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Imagine this scenario: A young professional, male or female, with clean and sober habits, wakes up one morning with muscle pain the day after a heavy workout session. No big deal. They take a couple of aspirins and go to work. By lunchtime their muscles aren’t any better, so they bring it up with a co-worker who hands them two ibuprofen tablets. Hours later and still uncomfortable, they make a quick stop at a pharmacy and explain their situation to their pharmacist who hands them a packet of Kapake, Solpadol, or Tylex after 30 seconds of conversation, and sends them on their way. An hour after taking two 8/500 tablets, our young professional feels amazing. Their pain is gone, along with their work stress and worries about unpaid bills. Six months later, they check into a rehab clinic for opioid addiction.
What do you think? Is this plausible? Is this something that could happen to someone who’s aware of the dangers of drugs and has managed to steer clear of them their whole life?
The correct answers are yes, and yes. Kapake, Solpadol, and Tylex are the brand names for extremely common painkillers sold in pharmacies without the need for a prescription in the UK. They’re all part of the co-codamol family of drugs, which consists of a mixture of paracetamol and codeine. While the paracetamol part of the drug is largely considered safe when used as directed, codeine is an opioid derivative closely related to heroin and morphine.
While our young professional initially started taking the drug innocently enough and without any intention of becoming hooked, opioid derivatives like codeine are some of the most addictive substances known to man, and no human is immune to its effects. Even after just a handful of doses, any person is fully capable of developing a dependence on the drug, and, eventually, full-blown addiction.
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Co-codamol is used to treat mild to moderate pain when other, less-addictive non-opioid analgesics (painkillers) like paracetamol, aspirin, or ibuprofen fail to do the trick. In the UK, co-codamol and other codeine-based drugs are extremely popular, with a 2016 study claiming that the UK was the second largest consumer of codeine in the world at 44.2 tonnes (Kinnaird et al.).
Co-codamol is considered a ‘mild opioid’ and is available in three different strengths. All three contain 500mg of paracetamol (the same as a standard paracetamol tablet), and either 8mg, 15mg, or 30mg of codeine. While only the 8mg codeine tablet is available without a prescription, co-codamol remains the second most dispensed drug in England (Mikulic). This high prescription rate, along with a robust black market for the drug, has contributed to an opioid crisis in the UK. While the term opioid crisis is typically associated with the US, it’s in fact the UK that had the highest rate of opioid consumption in the world in 2019, with opiate-related deaths increasing by 388% since 1993 in England and Wales (Roberts and Richards).
Considering how much harm opioids can cause on both the individual and societal level, it’s not surprising that 25 countries, including Germany, Japan, and Australia have banned over-the-counter sales of codeine (Guirguis).
Codeine dependency, like other opiate dependencies, is associated with a litany of morbid effects, including death. In broad strokes, these dangers can be split up into three categories:
In addition to the dangers associated with codeine in co-codamol, abusers also run the danger of developing blood disorders such as thrombocytopenia and leukopenia, or liver and kidney damage due to the high paracetamol content. Left untreated, these conditions could prove fatal in the long run.
Co-codamol withdrawal symptoms are similar to those associated with other opiates. In other words, they are generally considered to be on the more severe side and are associated with being extremely uncomfortable and painful. It’s important to note that even people with similar health and abuse profiles might suffer different withdrawal symptoms at different intensities over different timelines. Co-occurring physical and mental health issues, as well as the interaction with other drugs such as alcohol, will all affect a withdrawal patient’s symptoms.
The onset of codeine withdrawal symptoms typically starts within a few hours of the last use (8 to 12 hours). Early onset symptoms could include any combination of these symptoms:
At around 4 days after the last use, more severe physical and psychological symptoms could present. These include:
After day 5 of detox, a patient in withdrawal might start feeling the first signs of relief as the codeine concentrations in the body start dropping and normal brain chemistry starts returning. The patient is still likely to feel weak and dehydrated due to the sweating, vomiting, and diarrhoea; however, in most cases, the worst of the physical symptoms are behind them and primary rehab may begin (Perez).
In many cases, a person wishing to stop codeine abuse can go through withdrawal at home. It’s important to note that the cold turkey approach isn’t advised based on how uncomfortable the withdrawal symptoms could become, and this approach could easily lead to a relapse and further feelings of anxiety and depression. Gradually tapering down the dose, or taking prescribed antidepressants during detox could significantly improve the odds of a successful home detox.
In cases of severe or long-term codeine abuse, or where the patient is also seeking treatment for other substance abuse, such as co-occurring alcoholism, it’s highly recommended to go through the detox process under medical supervision. Opioid receptor agonists such as methadone, partial agonists such as buprenorphine, and adrenergic receptor agonists like clonidine and lofexidine might all help reduce the severity of the withdrawal symptoms, but may only be prescribed by a licenced physician and used under medical supervision (Srivastava et al.).
At Gladstones Clinic, we’ve witnessed the devastating impact of co-codamol, codeine, and other opiates time and time again. The story of an individual finding themselves ensnared in co-codamol addiction is neither rare nor exaggerated, and neither are the dangers.
With over two decades of dedicated addiction rehabilitation behind us, our trained and experienced addiction specialists take an integrative and holistic approach to beating addiction. We recognise that each patient’s experience with addiction is unique, and we take the time to understand the underlying causes before developing personalised strategies to beat addiction.
Our residential facilities located in London and the Cotswolds offer a sanctuary for recovery, with caring and understanding addiction specialists by your side during the detox phase, and skilled psychiatrists and mental health professionals offering evidence-backed and time-proven primary care.
You can read more about our rehab programmes, treatment services, and facilities by clicking on the links.
If you or a loved one find yourself addicted to co-codamol, codeine, or other opioids, please don’t hesitate to contact us.
“Codeine.” MedlinePlus, MedlinePlus, 13 April 2023, https://medlineplus.gov/druginfo/meds/a682065.html. Accessed 15 August 2023.
Guirguis, Amira. “Over-the-counter opioids: does Britain have a codeine problem?” The Conversation, 13 June 2023, https://theconversation.com/over-the-counter-opioids-does-britain-have-a-codeine-problem-205331. Accessed 15 August 2023.
Kinnaird, E., et al. “From pain treatment to opioid dependence: a qualitative study of the environmental influence on codeine use in UK adults.” BMJ Open, vol. 9, no. 4, 2019. National Library of Medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6500317/. Accessed 15 08 2023.
Mikulic, Matej. “Top analgesic drugs dispensed in England by item number 2022.” Statista, Statista, 13 June 2023, https://www.statista.com/statistics/377895/top-ten-analgesic-drugs-dispensed-by-item-in-england/. Accessed 15 August 2023.
Perez, Alexandra. “Codeine Withdrawal: Symptoms, Diagnosis, and More I Psych Central.” Psych Central, Psych Central, 31 August 2021, https://psychcentral.com/addictions/codeine-withdrawal#timeline. Accessed 15 August 2023.
Roberts, A., and G. C. Richards. “Is England facing an opioid epidemic?” British Journal of Pain, vol. 17, no. 3, 2023. Sage Journals, https://journals.sagepub.com/doi/10.1177/20494637231160684. Accessed 15 08 2023.
Srivastava, B., et al. “New directions in the treatment of opioid withdrawal.” Lancet, vol. 395, no. 10241, 2020, pp. 1938-1948. National Library of Medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7385662/. Accessed 15 08 2023.
