Eden Caceda heads to the medicine cabinet to find that addicts have emptied it out.
It starts with a cold, cough, headache, diarrhea or an unexpected pain in a joint. It’s something that’s too mild to visit the doctor but too severe to just sleep off. You go to the pharmacy, buy a packet of painkillers, pop enough to feel better until it passes and put the tablets away once you’re back on your feet. But not everyone stops there.
Over the counter (OTC) medicine addiction – addiction to drugs that are legal and for which you don’t need a prescription, such as paracetamol, pseudoephedrine, and codeine – is one of society’s unrecognized forms of substance abuse. While it is considered relatively safe in contrast to prescribed and illicit drugs, OTC medicine addiction is a growing problem in Australia.
A Sydney University student, Linda*, believes she was mildly addicted to codeine, a key ingredient in strong pain relievers. “I was taking 40 tablets of generic painkillers in about two to three days. I’d wake up by about 9 am and I’d have a killer headache that just wouldn’t go away unless I took the tablets. I would take four every three hours instead of the recommended two every eight hours. I eventually realised one day that the tablets were causing the headaches and I was taking them because of the headaches.”
Linda began to acknowledge her addiction, describing the “vicious cycle of it all” and decided to quit cold turkey. “I got bad headaches for about a week after I stopped taking them, I had diarrhea and stomach cramps, I even had slight shakes. It all lasted about seven days, then about another week after that I was feeling ‘lost’ or even depressed. Then after that I felt fine and I’ve felt great since not having them.”
In some circles, OTC medication has been considered the middle class addiction that contributed to sales of 16 million packs of codeine in 2012, worth $145 million annually. Its accessible nature and cheap price make it a more common form of substance abuse. In September a report by the Pharmacy Guild of Australia released a statement on the growing number of people seeking codeine based medication in Tasmania, with some pharmacies exposing that more than ten patients came in to seek such medication before 9am each day.
Richard*, a University of Sydney student, described his brief but intense road down dependence on Codral Nightime during his final year of high school. “All I had was one Codral Night to sleep when I had a cold and it all went downhill from there. I was suffering mild anxiety and insomnia so I began taking two Codrals every night for two months just to sleep and survive the HSC. But during the day everything was perfect.” Richard echoes one of the many differences between OTC medicine addicts and illicit drug addicts, in that these individuals are still socially and economically active, despite their dependence.
One of the many issues with addiction to OTC medication is that tolerance develops which means that higher doses are required to achieve the same effect. Wendy* attests to this. Following a minor car accident she turned to regular OTC pain relievers, Wendy’s addiction got worse as she became accustomed to Panadol. “It was part of routine – nothing more. But day by day I felt its effect on me lessened so I took more,” she said. Fortunately for Wendy she began to understand the higher dosages had no effect so she began slowly taking less and less until she lost her reliance.
A significant difference between Panadol and Codral and pain relievers such as Nurofen and Panadeine, is the use of codeine. Codeine is one of the most common substances in over the counter medicine and is prevalent in many OTC painkillers. As an antidepressant sedative with hypnotic effects, codeine has the same physically addictive properties as heroin and morphine. Despite codeine being a fraction of the potency of these substances, prolonged and excessive use of codeine can have short-term effects of troubled breathing, decreased urination, vision changes, dizziness and nausea, and long-term effects of diminished libido, apathy and memory loss.
In September, Melbourne researchers discovered that 115 deaths over the last decade have involved use of codeine, with 63 of these deaths being the direct result of drug toxicity. Many more scientists are now pushing for products with codeine to be banned in OTC medication as a consequence of this report. Furthermore an Adelaide University study discovered after a number of tests that codeine may in fact cause a heightened sensitivity to pain rather than relieve it.
A primary distinction between prescribed and OTC medication is that these drugs are sold directly to customers without a prescription at the discretion of a pharmacist. For medication with bigger doses of addictive substances, pharmacists are directly involved with the customers with usage history monitored in order to deter misuse and dependence.
Rachel*, a University student, worked under a boss she now realises had an addiction to Panadeine Extra. “She asked me and other younger shop attendants to go to various chemists around town, sending different employees to different pharmacies on different days,” Rachel said. “I obviously didn’t realise it was an addiction, she was good at hiding what she was doing. She would casually say to me, ‘Just say it’s for you if they ask.’ I later realised it was a measure to prevent anybody finding out about her addiction.”
Likewise Sam*, an executive, speaks of his addiction to the codeine in Nurofen Plus for just under a year. “I would wake up and have Nurofen for breakfast. Go through at least six to nine every day, 10 on stressful days.” A common issue raised by OTC medication addicts is trying to hide their addiction from pharmacists. “I would shop at different chemists to get them and not be noticed. I would go through a box of 72 in a week easy,” said Sam.
Rachel too faced the challenging role of getting a continuous supply of codeine from Panadeine Extra. “It got to the point where I would go to the pharmacy, they would ask me if it was for me, and when I said ‘No, it’s for my boss’ and they would say ‘Well, we can’t give it to you’ and I would return empty handed. A couple of times my boss became quite angry and suspicious of whether I had gone to the pharmacy at all. If she did not have access to the medication, she would become extremely vague and complain about having a severe headache.“
Fortunately, OTC abuse and addiction is being increasingly recognised, with a 2010 crackdown on codeine by the Pharmacy Guild of Australia, which decreed that painkillers had to be released in smaller packets with smaller doses of codeine. The change came as a result of some addicts reportedly crushing Nurofen Plus and injecting them into their blood directly to get faster euphoric effects. The change primarily focused on Nurofen Plus, Panadeine and Panadeine Extra.
For Richard, he says that without the continuous support of his family, things could have spiralled out of control. “I would have kept going if my parents didn’t pick me up for it and force me to stop having them. It’s hard at first of course but I feel liberated without feeling dependant on it”. Echoing these sentiments, Sam commented that “going to a therapist for stress, depression, whatever you have, is always better, and while it might not be easier than taking a pill, it’s better to deal with the issue head on.”
*Names have been changed.