Painkillers

Main type

Painkillers are used widely for a variety of ailments and to relieve pain for many everyday different conditions, from headaches and muscle pain to toothache, fever and sore throats. These kinds of conditions are usually dealt with via ‘over the counter’ painkillers, that is, those which are available from a shop or pharmacy without the need for a doctor’s prescription. Examples of common over the counter painkillers include Paracetamol, Aspirin and Ibuprofen. Over the counter painkillers usually come under the classification of Non-Steroidal Anti-Inflammatory Drugs, or NSAIDs.

In the case of more severe and recurring pain, stronger painkillers may be made available on prescription. Many of these are opiates, such as Morphine and Codeine. Because of their high potential for addiction, opiate-based painkillers are generally only prescribed when other painkillers have proved ineffective, and for particularly serious and debilitating conditions involving chronic pain. However some opioids are also used in smaller doses in conjunction with an NSAID and packaged as over the counter medicines. An example of this is Co-codamol, which contains a small dose of Codeine mixed with a larger dose of Paracetamol.

Though prescription-only painkillers are often more closely associated with addiction and abuse, even over the counter painkillers have a potential for addiction when not used as directed.

Most over the counter painkillers work by blocking messages to the brain which tell it that a certain part of the body is in pain. The exact mechanism by which they do this can vary, but many NSAIDS, like Paracetamol work by blocking the enzyme cylo-oxygenase from producing chemicals known as prostaglandins.

Prostaglandins are produced in the body normally as a ‘self-defence’ response to injury and other disturbances, and trigger a range of responses, including the physical sensations of pain, inflammation in the affected area and fever. By blocking their production, painkillers can reduce or even eliminate these painful sensations.

Some kinds of over the counter painkillers are physically addictive, particularly those that contain Codeine or another opiate. This means that the individual’s body can become dependent on them, triggering severe withdrawals if the painkillers are not taken.

Others, like Paracetamol and Ibuprofen are not physically addictive, but they can become psychologically addictive. Despite the common perception of these drugs as harmless, abusing them in large quantities can lead to severe liver damage and even liver failure.

Other Types

he most common over the counter painkillers in many parts of the world are Paracetamol, Ibuprofen and Aspirin. These are manufactured by many different pharmaceutical companies and sold under a variety of brand names.

Trade names for Paracetamol include Panadol, Tylenol, Vitamol, Doliprane, Calpol and Benuron. It is also sold as a generic unbranded medicine.

Ibuprofen brand names include Anadin, Advil, Nurofen, Rimafen, Brufen and many others.

Brand names for Aspirin include Anacin, Excedrin, Disprin and Aspro clear. Ibuprofen and Aspirin are also sold generically.

Some stronger over the counter painkillers also contain a relatively small amount of opiate-based painkillers, usually codeine. Co-codamol for example is a mixture of Codeine and Paracetamol, offered in branded medications such as Solpadine and Panadeine. Nurofen Plus contains Ibuprofen and Codeine.

Common prescription painkillers include and Morphine, Codeine, Oxycodone, Fentanyl, and are available under a wide variety of brand names.

The medical name for a painkiller is an analgesic.

Major Effects

Painkillers are invaluable in the lives of many people, as they can be used for short term pain relief and are easily available over the shop counter or, in the case of stronger medications, via a doctor’s prescription.

However, the ease with which they are available and the tendency for people to self medicate leaves painkillers open for abuse, and many people get unwittingly hooked on the drugs while taking them to relieve pain.

Though most over the counter (OTC) painkillers are not physically addictive, they can form a psychological habit, particularly when used to medicate persistent pain. In many cases the OTC drug is not strong enough or well suited to control and relieve the specific pain experienced, so the person continually takes larger quantities and more frequent doses in response to continued pain.

Even addiction to painkillers such as Paracetamol can be harmful, as an accidental overdose can occur. Overuse of the drugs can also lead to serious irreversible liver damage. Recent scientific research has shown that even just a few extra pills than recommended taken everyday can lead to a ‘staggered’ overdose, due to the slow build up of chemicals. In many cases an overdose can have dire consequences, and is potentially fatal.

Addiction to prescription painkillers is also dangerous, and these have a greater potential for abuse. These are often opiate-based (derived from the opium poppy) and like illicit narcotics such as Heroin, they can result in very strong physical and psychological dependencies.

In addition to their prescription use for pain relief, some painkillers may be abused in conjunction with illicit drugs. In these instances, and use with legal drugs such as alcohol, the risk of overdose and other complications is increased substantially.

Production countries

There are many different types of painkillers which are available today, and virtually all of these are manufactured legally by multiple pharmaceutical companies in locations across the globe.

Some painkillers are sold without restriction over the counter at convenience shops, while others which are slightly stronger may only be sold by licensed pharmacies. Prescription painkillers may only be sold legally by a licensed pharmacy to an individual who has been prescribed them by a doctor or other qualified medical professional.

In instances where a person taking prescription painkillers is suspected to be addicted, their doctor may withdraw the prescription and if necessary prescribe an alternative. In these cases the individual may seek out the same or similar painkillers on the black market to maintain their habit and avoid withdrawal symptoms.

Black market painkillers can come from a number of sources. There have been incidents reported where unscrupulous pharmacy workers have sold prescription painkillers ‘on the side’ to addicts or dealers. Doctors may also supply prescriptions for painkillers in exchange for payment.

In other circumstances, supplies of the drug are stolen or diverted from hospitals and pharmacies that hold stocks of the drugs, or from the suppliers or delivery depots involved in distribution.

Because of their chemical similarities with illegal narcotics such as Heroin, opiate-based painkillers are often sought out for illicit recreational use and abuse, either as a substitute or to enhance the effects of the drugs. They are also sometimes used to counteract the negative effects of stimulant ‘comedown’, further fuelling black market demand.

Facts and stats

Facts

  • There are many different types and brands of painkillers. Some, like Paracetamol, Aspirin and Ibuprofen, are available over the counter at any shop. Others are only available with a doctor’s prescription.
  • Many painkillers work by inhibiting the production of chemicals responsible for communicating pain and injury to the brain.
  • Some painkillers are also used to prevent or reduce inflammation.
  • Even over the counter painkillers can be habit forming. Though they do not usually contain chemicals which are physically addictive, a psychological addiction can occur.
  • Prescription painkillers which contain opiates are highly addictive both physically and psychologically. Tolerance can develop quickly, and withdrawal effects can be severe.
  • Some over the counter painkillers contain lower doses of opiate painkillers, such as Codeine. Though the dose amount is substantially lower than is found in prescription painkillers, addiction can develop when taken for longer and in higher doses than is recommended on the packaging.
  • Paracetamol abuse can lead to serious liver damage and even liver failure. Overdose can be fatal.
  • Ibuprofen overdose can result in abdominal bleeding, breathing difficulties, seizures, and, when in particularly large quantities, coma or even death. Long term heavy use of Aspirin and Ibuprofen can result in serious kidney damage.
  • In many cases, people take painkillers for legitimate reasons but then continue once the pain has subsided, resulting in an addiction.
  • Strong prescription painkillers can also generate feelings of euphoria and detachment, in common with illegal drugs which are abused.

Stats

  • A US survey on drug abuse found that after Marijuana, over the counter drugs and prescription drugs were the most commonly abused substances. The statistics revealed that 5.1 million people were abusing painkillers in 2010.
  • Approximately 1 in 12 US high school ‘seniors’ admitted to abusing Vicodin (a mix of Paracetamol and Hydrocodone), while 5% said they had abused Oxycodone, a narcotic painkiller.
  • The same survey found that 70% of 12th graders (17-18 year olds) who had abused prescription only opiate-based pain killers said they were given them by someone they know.
  • Another US survey, in 2002, found that 3.2% of young people had abused prescription painkillers in the previous month.
  • It has been estimated that 20% of people in the US use painkillers too often.
  • According to a government report in 2009, an estimated 30,000 people in the UK have suffered addictions to over the counter painkillers containing Codeine. The report also stated that such medicines can form the basis of an addiction after as little as three days use.
  • In Scotland, from 1994 to 2000 there were 644 poisoning deaths in which Paracetamol was involved.
  • In the UK in 1998, the number of OTC painkiller tablets allowed to be sold in a pack was reduced from 100 to 32 in pharmacies, and from 24 to 16 in shops. Restrictions were also placed on the number of packs that could be sold to an individual.
  • According to a study by researchers at Oxford University, these changes resulted in a 22% drop in Paracetamol-related suicides in the year following the changes. Over four years, treatment for Paracetamol induced liver damage and liver failures dropped by 30%. Substantial overdoses of Paracetamol fell by 20% in the second year, while Aspirin overdoses were reduced by 39% in the third year after the changes.

Addiction Signs

The exact nature and signs of addiction and abuse of painkillers will vary depending on the specific OTC or prescription drug being abused, but there are some common signs of addiction which may be visible.

In some cases painkiller addiction begins with a legitimate use for the drug which then grows to constitute drug abuse and dependence. Particularly in the case of Opiate-based painkillers, tolerance can develop, so the individual has to take more and more of more of the drug to achieve the desired effect. This may be accompanied by withdrawal symptoms when they are not taking the drug, such as mood swings and other emotional substances, anxiety and irritation.

In cases where the pain has subsided but the person has become addicted, they may continue to assert that they are still experiencing pain and so need the medication, despite evidence to the contrary. When confronted about their use of the drug they may become defensive and even angry.

People who have developed a dependency on either OTC or prescription painkillers may seem uninterested in any method of pain relief that does not involve taking further medication. They may also rely on deception or turn to black market sources to acquire more of the drug, even if this is uncharacteristic of them.

While addiction to over the counter painkillers is less common, because they are far easier to obtain than prescription drugs, the addiction may continue unnoticed far more easily. Taking more than the recommended dose of any OTC drug, having a substantial ‘stockpile’ of them or regularly buying more are all signs of a potentially harmful addiction.

Treatments

The types of treatments which are suitable for painkiller addiction depend largely on which substance the individual is abusing, as well as the length and the severity of their habit.

In the case of sustained Paracetamol abuse, the first step should always be to have a thorough examination by a doctor. Even if there are few visible side effects from taking the medication, liver damage may already have occurred or be occurring, so a prompt and accurate diagnosis is required to ascertain whether any treatment for liver damage or other internal problems is required. Similarly, heavy use of Ibuprofen and other OTC painkillers can result in abdominal bleeding, and this should be checked out by a medical professional.

In some instances, particularly with OTC painkillers, the addiction is primarily psychological rather than physical. Unlike the opiate based prescription painkillers, medications like Paracetamol have few withdrawal effects.

However, constant overuse of these painkillers can actually result in headaches, known as ‘rebound headaches’, creating a vicious cycle in which the individual takes more of the medication to relieve the headache. They may also begin to take more in attempt to relieve these headaches. Combined with any tolerance effects of the drug, the quantities taken can increase exponentially, leading to toxicity build-ups and a higher risk of harmful side effects.

Opiate painkillers, such as codeine (which may be found in small doses in some OTC painkilling remedies) are physically addictive because they create a chemical dependency in the individual.

Over time, the body comes to rely on the drug to carry out the same role as chemicals that are normally produced in the body, while at the same time reducing its own production of these natural substances. This leads to a range of severe withdrawal effects upon cessation of the drug including depression, anxiety, palpitations and insomnia. Drugs such as Morphine and Codeine can also produce psychological dependency in the same way that illegal opiates like Heroin can.

In some cases, addiction to opiate-based painkillers is best dealt with in a specialist rehabilitation centre or in hospital. As well as prescribing medications to lessen the withdrawal effects, and monitoring detox progress closely, these clinics can also offer expert psychological and emotional help to deal with the addiction and its aftermath.

In cases of OTC painkiller addiction, inpatient treatment is not as likely to be needed, however support may be required to help the individual break their addiction. Therapies such as cognitive behavioural therapy (CBT) have proved to be highly effective in the treatment of a wide range of addictions. In this capacity, CBT works by addressing the personal causes and triggers of drug-seeking behaviour and addictive actions, while helping the individual to develop healthier replacement behaviours.

Simple talking therapies like counselling can also be useful for helping the addict to identify and deal with the reasons for their addiction. If they are still experiencing ongoing pain for which they were legitimately taking painkillers then alternative methods of pain relief and safer medications may be discussed.