March 2018 - Hader Clinic Queensland

Can I Really be Addicted to Codeine? Yes!

An unexpected addiction

In early 2017, corporate lawyer, Anna*, panicked when she discovered that the medication that she used to treat her migraines, Nurofen Plus (containing ibuprofen and codeine) was becoming prescription only in February 2018.

After trying everything else, she felt like Nurofen Plus was the only thing that had “worked” for her pain.

Even better, she’d discovered that it helped with the low back soreness she developed at netball and occasionally she took them to help her sleep.

They’d been working so well that she’d been experimenting with the dose, and having a few extra here and there, figuring that because she could buy it over the counter that it must be safe.

However, when she stopped taking it, she’d begin to feel nauseous and dizzy, which she attributed to her migraines.

Unbeknownst to Anna, she had become addicted to codeine, reacting angrily to her local pharmacist who had gently quizzed her about her pain.

Feeling insulted, Anna purchased Nurofen Plus from another pharmacy and soon worked out that if she used a number of different pharmacies to buy from, nobody would ask her too many questions and she would be left alone to manage her pain as she’d always done.

What is Codeine

Codeine is a member of the opiate family of drugs, which also include heroin, morphine and oxycodone.

Opiate drugs affect the body’s opioid receptors that modulate pain awareness, and have a depressant effect within the body.

Moreover, depending on the individual, opiates can rapidly become physically and psychologically addictive.

Codeine effectiveness hinges on how much of the drug is metabolised into morphine within an individual.

Prescription only

This year, the Therapeutic Goods Administration (TGA) ruled that preparations containing codeine would be no longer available without a prescription.

These changes occurred after a substantial investigation into codeine use within Australia, which found that deaths associated with excessive codeine usage more than doubled between 2000 and 2009.

Accidental overdose accounted for most of the increase in these deaths with 84% due to multiple drug toxicity and where the type of codeine was reported, a whopping 40% of deaths were related to products containing codeine that were bought over the counter.

Therapeutic Goods Administration research also showed that 75% of misuse of painkillers and opiates occurred with products purchased over the counter.

A Cochrane systematic review of pain relieving medicines showed that over the counter pain relieving medicines containing codeine were no more effective than codeine free sources of pain relief.

According to a KPMG report tabled for the TGA, the positive net benefit to society in restricting codeine availability saves over five billion dollars in ten years, due to reduced death rates, improved quality of life due to more effective treatment options and the prevention of adverse effects related to the unintentional overdose of paracetamol or ibuprofen, which are present in over the counter medicines containing codeine.

On the basis of this information, the TGA determined that the presence of codeine in over the counter products was a public health safety concern and sought to reschedule the drugs to prescription only (S4).

They found, “the combination of lack of efficacy, risk of acute toxicity and dependence suggests that the use of over the counter codeine is not warranted” .

However some authorities fear that the rescheduling of codeine will lead to desperate users seeking access to the drug via the dark web or that pharmacies will become victims of crime as users attempt to steal the drug.

This has already occurred at one Melbourne pharmacy.

The Australian Medical Association, however, sees the rescheduling of codeine as an opportunity to better educate patients about better pain management and states that many strategies have been put in place already to help patients who may be codeine dependent through not for profit organisation, NPS Medicinewise.

Recognising that treatment for drug dependency should be tailored individually and that self withdrawal is rarely effective for users with opioid addiction, NPS Medicinewise recommends specialised support from drug addiction treatment services, such as the Hader Clinic.

Rehabilitation

Until a desperate Anna saw her GP for a supply of codeine to “top up her pain relief”, she was unaware that she was addicted to the drug.
Anna’s anxiety around access to the drug prompted suspicion in her GP, who after questioning her further about her usage, referred her to a drug rehabilitation clinic.

In rehabilitation she learned that the nausea she was experiencing was a side effect of opioid withdrawal.

“I’m what you’d describe as an accidental addict,” Anna explains.

“As a corporate lawyer with a decent income and lifestyle, I just don’t fit the narrative of what society considers to be a drug addict. It was a wake up call learning to accept that I was a drug addict and that I needed help.”

“The only “cure” for addiction is total abstinence. The withdrawal was difficult, however, I haven’t touched codeine since and I’ve been learning to manage my migraines in other ways. I’m back at work and everybody tells me I look much healthier.”

Help and more information

If you feel that the change of codeine to prescription-only is adversely affecting you please contact us for a confidential consultation.
You can find out more here about codeine addiction.

References:
“Trends and characteristics of accidental and intentional codeine overdose deaths in Australia.” Amanda Roxburgh, Wayne D Hall, Lucinda Burns, Jennifer Pilgrim, Eva Saar, Suzanne Nielsen and Louisa Degenhardt
Med J Aust 2015; 203 (7): 299. || doi: 10.5694/mja15.00183
https://www.nps.org.au/medical-info/clinical-topics/news/paracetamol-ibuprofen-combinations-for-acute-pain
BMJ Case Reports 2015, O’Reilly D et al.
*Name changed for privacy reasons

Chris’ Addiction Recovery Story

‘A couple months ago I was on the verge of losing everything. I was trying to decide whether to keep going or kill myself.’

Chris started drinking and smoking cannabis when he was 11 years old. His young parents were users and they weren’t always around. At 12, he moved in with his grandmother and an uncle who was recently out of jail.

‘I was allowed to do whatever I wanted, so I smoked weed all day and drank whenever I could,’ Chris says.

Chris left school in year nine. He couldn’t sit still and focus. He was good at sports, but he had no time for the classroom. He was using a range of drugs. When he was 15 he was addicted to oxycontin and became unwell. He gave it up, but continued with other drugs.

‘I’ve tried everything but heroin and ice. They say morphine and heroin are pretty much the same though. I’ve tried everything else,’ he says.

‘I paid for a lot of it with crime. A lot of theft and stealing and working. Having a family that would sell and deal, I was always around that criminal scene. It was never really hard to get my hands on stuff.’

Chris saw a lot of bad times when he was drinking. He burnt his arm starting a bonfire with petrol and came off a motorbike at high speed without safety gear. The worst thing he ever did, he says, is steal from his family.

‘That’s what’s really affected me at an older age. I stole my brother’s and sister’s pocket money. I stole every one of my dad’s DVDs,’ he says. ‘I’d never had a friendship because I would’ve stepped over you to get what I wanted.’

Nine years ago, Chris met his partner. They had a son. Chris stopped taking drugs but couldn’t give up drinking. He tried seeing a psychologist, going to counselling, moderating and cutting back but it didn’t work.

‘I’d end up doing it again,’ Chris says. ‘I really didn’t want to, but it was the only way for me to get out of my own head, to get away from the day to day life stuff that I couldn’t handle.’

Now 27, Chris is a qualified horticulturalist. He’s been working for about eight years and from the outside things have probably seemed ok. But in the past year, everything started falling apart.

Although he tried to be a good dad, Chris’s relationship with his son and partner suffered. He would be moody and unstable. His relationship with his partner was only around caring for their son, they no longer had an intimate connection. Chris realised his son wasn’t always comfortable with him. He knew he had to deal with the problem this time.

‘The Hader Clinic said they could get me a bed straight away. That was crucial to me, because I had to go now. I didn’t have a minute to wait, let alone a month,’ he says.

During rehab, Chris was able to focus on the thoughts and feelings he had previously avoided. His partner did a lot of research while he was away to understand what Chris was experiencing. Chris was able to admit he is powerless over his addiction and start to move forward.

‘Being with yourself 24 hours a day and working the program, you’ve really got to want to be better. That’s a key thing,’ he says. ‘That’s what I needed, to be secluded away from everything and work on what’s going on inside me.’

Since leaving rehab, Chris has been attending 12 step meetings every night. Participating in the fellowship and doing the steps is keeping him sober. His son recently turned four and their relationship has improved.

‘I was always on edge. Now I have a lot of tolerance and patience, thanks to the program. I think he feels a lot safer that I’m more stable emotionally, and life is a million times better because me and my partner aren’t fighting and arguing and I’m not drinking and walking out,’ Chris says. ‘

‘I’m here. I’m there for him. He definitely notices the difference. To what extent, I don’t know. I don’t think he’ll remember because he’s so young, but for now it makes a difference.’

Chris and his partner are working on their relationship too. Now that he’s sober, they can see each other in a different way. Chris is amazed with how much better his life has become in only a few months.

‘I’m very surprised my partner stuck it out,’ Chris says. ‘I think I’ve broken her pretty bad, but I’m here to try and make it better. We’re both making conscious effort to work on our relationship.’

Chris is now studying to become an addiction counsellor through the Hader Institute. When he’s not studying, he’s taking care of his son.

‘Until I went to rehab and looked at myself and was told that I’m an alcoholic and an addict, I didn’t know what was going on. I just thought I was a bad person,’

Chris says. ‘It’s good to not be hurting anyone any more.’

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