More than 900,000 people across the UK could be misusing over-the-counter painkillers containing codeine, a drug derived from morphine, the Tonight programme has found.
There are no firm figures about the scale of this problem yet so Tonight commissioned a survey. We asked 2000 people whether they took these drugs, what they used them for and if they took them in accordance with the guidance of 6-8 tablets a day for a maximum of three days.
75% of those asked had used these painkillers and of those, one in five admitted to using more than the recommended daily dose. Almost half of the people who had used over-the-counter painkillers said they took them for more than three days in a row and almost six percent of this group said they had taken them for more than a year. This could statistically mean that more than 900,000 people in the UK are misusing and are potentially dependent on these drugs.
Guidelines for the sale of codeine-based painkillers were tightened in 2009 to minimise the risk of overuse. Prominent warnings were placed on packets about the risk of addiction and the importance of not taking them for longer than three days was emphasised. However, in our survey almost of third of those who took these medicines said they were unaware that codeine-based painkillers could be addictive.
Codeine-based medicines are used to treat moderate pain, such as headaches or dental pain, if regular pain medicines such as paracetamol or ibuprofen are insufficient. But they are opioids – part of the opiate family - and they can induce feelings of calm, relaxation and lethargy. If used for longer than the recommended three days they can produce 'cravings' and a psychological desire to keep on using them – akin to the addictive effects of the more dangerous opiate heroin, which like codeine, is derived from the poppy plant.
While pure codeine is only available on prescription, small doses of codeine are combined with aspirin, ibuprofen or paracetamol in many over-the-counter medicines. Taken correctly, these drugs are safe and effective but the Tonight programme found that despite the guidelines being tightened in 2009, it is still possible to ‘bulk buy’ these medicines. Visiting ten pharmacies near her house and then accessing another ten pharmacy websites, Tonight reporter, Fiona Foster was able to purchase a total of 576 tablets in just a few hours. Very few questions were asked by the pharmacists in the shops and only one explicitly warned about the risk of addiction, with three pharmacists not asking a single question.
Ash Soni, President of the Royal Pharmaceutical Society, commented that Fiona Foster’s findings were “very disappointing from a pharmacist’s perspective”.
The Medicines and Healthcare Products Regulatory Agency (MHRA) responded to Tonight by saying that the “risk minimisation measures” introduced in 2009 enabled the drugs to “remain available for sale in pharmacies” for the vast majority of people who use them appropriately, while “safeguarding against inappropriate use”. The body says that it monitors the safety of all medicines, reviewing any emerging evidence on safe use and taking further action as necessary.
But Noreen Oliver who is the MD and founder of the Burton Addiction Centre is concerned about the impact of people feeding a codeine dependency with over-the-counter products. These drugs combine codeine with paracetamol, ibuprofen or aspirin and if people are taking more as their tolerance to codeine increases then they start to take seriously harmful amounts of these drugs too. This can lead to many complications including kidney failure, enlarged liver, stomach ulcers and intestinal issues.
Tonight spoke to one of their clients Chris, who was proscribed codeine by his GP for a back problem. He went on to buy medicines containing codeine over the pharmacy counter sometimes taking as many as 64 tablets a day.
“I ended up having to go and have endoscopies and had major stomach problems, but, I was addicted to the Codeine, it was the only way I could get it” Chris told Fiona Foster, saying that he would have been better off on heroin because the impact of the paracetamol and ibuprofen on his health.