ACTING on medical advice, a 36 year old farmer's wife innocently began buying painkillers at her local pharmacy to ease arthritis pains, now she scours Northern Ireland to feed a 16 year addiction.
Attempts to stop taking the codeine based tablets resulted in nausea, depression and agony, so she tripled the recommended daily dosage. After consultation with her local GP, the mother of two turned to a different brand of painkillers, which contains dihydrocodeine, another opiate like drug. The medicine made her feel happy and relaxed, and relieved all arthritic pain. But again, as her drug tolerance levels increased, she needed to increase the recommended daily dosage from eight to 20 tablets.
Each week, she drifts anonymously from chemist to chemist, stocking up on painkillers, spending on average £50 to satisfy the addiction. When, knowing she had a problem, she turned once more to her local GP, the response was a threat to strike her from the practice list if she raised the issue again.
The local drug centre said that after an 18 month waiting period it could offer a 15 minute counselling session and suggested valium as an interim measure. "I cannot live like a normal person without taking my pills. My husband is threatening to divorce me because of my mood swings," she wrote in a letter to David Greive, director of OverCount, a voluntary agency in Scotland, which offer advice and counselling to more than 4,000 over the counter (OTC) drug abusers.
Over Count, which deals specifically with OTC medicine abuse was formed by Greive three yearn after he quit a 10 bottle a day cough mixture habit, which cost him his career, almost ended his marriage and left him £18,000 in debt.
"If my client continues at the present rate of abuse she risks irritable bowel syndrome, liver failure, ulcer growth, colon damage and eventually could fall into coma," says David Greive.
Although lack of research makes it almost impossible to accurately judge the extent of OTC abuse, Greive, a trained psychiatric nurse, makes a revealing observation about the problem in the North: "On a per capita basis Northern Ireland has currently a higher level of OTC abusers than in the rest of the UK." At present he counsels 152 clients in Northern Ireland. Marie King, of Breakthru, a partly European funded drugs awareness project in Dungannon, Co Tyrone says OTC abuse is rising. Last year, one fifth of all counselling calls Breakthru received were related to OTC medicine abuse. "It is a very secretive thing, people are embarrassed and ashamed to admit it," she says.
Last month, Queen's University, Belfast, hosted the first conference in Northern Ireland aimed at exploring ways in which pharmacists could combat OTC abuse. Terry Maguire, a Falls Road chemist and vicepresident of the Northern Ireland Pharmaceutical Society, who attended the conference, says pharmacists are making efforts to clamp down on abusers, but difficulties often arise in identifying OTC addicts.
"It is not something that can be categorised by socioeconomic grouping. They could be law abiding family people, with homes to go to, who are deluding themselves or those who are overtly busing," he said. While perceptions of a typical OTC abuser vary among pharmacists, certain traits often sound alarm bells. When a customer directly requests a drug by name, makes repeated purchases, appears unwilling to identify the symptoms of the illness and refuses alternative remedies, most chemists will decline service.
But addicts are not easily disuaded. If they are not served by one chemist, they go to another, or purchase tablets on the black market.
One man regularly dressed up as a vicar to purchase a cough medicine, containing an opiate like substance, telling chemists he urgently needed the medicine to clear his throat for the Sunday sermon.
FRANK McGoldrick, director of the Research On Chemical Dependency Group, a voluntary Belfast based organisation which promotes drug awareness, says most OTC medicine abusers are loath to admit dependency and casually dismiss the notion they are causing physical and mental damage to themselves.
"They are getting drugs from a man in a white coat, not some shady street corner and they are not breaking the law, so it is easier to legitimise for some people. Most don't even realise they are abusers," he says.
Overt OTC medicine abuse is also rising sharply, particularly in inner city areas among young people. "Nowadays there is a huge pool of knowledge among 16 to 25 year olds in regard to what chemicals can do to the body. They know which OTC medicines to use to ease coming down from illegal drugs, particularly ecstasy. Younger people are becoming store front chemists," adds Frank McGoldrick. Five pills containing diphenhydramine and one can of a certain beer causes an eight hour buzz, similar to that of cannabis, all for under £3.
Another concoction used on Belfast's streets is "Blood": made from mixing a half bottle of vodka and a cough medicine, which contains diphenhydramine, a sedative, plus dextromethorphan, an opiate like drug. This red potion induces a dream like state and causes similar effects to those produced by LSD.
Ken Ball, director of West Cumberland Hospital, who has worked in the field of OTC medicine abuse for 25 years, agrees. "Kids know that stuff and the information spreads quickly among them."
According to Ken Ball's research OTC abuse is a bigger problem than hard drugs, such as heroin, cocaine and morphine because the age group is so wide and the range of products so large." Experts estimate that 50 per cent of alcoholics have taken OTC medicine as a substitute for alcohol, the most common forms being codeine based painkillers, morphine and ephedrine.
Dr Anne Watts, who works at Carlisle House, a drugs and alcohol rehabilitation centre in north Belfast says: "Few people come here presenting OTC as a problem. It's only when you Inquire what they are using as a substitute that you find evidence of abuse."
Despite a plethora of "anecdotal" information on growing OTC abuse, which has been gleaned by voluntary organisations in Northern Ireland, some seem reluctant to acknowledge the extent of the problem.
Rob Phibbs, director of the Drugs Management Programme at the Britishgovernment funded Health Promotion Agency in Belfast says: "The current research available does not show OTC abuse as a problem," but adds that there has been no specific research in this area.
The Northern Ireland Department of Health and Social Services has no statistics on OTC abuse. Prof James McElnay, head of Queen's University School of Pharmacy agrees OTC abuse is a problem in the North, but adds that only "a tiny amount of OTC medicines being sold are being abused." In September, Queen's University hopes to launch a pilot scheme to monitor a harm reduction programme, whereby OTC patients are weaned off medicine over a period of time.
When he was 25, David Greive bought a cough medicine, which contained ephedrine and codeine to ease a sore throat. He took the recommended course but the cough returned, so he purchased more medicine and increased the dosage which eased his cough and gave him a feeling of wellbeing. But again when be stopped, he felt shaky and unwell. As a registered psychiatric nurse he found work at a prison hospital in Liverpool.
Working shifts, he found it easy to fit in his addiction and was taking between one and two bottles of cough mixture a day. He moved jobs and worked with the Merseyside police for several years, again managing to conceal his habit. When his wife became ill with postnatal depression, he took time off work to care for her. The couple moved back to Dumfries when they inherited a bungalow and a large sum of money from a deceased aunt.
David Greive had money and time to satisfy his craving for cough mixture, but it soon ran out. Every three days, he would go on a "trawling" journey and travel on average 600 miles roundtrip to visit 10-12 chemists, where he purchased 25-30 bottles of cough medicine. Over five years, he ran up a debt of £18,000, had spent his inheritance and sold his home to feed his 80 bottle a week addiction.
In 1991, David Greive was admitted to intensive care and doctors said he had 12 months to live unless he kicked the OTC habit. Reluctant to take methadone or valium, Greive and his local GP agreed he should slowly wean himself off the cough mixture.
At 10.25 a.m. on September 13th, 1992, he took his last 500 mls of cough mixture. It took him a year to recover from the physical addiction. His wife was so concerned that she wrote to the Medical Directorate of the pharmaceutical manufacturer explaining the cough medicine he had used had addictive qualities. The company replied saying the problem lay with her husband, not with the drug, and enclosed a rally jacket complete with company logo thanking Mr Greive for his custom. In 1995, he formed the counselling agency OverCount.