Vicki has been clean for three months after she overdosed and nearly died
But what she didn’t realise, when her GP prescribed codeine for kidney stone pain, is that this common painkiller and its derivatives can be every bit as addictive as heroin when taken in large doses. And some of them, like fentanyl, can be many times stronger than heroin. Within two years she had developed a 60-a-day habit that nearly killed her, before she started detox.
“I was having two boxes of Solpadeine Max every day. There are 30 in a box,” Vicki, 32, tells me.
Codeine is one of a class of medicines known as opioids that are related to heroin. In the UK the rate at which they are prescribed has rocketed, leaving hundreds of thousands of people unable to wean themselves off potentially lethal drugs.
Opioids are currently devastating America – the prescription opioid epidemic there accounts for more deaths than gun crime. Now a landmark study has raised grave concerns about our own relationship with painkillers.
The Public Health England report has revealed that 5.6 million people in England and Wales were prescribed an opioid last year, and more than half a million people have been on them for three years.
According to a BBC Two Horizon investigation, presented by Dr Michael Mosley, the opioids we are consuming collectively have doubled over the past 20 years.
“There’s no doubt that opioids have a vital role to play in cancer pain, end of life care, or to relieve pain after an operation, but that doesn’t begin to explain the surge in prescribing we’ve seen in recent years,” he says.
“One in eight of us is taking them, and millions of us get stuck on these painkillers long term.”
Vicki’s is certainly a cautionary tale. The connections coordinator for a utility company has been “clean” for the past three months after she overdosed and nearly died, but each day remains a struggle.
Within two years she had developed a 60-a-day habit that nearly killed her, before she started detox
“I started because of the kidney stones, but really I was taking them for mental pain,” she adds. “I lost my father when I was five, and my mum to cancer when I was 18.
“The year after she died, my aunty was diagnosed with breast cancer and she died when I was 27. My best friend was killed in a car crash and then my uncle died.
“That’s the back story. Once I’d found codeine it gave me this warm fuzzy feeling that helped me cope with my negative thoughts.
“My whole body was relaxed. I felt I could function well on a daily basis. It was a very comforting emotion and at the time there was no better feeling because I just wanted to not feel anything.”
Before long, in a desperate bid to feed her habit, Vicki, who lives in Salford, Greater Manchester, had started to steal opioid medication from her dying aunt.
Vicki’s waking thoughts were consumed with sourcing her supply – scouring the area around the office where she was working to find pharmacists who wouldn’t recognise her, so would sell her the drugs.
“My life was organised around the tablets,” says Vicki. “I would find myself getting up an hour earlier in the morning and Googling to find chemists I could go to before work.”
Pharmacists are supposed to ask questions before selling these painkillers over the counter
Pharmacists are supposed to ask a series of questions before selling these painkillers over the counter to weed out addicts but, as the programme shows, these questions are often asked in a cursory fashion, if at all.
“It would sound like they weren’t really bothered, and you could easily go into another chemist,” adds Vicki.
Friends grew concerned, as did her GP. “He noticed I was going to him more and more, trying to get him to prescribe them to me. He told me that codeine was part of the heroin family and that I was going to have to go on to some sort of treatment programme.
“He said ordinarily he would have put me on methadone, but that it was just as addictive. I was lucky, he put me into a detox centre, because he had a background in mental health and addiction.” After three weeks she was clean.
The danger with opioids is that the body develops a tolerance of them, and they are often mixed with paracetamol which, while it is not addictive, can cause fatal liver damage when taken in larger quantities than the recommended dose.
Which is exactly what Vicki was risking when she was in the grip of her addiction.
“Frankly, I’m shocked that she isn’t dead,” says Dr Mosley, who interviewed her for his Horizon investigation. “Those doses she was taking were extraordinary.”
Now, the concern from Public Health England is that the well-meaning but misguided opioid over- prescribing by GPs is placing many patients in the grip of an addiction of which they are unaware – until they try to come off their medication.
The side effects of these drugs can include memory loss, addiction and even accidental death
These drugs all come with a health warning, that they should only be taken for a limited time span, days rather than months or years.
“For end-of-life care and acute pain they are highly appropriate. If you are dying and in pain, there is nothing better. But the problem is that they are now being prescribed for chronic pain, where they are actually less effective,” says Dr Mosley.
“I hadn’t fully appreciated just how inappropriate they are for chronic pain, how you have to keep upping your intake to sometimes quite extraordinary doses in the hope of getting any benefit while increasing the side effects.”
He fears the UK could see an opioid crisis approaching that in the US over the next five years, partly due to the ease with which over-the-counter opioids can be purchased in pharmacies and online.
Dr Mosley discovered British pharmacies selling opioids without applying standard guidelines, and also managed to buy strong prescription-grade opioids online under a fake name.
The side effects of these drugs can include memory loss, addiction and even accidental death by overdose.
But just as perilous, he says, is the psychological aspect of long-term high dosage use.
“Long-term users are actually afraid to come off opioids because they fear that their pain will get worse. When they do, they are often surprised it doesn’t.”
But many never get that far, afraid to give up dependency on pills they believe to be helping them manage chronic conditions.
Although it is possible to quit, the temptation can remain.
“When I came out of detox, I was faced with the big bad world, raw,” says Vicki.
“You have to find some inner strength. I looked at my home and I thought ‘It’s not that bad.’ And that was it.
“But make no mistake. I don’t think you can ever truly overcome it. When I walk past a pharmacist, there is still the pull, there is always the pull. Everyone wants to feel great every day. I’m lucky because I’m fairly strong-willed, but in future I believe that there should be some sort of safeguarding system for vulnerable people who are in the grip of this addiction. We definitely need more protection.”
* Addicted To Painkillers? Britain’s Opioid Crisis is on BBC Two, 16 January, 9pm