The development of dependency on over the counter (OTC) drugs is often forgotten.1 In the past three months we have seen three patients with addictions to Nurofen plus (ibuprofen and codeine phosphate). All three had started using the product for its approved indications, but their use had escalated as they became tolerant to the codeine element. Each patient presented with side effects related to ibuprofen.
Codeine phosphate is now only available on prescription but has been available over the counter in combination with aspirin, paracetamol, or ibuprofen for many years.
A Medline search found no research into addiction to OTC drug dependence in the UK. Numerous websites are, however, documenting cases of addiction and offering support to those people trying to withdraw from these drugs. Websites such as over-count.org.uk and codeinefree.me.uk tell many personal stories, often remarkably similar and usually starting with appropriate use of analgesia for pain such as back injury or menstrual cramps. Postings on the over-count website illustrate the most common addiction is to Solpadeine (paracetamol and codeine) and suggest more than 4000 people registered on their website currently have this problem.
There are no official statistics documenting the extent of dependence on legal non-prescription drugs. Although addiction to codeine combined in OTC painkillers has been recognised for many years, anecdotal reports suggest this problem is increasing, and we need large scale research to assess and monitor the extent of the problem.
Competing interests: None declared.
References
- 1.Zarocostas J. Misuse of prescription drugs could soon exceed that of illicit narcotics, UN panel warns. BMJ 2007;334:444 (3 March.) doi: 10.1136/bmj.39140.394410.DB [DOI] [PMC free article] [PubMed] [Google Scholar]