Many medicines available in chemists without prescription pose threats of addiction and other potential misuse, writes Gráinne Faller.
There is a presumption about over-the-counter (OTC) medicines. They're available without prescription, so they must be harmless - they are "drugs-lite", as it were.
Although we grow increasingly inquisitive about the food we eat and what it does to us, medication is taken on blind faith. The differences between paracetamol, aspirin and iboprofen - if they work, who cares?
Brendan Quinn, a pharmacist in Gort, Co Galway, is concerned. He teaches over-the-counter medicine as part of a FÁS course in his area and warns students of the pitfalls. "The more these medicines are pushed into the consumer end of things, the more trouble you're going to have with abuse."
Suzie does not present the typical image of someone with a drug problem. She is 39 years old, married, with three children. She asked that her name be changed for their sakes. "There's an awful stigma attached to having an addiction. When you're addicted to something that people see as harmless, you don't get the same understanding or support as you might otherwise."
The staple of Suzie's 18-year addiction was Solpadeine. Containing paracetamol, caffeine and codeine, it is a very effective painkiller - however, if misused, it can be addictive because of the codeine in its make-up.
Brendan Quinn cites it and Codeine Linctus as being the most widely abused non-prescription medications in his experience. Over-Count, an organisation that helps people addicted to OTC medication, has a list of medicines including Syndol, Feminax, Nurofen Plus, Sudafed, decongestants and various cough mixtures that are commonly misused.
But how does it happen?
Suzie explains: "I had a virus that left me with sciatica so I started taking tablets for that. They made me feel relaxed so I started making up excuses to take them even after the sciatica had cleared up. After a while, I'd get headaches if I didn't take them."
Codeine is a narcotic and one of its side-effects is that, if you have been taking it and you stop, you get what is known as the "codeine headache". The problem begins if you take more codeine-based medication to get rid of that pain.
"Addicts are often hard-working professional people. I would have had a garda, a solicitor and a teacher all with problems," Brendan Quinn notes.
"Physically, I was functioning normally, but I needed the Solpadeine to help me through the day. I had a rota of chemists who I would buy from - because I didn't want anyone to notice how much I was taking," Suzie adds.
The addiction works like any other, according to Stephen Rowan, clinical director of the Rutland Centre. "Built into every addiction is denial. The individual won't deny the fact that he or she is taking the medication, but they will deny its addictive power. It's only a tiny percentage of people that use this medication who will abuse it, but it happens."
Over the years, Suzie progressed from four to 14 tablets a day. She used other products such as Syndol as well. She says, "Towards the end, I found that the dosage was doing me no good so I started using my mother's prescription of Kapake."
Kapake is a codeine-based drug that contains 30mg of codeine per tablet. Solpadeine contains just 8mg. For the last six months of her addiction, Suzie was taking eight Kapake a day.
"I was in denial, but I really didn't know that you could be addicted to things like Solpadeine so it was easier to ignore the problem."
Indeed, there is no warning on these products about the addictive nature of codeine, although there are instructions about proper usage.
Olive Stephens of the Irish Pharmaceutical Union says, "We'd certainly be in favour of warning people. More could be done to raise awareness among people about the potential problems."
Brian Murphy, commercial affairs manager with the Irish Pharmaceutical and Healthcare Association which represents the pharmaceutical industry, says patient information leaflets provide all the necessary advice about correct dosage. "The whole point of these medicines is that they are only for short-term use. People are advised to see a doctor if symptoms persist."
The regulatory body in charge of approving these drugs is the Irish Medicines Board (IMB). Its director of human medicine, Dr Joan Gilvarry, noted that people abusing OTC medication was not something one could legislate for.
"We have very strict controls in this country for these medicines. They are not freely available - you have to get them in a pharmacy and the pharmacist provides that extra security. The patient information leaflet warns about the dangers of misuse or prolonged use. People have to act responsibly."
Suzie's quest to buy even more codeine-based medicines led to the wake-up call she needed.
"I was searching the Internet for a way to buy more. I typed in 'Solpadeine' and this website for people who are addicted appeared. It was amazing. I had genuinely thought that I was the only one."
To her surprise, it is a problem pharmacists encounter a lot. But dependency isn't the only issue, as people abuse medication in other ways. Brendan Quinn says, "I regularly get phone-calls from publicans telling me that they've found a load of cough bottles in the toilets after a Saturday night. Sometimes word will spread among school children that a particular product will give you a high, and you'll get a spate of them coming in trying to buy certain medicines."
After finally recognising her problem, Suzie decided to stop. "Withdrawal was awful. I was physically ill. I couldn't stop shaking - I'd get hot and cold sweats and I couldn't sleep. The physical effects lasted for three or four weeks but the emotional side was even tougher to deal with. People tell me that I'll be different without the drugs. More like I was eighteen years ago, before I ever took anything."
She was lucky not to have suffered long-term damage. Paracetamol can damage the liver if even a small overdose is taken. There are 500mg of paracetamol in Solpadeine tablets, so eight tablets is the absolute maximum that any adult should take in 24 hours.
Brendan Quinn adds: "It comes down to this - the more society treats medicine like sweets, the more we will see people abusing it. We need to acknowledge the problem."