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The secret addiction; Abuse of over-the-counter drugs is rife. Could you be at risk of this 'respectable' dependency? JENNY ELLIS talks to the experts to find out more.


BRITAIN lost one of its favourite comedians when Mel Smith died of a heart attack, aged 60, earlier this year. A host of stars and fellow comedians paid effusive praise to the Not The Nine O''Clock News funny man but behind the glowing tributes was a sad tale of addiction.

Mel had twice been treated for burst stomach ulcers after developing a dependency to Nurofen Plus, a mixture of ibuprofen and codeine. He admitted to swallowing 50 tablets a day to ease the pain from gout.

He said: "It was my dark secret and I got deeply depressed. Like an alcoholic hiding bottles, I started hiding my tablets in the backs of drawers, behind books on bookshelves and slipping them between scripts. They wreaked havoc with my insides, eating into my stomach wall."

" But Mel's 'respectable' addiction to over-the-counter drugs is not as unusual as you might think. Reaching for a painkiller is the quick fix many of us use for a headache.

We buy an estimated PS530million of painkillers in the UK each year and there's a sinister side to our pill popping.

Addicts can take between 20 and 30 pills daily, or the equivalent in cough syrup, and codeine dependence is widely called the 'secret addiction' as users appear to maintain 'normal' lives as their habit takes hold.

People can be hooked with astonishing speed. In 2005 the pharmaceuticals industry brought in voluntary guidelines for over-thecounter medication including codeine. These involved the addition of addiction warnings to packets stating: 'Can cause addiction. For three-day use only.' In the same year packs were restricted to 32 tablets, which is now the legal maximum for codeine painkillers sold over-the-counter.

But addicts determined to get their supplies will often visit several chemists. Richard Cooper, a lecturer in public health at Sheffield University, conducted research into the misuse of over-the-counter (OTC) opiates and found that community pharmacists felt frustrated as they could not track the supply of opiates to customers from other outlets.

However 'respectable addicts' - a term for people who are secretly hooked and who blame themselves for the abuse - said the questions asked by pharmacists and counter assistants about their OTC purchases were often 'ineffective'. '.

Of course, OTC products containing codeine are safe and effective when used according to the instructions but there is a risk of addiction if used for longer periods or at higher doses than stated on the pack.

Dr Kostas Agath, Medical Director of drugs charity Addaction, says: "Codeine is an opioid, a member of the same class of drugs as heroin and methadone. All opioids are addictive and codeine is no exception."

" Opioids are among those drugs capable of activating the part of the brain that researchers refer to as the 'reward circuit', the area where the chemical dopamine is produced. If drug taking is rewarded it's likely the behaviour will be repeated.

Dr Agath says: "Dependence on codeine is no different from dependence on heroin - one needs to keep increasing the dose to have the same effect."

" This is how codeine addicts enter the realm of astounding intake, up to 200 tablets a day. And too much codeine is not good; symptoms include nausea, constipation, memory problems, sedation and, in large amounts, cardiac and respiratory arrest. And withdrawal isn't easy.

The most common symptoms of withdrawal are a heightened sensitivity to pain, sleeplessness, a lethargic feeling, and uncontrollable muscle movements.

People also often feel an overwhelming sense of nausea, headaches, and moderate to severe muscle aches and cramps. Dr Agath says: "The good news is there is treatment from dependence on codeine. Addaction can help.

"After a confidential discussion with a member of our staff, the treatment package involves the prescribing of substitute medication for a short period of time; the identification and treatment of any causes of physical pain; and addressing any psychological and social problems underlying the misuse of the drug."

The symptoms of codeine addiction ? Persistent drowsiness ? Fatigue ? Itchy skin ? Loss of appetite ? Excessive sleeping ? Bluish tint to lips/nails ? Nausea and dizziness ? Muscle twitching ? Withdrawal from social activities, loss of interest in usual hobbies/activities

"All opioids are addictive and codeine is no exception." - Dr Kostas Agath


Comedian Mel Smith admitted to swallowing 50 tablets a day to combat the pain of gout

We buy around PS530million of painkillers in the UK each year and pharmacists are voicing concern over the lack of safeguards in place
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Title Annotation:Features
Publication:Evening Gazette (Middlesbrough, England)
Geographic Code:4EUUK
Date:Nov 2, 2013
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