, then four with two, and suddenly I was in trouble.

 

'Outwardly I was successful with a large income, a lovely wife and three kids.

But inside I started to feel guilty and ashamed, with a little secret.

 

'At home I kept the packets hidden in my briefcase so that Julie wouldn't see

them; at work I was so busy that I managed to keep my intake to the recommended

dosage. I would panic if I thought I was about to run out of supplies, and like

all addicts I would get crafty about making excuses.'

 

In the days of the high street chemist where everyone knew who was coming in, it

was easy to recognise someone who was regularly buying pills.

 

The guidelines for the Royal Pharmaceutical Society of Great Britain state that

pharmacists and their staff must be aware of the abuse potential of certain OTC

products, and should not supply them if there are reasonable grounds for

suspecting misuse.

 

Mark says: 'I became obsessed with making sure I didn't see the same chemist too

often, and I was only challenged once by a pharmacist. I never went back to that

shop.'

 

Finally Mark's health began to be affected by his massive intake. 'I had a

really bad chest infection in October 2004 and I went to my doctors and she took

my blood pressure,' he says.

 

'It was through the roof: the upper reading was over 200 and she looked pretty

shocked. 'She - and I - blamed stress of work, and she signed me off for a week.

 

'When my blood pressure stayed high it was like a light coming on. I knew it had

to be the pills that were causing real damage to my health. I started surfing

the web and came across websites like Over-Count (a website that gives

information and advice about OTC drug abuse) and realised I had a recognised

problem.

 

'In December I resigned from my job. Julie's career in charity work was taking

off so we decided I would look after the house and children and she would work.

 

'I started off by slowly reducing my intake. By April I was down to eight

co-codamol tablets spaced through the day, but then I got stuck, so I went back

to my GP. I remember walking into the surgery thinking: " I am going to have to

tell her. Until then I hadn't confided in anyone. In the surgery I took a deep

breath and told her: " I'm addicted to painkillers. "

 

She responded positively and I felt a huge wave of relief. 'She put me on the

antidepressant temazepan and asked me to report to her every four weeks. She

carried out liver function tests on me which, to my relief, came back as normal,

and my blood pressure came right back down.'

 

At this point Mark decided he had to tell Julie. She was incredibly surprised

and shocked, even though she agreed he had always seemed to be taking pills.

 

Like most people, she had no idea that this could mean he had an addiction. Mark

spent nine months on temazepan, which completely removed his desire for

painkillers, and by March 2006 he was free of the need to take any drugs - a

feeling he describes as 'amazing'.

 

His lethargy has lifted, he is rebuilding his career, as a self-employed

computer programmer, and is a founder member of the CodeineFree website.

 

'I sleep well and I am much better with the kids. I'm very proud I've managed to

stay clean,' he says.

 

But the fear of returning to his addiction is always there. Last year Mark had a

raging toothache and while waiting for an appointment he succumbed to taking

paracetamol.

 

'I was quite frightened,' he says, 'but because I knew about my weakness I kept

a strict eye on myself and managed to stop taking them when the pain went.' So

is there anything that can be done to prevent people like Mark from becoming

addicted?

 

The dilemma is that while codeine-based products can be abused, for millions of

people they are a safe and highly effective form of pain relief. To penalise all

these people by withdrawing the product because of an unknown number of addicts

is clearly not the answer.

 

Dr June Raine, director of medicines postlicensing at the MHRA, says: 'Their

benefits clearly outweigh any risks, but we need to highlight those risks to

ensure that people take their medications safely and correctly.'

 

Visit www.codeinefree.me.uk. Contact Dr Gross through his website,

www.neurologyclinic.co.uk or contact the MHRA to discuss OTC misuse on 0808 100

3352.