• OTC medicines and addiction
• Paracetamol
• OTC medicines and drowsiness
• Can I trust the advertising?
• Ibuprofen and NSAIDs

OTC medicines and addiction

Codeine is an ingredient contained in some over-the-counter (OTC) painkillers.  It is combined in low doses with paracetamol or ibuprofen to provide pain relief for treating short-term moderate pain, such as muscular and rheumatic pain, headache, migraine, backache, period pain and toothache that is not relieved by paracetamol, ibuprofen or aspirin alone. 

Codeine is an opioid and is similar to, but weaker than morphine.  It works by blocking pain messages in the brain and spinal cord. 

OTC products containing codeine are safe and effective when used according to the instructions.  However, there is a risk of addiction if used for longer periods or at higher doses than stated on pack.

Measures to minimise the risk of addiction
To ensure products containing codeine are used safely there are a number of measures in place to minimise the risk of addiction:

• Products can only be sold under the supervision of a pharmacist.  They are not on general sale in supermarkets and other retail outlets.
• There are prominent warnings on the front of packs: ‘Can cause addiction.  For three days use only.’ 
• Advertising is also required to feature the same warning (although there is very little advertising of OTC codeine products). 
• Over-the-counter pack sizes are legally restricted to 32 tablets. 

Do people get addicted after 3 days?
The three day limitation on dose is intended to limit use of codeine to ailments that normally last for less than three days – such as headache and period pain. 

Some people have to take codeine products for long-term use for chronic conditions such as arthritis. They do not all become addicted to codeine but it is peferable that the products are supplied on prescription where the doctor is available to help weigh up the risks and benefits of treatment.

How many people are addicted?
There are 27 million packs of OTC products containing codeine sold in the UK every year, which is about 10% of the total number of pain relief products sold. 

The number of people addicted to OTC codeine products in the UK is unknown.  However, doctors and researchers are in agreement that it is a relatively small problem.  There is no evidence to suggest that more people are becoming addicted although media coverage over the past few years may have led to increased awareness of the issue. 

Department of Health review
The Department of Health commissioned two reports on addiction to prescription and over-the-counter drugs which were published in 2011.¹

For over-the-counter medicines, the conclusion was that:

• Little risk results from the appropriate use of codeine-containing OTC preparations to treat occasional pain when taken as directed and in the recommended doses. 
• As only a small number of studies exist on the misuse of over-the-counter codeine-containing products in the UK, further research is required to quantify the prevalence of misuse and dependence, as well as characterising the populations most at risk.   

Long-term pain
OTC products containing codeine are only suitable for short-term use.  If pain persists you should speak to your doctor who can investigate the cause of the pain and if necessary, give individual and detailed advice on managing long-term pain.

Many people are prescribed painkillers containing codeine to help with long-term pain such as arthritis.  This is appropriate pain management as it is under the supervision of a doctor. 

Further information
PAGB has produced a leaflet with the British Pain Society about managing pain using OTC medicines. 

To download it click here