We all know that just because we can buy certain drugs ‘over the counter’ without a prescription, they are still potentially dangerous and it is important for us not to get too lackadaisical about our use of them. 
Some over-the-counter analgesics (painkillers), especially those that contain codeine, can be highly addictive. The codeine-containing analgesics currently available in New Zealand are Nurofen Plus, Panadeine, Panadeine Plus, Mersyndol, Paracotene, Panafen Plus and Codalgin. 


Excessive use of these drugs is on the rise and last year an article in the New Zealand Medical Journal – “Misuse of the over-the-counter codeine-containing analgesics: dependence and other adverse effects” – reviewed cases of codeine dependency from over-the-counter combination analgesics presenting at a Christchurch detox unit over a two-year period. The authors state that they found a new pattern of admission related specifically to these medications. They thought that the increase of people presenting to their service may relate to higher codeine content in the combination product and to marketing techniques.


According to the authors, there is little evidence of any additional benefit from the inclusion of codeine in the analgesics. In fact they state, “The low dose of opioid may be enough to cause opioid side effects (in particular constipation)… yet may not provide significant additional relief of pain.” 
Another problem can be that when taken over a long period of time, people will build tolerance to codeine and so will need to use more of the combination medication than the recommended dose. The side effects from too much ibuprofen or paracetamol can be nasty and include ulcers, irritable bowel syndrome, exacerbation of asthma and renal adverse effects. Then of course there is the dependency potential to the codeine.
Unfortunately there is little research into over-the-counter dependence, but there are websites based in the United Kingdom that provide personal stories, information and support for people who are trying to withdraw from these drugs. The addresses are: www.over-count.org.uk and www.codeinefree.me.uk.


The message is clear – take those over-the-counter drugs seriously and at all times only use the recommended dosage. Using them to satisfy an opioid dependency is not a good idea, as the side-effects from excess use of ibuprofen (in Nurofen) or the paracetomal (in Panadeine) can be life threatening. If you are unsure, you can visit the above websites, or call us at CADS or the Alcohol and Drug Helpline (see below for numbers).


If you have concerns about your own or someone else’s drug use, or if you’d like more information, contact CADS on 09 845 1818 or www.cads.org.nz or if you live outside Auckland contact Alcohol and Drug Helpline 0800 787 797.

| Diana Rands
www.cads.org.nz