Durban - Mrs Moodley is a 47-year-old housewife from the suburbs. She has been married for 23 years and has three children. Her husband is an accounts clerk who works hard and earns barely enough to get through the month.
Moodley starts her day with two Stilpane tablets and has done so for the past 12 years.
She will take between four to six more on an average day and up to 12 or 14 on a really bad day. It is to ease the daily headaches and body pains she has been having since her twenties.
Her GP and a specialist neurologist have investigated her extensively and she has been told that there is nothing seriously wrong with her. It is most likely a type of migraine.
She gets the painkillers from her GP twice or three times a week and sometimes without even having to see him. They are handed to her by the receptionist at his rooms. Or she gets a six-month repeat script from her specialist during her follow-up visit.
When she runs out of the Stilpane, she goes to her local pharmacy where she is able to purchase Adco-Dol painkillers without a prescription. She says this also helps with the pain.
Moodley has not gone a single week without painkillers for as long as she can remember.
The substance she is no doubt addicted to is codeine, which belongs to a group of substances known as opiates.
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 (anxiolytic) and progressing to a sense of well-being (euphoria) and sedation (sleep).
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 Moodley and millions of other 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.
As published in Harvard Health Publications, Columbia University researchers found that opioid addiction had tripled over 10 years.
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 three 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 behaviour 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 our country 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 to alcohol and cannabis.
It occurs in all races, classes and gender. It is difficult to get accurate statistics because of the sheer numbers and variables involved. Codeine is contained in cough mixtures, cold and flu preparations, sinus preparations and is sometimes even used to treat diarrhoea. The World Pain Association defines abuse as taking more than eight to 12 painkillers in a month. On average most sufferers take between six and eight a day.
There is an alternative.
A proper assessment and treatment can lead to a 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 at the Durban Pain Clinic, where we often see the worst of this epidemic.
* Dr Salduker is a local psychiatrist and director of the Durban Pain Clinic at Netcare St Augustine’s Hospital. - The Mercury