Over-the-counter drugs abuse rife

By Helen Grange Time of article published Jul 24, 2007

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Tens of thousands of "ordinary" South Africans are addicted to over-the-counter painkillers and sedatives like Codis, Stopayne, Nurofen-Plus and Valium.

This is according to the latest research by the Medical Research Council (MRC) among 73 drug treatment centres countrywide.

It was conducted over the second half of 2006. It shows that 5 percent to 8 percent of their patients are abusing analgesics (codeine-based pain- killers) or benzodiazepines (prescribed tranquilisers like Valium, Librium, Rohypnol or Atavan).

Codeine - the most commonly abused of the non-prescription drugs - is a narcotic, which makes the user calm and relaxed, the reason addicts continue taking it even after the pain has gone.

And as the body's codeine tolerance increases, so you need more and more to feel the same effect.

It is easily accessible in the form of painkillers like Panado-co, Paracetacod, Codis and even some cough mixtures like Phensedyl.

Some dependents are popping 10, 15, maybe 20 tablets a day, the drug treatment centres reported.

"Addicts are adept at finding ways to get their fix. They will go to different pharmacies or different doctors if a prescription is needed, or they'll falsify their particulars," says David Bayever, deputy chairperson of the Central Drug Authority.

"This sort of addiction has been going on for years," says a pharmacist who wants to remain anonymous.

"Some people fax scripts for stronger stuff like Myprodol to different pharmacies, so you don't know how much they're really taking."

Benzodiazepines (so-called "benzos") are sedatives, used to "take the edge off", but you need a prescription for these, so getting them is more prohibitive.

Yet, they are the most widely abused of the over-the-counter medicines, the MRC survey found, often to enhance the effect of, or alleviate the withdrawal symptoms of an illegal drug like cocaine, heroin, mandrax or alcohol.

Another common over-the-counter addiction is to antihistamines like Syndol, used to induce sleep, and Grandpa headache powders, typically swallowed with Coke.

Grandpa contains a combination of paracetamol, aspirin (both painkillers) and caffeine, which, loaded with extra caffeine from Coke gives the user a mildly euphoric feeling and a "lift".

"Dependency on Grandpa is very dangerous," says Ane Carelson, social worker and marketing manager for Elim Clinic, a drug rehabilitation centre in Kempton Park.

"An overdose of paracetamol causes a lot of damage to the liver and kidneys. You can develop ulcers.

"Some people are taking 10, maybe 15 a day, which can be lethal."

Slimming tablets like Nobese, with pseudoephedrine (usually in colds and flu remedies), are also commonly abused - for its stimulating effect, the MRC survey found.

There are a slew of other serious symptoms of over-the-counter drug addiction, aside from liver and kidney dysfunction. Gastrointestinal disorders, gallstones, chronic constipation, depression and constant headaches are also among the risks.

Alarmingly, withdrawing from these drugs can be deadly.

The three drugs that present life-threatening withdrawal symptoms are "benzo", drugs from the opiate family.

These include codeine, and alcohol (25 percent of full-blown alcoholics die from trying to go "cold turkey").

"If you've been using codeine or benzos for a long time, you can't just stop. You need a doctor to guide the body back to its normal patterns with the help of medication."

The profile of these drug addicts is interesting. Ane says many are employed and in stressful, professional jobs.

"They use over-the-counter drugs to de-stress. You find more women taking them than men."

The other group at risk are the "desperate housewives", women who spend their days watching soapies and "making the time pass", as Ane puts it.

"Retired older people are also prone, as they are nearing the end of their lives."

Many addicts are people who started off with legitimate prescriptions for, say, a backache, and then became hooked over time.

Over-the-counter drug addiction is easy to feed given the accessibility and these medicines are cheap.

But that is not the primary problem, says David Bayever.

"The regulations are in place, but they are implemented inappropriately. Does the pharmacist ask for an ID to verify name and address?

"Does the doctor prescribing make sufficient inquiries about the need for more? Should the patient be allowed to "demand prescribe" (ask for a drug instead of present symptoms first)? Should the medical aid not intervene when submissions show the patient is abusing a drug? And shouldn't the drug manufacturers make the dangers of overuse clearer on their packaging?

"These are the questions that need to be addressed if we are to tackle this insidious kind of addiction."

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