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.
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.
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
“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
BMJ Case Reports 2015, O’Reilly D et al.
*Name changed for privacy reasons
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