The mother so hooked on over the counter painkillers she wore disguises to buy them from chemist
It started when she took codeine for pain caused by playing the violin
Helen White-Knight, a 37-year-old mother-of-one from Milton Keynes, has spent most of the past 15 years dependent on the painkiller codeine.
At times, this has left helen, who has a four-year-old son, Albie, so desperate that she would trawl all the chemists within a five-mile radius of her home every morning to buy codeine over the counter.
her problems started when she was 22, with an innocent request to a boyfriend’s father — who was a gP — for something to alleviate the chronic shoulder pain she suffered from having played the violin since childhood.
‘he said to look in his bag for a packet of paracetamol and codeine pills,’ recalls helen. ‘ they really did the trick. But i had no idea at the time about codeine’s addictive powers.’
She started regularly buying codeine in the form of co- codamol — a mixture of codeine and paracetamol — over the counter. Within two years of taking those first codeine pills, helen had become a habitual pharmacy shopper.
‘it took over my life. i’d get up early each morning to get a packet of 32 co-codamol to get through the day,’ she says. ‘i’d also buy them whenever i passed a chemist.’
Worried that pharmacists might recognise her and refuse to sell her the medication, sometimes helen even wore a ‘ridiculous’ disguise and put on a fake voice.
Codeine is an opioid drug that’s turned into morphine by the liver. it’s supposed to be taken for mild to moderate pain, coughs (although there is only weak evidence for this) and, to a lesser extent, diarrhoea.
like morphine, codeine binds to opioid receptors in the brain that are important for transmitting pain.
But it also mimics natural ‘feel-good’ brain chemicals, such as endorphins, only more intensely.
the brain quite quickly develops a tolerance to this, meaning that you crave more in order to get the same effect.
the pharmacists’ journal Chemist + Druggist warns that codeine ‘can only be used for a few days before tolerance to the steady dose occurs’.
nevertheless, codeine is freely on sale in chemists, usually combined with other painkillers such as ibuprofen (for instance, in nurofen Plus) or paracetamol (Solpadeine Plus).
UNDER
UK pharmacy rules, overthecounter codeine sales are restricted to one pack per customer, with a maximum of 32 tablets containing a maximum of 8mg codeine each (compared to up to 30mg for prescribed doses). the packets themselves carry the warning: ‘Can cause addiction. For three days’ use only.’
regular use puts people at risk of potentially lethal effects — overdosing on codeine itself, as well as suffering liver or kidney failure from paracetamol overuse, or stomach bleeding from ibuprofen overuse.
the problem is that coming off the drug can cause crippling withdrawal symptoms, including sleeplessness, headaches, fever, cravings, depression, muscle aches, sweating, stomach cramps, nausea and vomiting.
While there are no official statistics on the codeine addiction problem in the UK, it seems that it is spiralling. the rehabilitation organisation UK Addiction treatment Centres says that the number of people admitted to its six nationwide facilities for help for codeine addiction nearly doubled between 2015 and 2017.
David grieve, 67, a retired nurse who set up the codeine addiction charity Over-Count, says helen’s story is far from unusual — and that it is very difficult for people to get the help they need.
he says he’s helped 96,000 people who have contacted him since he launched a helpline in 1993.
David founded the charity after he had become addicted to codeine cough mixtures taken to alleviate his bronchitis.
he says: ‘As a nurse, i thought i knew the risks. But, after my bronchitis got better, i kept taking the medicine because it made me feel nice — and i ended up taking ten litres of it a week.’
David went looking for help. ‘gPs did not have specialist knowledge. they offered me methadone, which is what doctors prescribe as a substitute to people addicted to opioids such as heroin, as well as tranquillisers and Valium.’
instead, he asked for a prescription for codeine tablets, which he used to taper himself off slowly and carefully — a solution he knew from his nursing days might work. it took him ten months.
Concern about the dangers of codeine addiction led the government in Australia earlier this year to ban the sale of codeine over the counter. the February 1 deadline caused panic- buying — now, Australians can only get codeine products by visiting their doctor for a prescription.
More than 25 countries, including the U.S., Japan, France and hong Kong, have similarly made codeine a prescription-only medicine. But it remains perfectly legal to buy the drug over the counter here.
As good health can reveal, even if the UK were to follow suit and make codeine available only on prescription, it is worryingly easy to obtain online instead.
indeed, according to David grieve, many people who are addicted to codeine buy the painkillers online — ostensibly with a prescription — from websites based in Mexico and Canada, rather than trawling different high Street chemists.
these sites offer to sell the drugs and pay one of their local doctors to write a six-month personal prescription to be posted along with 250 tablets. that’s enough to get them through UK customs.
But you don’t have to look that far afield. A UK-based website,
pilldoctor.co.uk, offers to deliver codeine in ‘ discreet plain packaging’, along with a free prescription ‘ once it has been approved by a doctor’.
‘All consultations and prescriptions are performed by eU doctors,’ says the company website, which has a postal address in romford, essex. the website carries the approval logo of the government watchdog, the Medicines and healthcare products regulatory Agency (MhrA).
When i attempted to order 30mg codeine phosphate pills (a high dose, nearly four times the overthe-counter maximum) — 200 of them — the website directed me to an online form that took five minutes to complete.
the form asked my reason for wanting the pills.
i responded (truthfully) that i had suffered reactive arthritis after getting serious food poisoning in 1985 — though, mercifully, the symptoms had actually abated within two years.
THE online form effectively tutored me to give the right answers. For example, when it asked: ‘if you are already using this medication for your pain, how do you feel now compared with before you began to use it?’, i put ‘the same’. But the answer flashed up red — rejected. So i changed my answer to ‘better’ and was then allowed to proceed. the system seemed automated, though this is said to be an ‘online consultation by a doctor’. i was then directed to the checkout: 200 pills for £99.99 — 50p a pop. i did not press ‘buy’. ‘ is this legal?’ i asked lynda Scammell, senior policy adviser at the MhrA. She paused, then said: ‘it’s not illegal.’ this is because complies with UK regulations as they stand. Ms Scammell says: ‘You consult online with an eU- registered doctor. But they could be anywhere in the eU, because these prescriptions can be dispensed legally by pharmacies in any other country.
‘ We normally find that they are in countries registered in romania and Bulgaria who should be monitoring people’s online questionnaires.
‘ if the answers fit the legal requirements, they will dispense the codeine to the applicant.’
this is not, however, an eU-wide practice. ‘We allow this in the UK and a handful of other eU states, but it is banned in countries such as France, Spain and italy,’ adds Ms Scammell.
She says doctors involved are not necessarily registered with the UK doctors’ regulator, the general Medical Council (gMC).
‘there is concern about this,’ she adds. ‘the MhrA, the gMC, the general Pharmaceutical Council and the Care Quality Commission have joined in investigating this, in the wake of concern from coroner’s courts about people who have overdosed on codeine bought legally online.’
So, what else is being done to help people dependent on the painkillers? earlier this year, there was a ray of hope when Public health england announced a review into
prescription pill dependency. The review will look at benzodiazepines, commonly prescribed for anxiety and depression, antidepressants, benzodiazepine tranquillisers (such as diazepam or Valium), Z-drugs (such as zolpidem and zopiclone, which work similarly to benzodiazepines) and opioid painkillers (such as tramadol and codeine).
But the problem of non-prescribed codeine will not be considered. So over-the-counter addicts will remain unaided by the Government.
It comes as one of the few places that people can turn for support — David Grieve’s charity Over-Count — may be forced to close within weeks due to lack of funding. Escaping the grip of over-thecounter codeine has proved an insurmountable task for Helen White-Knight.
After two years on the pills and one unsuccessful attempt to come off them — ‘after 24 hours, I was sweaty and restless, almost like I was possessed’ — she saw her GP. She was referred to a heroin addiction clinic, which put her on another opioid drug, buprenorphine, supposedly to wean her off the codeine.
‘But it proved to be like using a sledgehammer to crack a nut,’ she recalls. ‘I had a full-time job, so to keep me from suffering any withdrawals from the buprenorphine, they kept me on it for a year — with no real plan to wean me off. They would only let you take it in front of a chemist, in case you went out and sold it, so I’d be there each morning, along with the people waiting for methadone to keep them off heroin.’
In the end, Helen had to withdraw from it with no help from the clinic, but just by going ‘cold turkey’ through the agonies of withdrawal for a fortnight. She remained drug-free for a year — until her shoulder pains again became unbearable.
This has become something of a pattern. Helen managed to come off the codeine again in order to start her family, but the shoulder pain has persisted, driving her back to codeine.
Two years ago, her GP referred her to a private neurologist, who put her on a pain-management regimen — which included prescription codeine. ‘Yes, I am back on codeine,’ she sighs. ‘But it is managed under professional supervision now. I have two or three tablets a day.’
She has also been given nerve-blocking injections in both shoulders, which have worked ‘like a magical charm’.
‘I only wish that I had been told about this years ago,’ she says. ‘My goal is ultimately to stop taking the codeine daily and use it only for flare-ups.
‘I just know that if I’d had the right support and advice at the start of my problems with pain, I could have got to this point much earlier.’ Good Health approached pilldoctor.
co.uk for comment, but has not received a reply.