Why over the counter painkillers can be as addictive as heroin

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Codeine, which is in over the counter (OTC) painkillers belongs to a group of substances known as opiates can be as addictive as heroin. It is derived from the seed of the poppy plant – also the origin of heroin and opium. Morphine, pethidine and codeine are all related to heroin. They affect the same receptor system in the brain and have the same effects, albeit in varying degrees. They are also just as addictive and habit-forming. Once ingested codeine leads to various effects, starting with a calming effect and progressing to a sense of well-being and sedation.

In South Africa codeine is available in pharmacies in the form of cough mixtures and painkillers, with the most commonly abused over-the-counter medications being Adco-dol, Lenadol, Betapyn, and Propain, all of which can be obtained without a prescription.

Legislation in South Africa limits users to 40 tablets every 10 days, but it is possible to go to multiple pharmacies on the same day to purchase 40 tablets per pharmacy. Previously users could legally buy 100 tablets per week.

As a person gets more accustomed to taking these pills, the sedation gets more tolerable, and the euphoria and calming effects dominate. So it’s not hard to see why millions of painkiller users worldwide are dependent on these seemingly innocuous and easily accessible drugs (available without prescription in many countries, including South Africa) to ease the pain caused by the stress of daily life.

The latest statistics compiled by the American Centers for Disease Control and Prevention show that in 2007 painkillers were responsible for twice as many deaths as cocaine and five times as many as heroin.
Opioid painkiller addiction was also more common than abuse of or dependence on any other type of prescription drug.

When you take painkillers consistently 3 things happen in the brain:

* The sensitivity to pain increases through rebound. So the more opiate painkillers you take, the more pain you experience.

* The feel-good effect lasts for shorter and shorter periods, so you need to take more and more tablets to feel the effect.

* Once it wears off, you go through irritability, mood swings and increased sensitivity to your normal stressors (withdrawal).

The effect of codeine is not only on mood and behavior but also on memory and sharpness of intellect. Prolonged use can predispose a person to dementing illnesses and people who take large amounts of opiates are often misdiagnosed as bipolar.

It is a massive epidemic in South Africa for several reasons:

We live with one of the highest levels of baseline stress in the world as a result of the fear, paranoia, and uncertainty that come with rapid transition.
Painkillers are easily accessible from doctors and pharmacists and there is inadequate legislation to deal with it. It is mostly a need and not a desire (as most other addictions are) as people self-medicate to get through the day.
It is estimated that addiction to painkillers is more common than alcohol and cannabis.
It occurs in all races, classes, and gender and is difficult to get accurate statistics because of the sheer numbers and variables involved.
Codeine is in cough mixtures, cold and flu preparations, sinus preparations and is sometimes even used to treat diarrhea. The World Pain Association defines abuse as taking more than eight to 12 painkillers in a month. On average most addicts take between six and eight a day.

There is an alternative:

A proper assessment and treatment can lead to complete eradication of the pain in these patients without needing to take painkillers again. The process starts with detoxification followed by a treatment of the underlying cause. The success rate of this approach is in excess of 70 percent.

* Dr Salduker is a local psychiatrist and director of the Durban Pain Clinic at Netcare St Augustine’s Hospital.

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