The silent addiction to everyday painkillers Daily Mail Online
Codeine, the crucial ingredient in extra-strength painkillers, is a member but with the opiate withdrawal symptoms which can include shivers.
'You get a migraine or back pain and initially the painkiller works. But for some reason the effect starts to lessen over time.
'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.
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.
'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.
At this point Mark decided he had to l Julie. She was incredibly surprised and shocked, even though she agreed he had always seemed to be taking pills.
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.
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.
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.
'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.'.
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.
'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.
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.
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.
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.
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 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.
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'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.
Last updated at 10:30 13 February 2007.
'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.'.
Finally Mark's health began to be.
'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.'.
'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.
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.
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.
Lying awake, staring into the pitch darkness, computer consultant Mark Edwards tried desperay 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.
'It all started in 1993 when I was hospitalised for a collapsed lung. A chest drain was inserted, which became infected,' says Mark.
'I wasn't a big drinker blowing a small fortune in the pub. I was just spending £20 a week in the chemist.'.
'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.
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.
His lethargy has lifted, he is rebuilding his career, as a self-employed computer programmer, and is a founder member of the CodeineFree website.
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.
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.
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'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.
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.'.
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.
Back in bed, he waited for the familiar feeling of calm and contentment to wash over.
'It's called medication overuse syndrome, it is medically recognised and it is happening to around 100,000 people in this country.'.
'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.'.
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.'.
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.'.
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.
'The investigation found that although misuse was significantly under-reported, it was exceedingly small compared to the amount of daily sales,' says a spokesman.
Opiates have long been used as painkillers, and codeine is an effective pain receptor inhibitor, enhancing the action of standard painkillers such as ibrobrufen.
'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.
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.
'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.
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.'.
'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.
'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.
'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.
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.
'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.'.
By ISLA WHITCROFT.
Codeine, the crucial ingredient in extra-strength painkillers, is a member of the opiate family of drugs - which includes morphine and heroin.
'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?
'I sleep well and I am much better with the kids. I'm very proud I've managed to stay clean,' he says.
him, and within 15 minutes was sound asleep.
'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.
From then on, Mark was never without his box of Panadol Ultra or Nurofen Plus.
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.
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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 ls his terrifying story:
Like most people, she had no idea that this could mean he had an addiction. Mark spent nine months on temazepan, which compley 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'.
'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 l 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.".
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'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.'.
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.'.
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.
'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 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.
Published by Associated Newspapers Ltd.