Any information on detox/withdrawal from over the counter neurofen plus addiction? (Ibruprofen and codine)
encountered someone who has been using 24+ tablets a day for about five years and dependant.
I know this is fairly low levels of codine so whats the coup with stopping?

could we titrate to a low dose of subutex/methadone or switch to a short course of diazipan?

This is only the second time someone has presented with this and the last person wasn't an issue because he collapsed with a perforated stomach/digestive system and never came back

any info or advice.

Cliff,
I have done quite a lot of work on a self-help group on an internet forum which supports people with this problem. A lot of people have managed to stop with the support on there.
The link is www.codeinefree.me.uk they could register and have a look and see if it is of use to them.
There is also another site called overcount and a Nurse who has had similar problems himself does personal withdrawal plans andhe claims to have goos success with this.
Having said this if it was one of my patients i'd put them on Subutex due to the high amounts of other gut-rotting stuff that they have been taking and to prevent any further use of this stuff.
Hope that helps

Simon

Cliff,
Did the other person not come back because they died?

Cliff,
You say that this is "fairly low levels of codeine" - but each Nurofen Plus contains the maximum amount of codeine which can legally be sold over the counter without prescription, i.e. 12.8mg per tablet (along with ibuprofen 200mg). At a daily dose of 24 tablets, this would give a total of 307mg, which perhaps is not such a "low level".
The potential risks of addiction to the codeine in OTC medicines is becoming better recognised, and is now mentioned in the new warnings on pack, which are included in the latest packs coming on to the market. At the same time, the maximum pack size for OTC codeine is being restricted to 32 tablets.
These changes have been agreed bewteen the manufacturers and the MHRA as a result of increasing awareness of the problem.
Lack of recognition of the potential for addiction/dependence has occurred largely because people can't believe that any OTC medicine may have side effects, and this has been bolstered by the lack of data on the problem.
All cases of addiction to licensed medicines should be reported to the MHRA via the Yellow Card system; have you reported this case yet? Without the factual data, the size of the problem will remain poorly understood.

At present, the lack of recognition and official awareness of the problem means that there is little formal provision to help people with this problem. I would entirely endorse Simon's comments about www.codeinefree.me.uk as one of the few places where codeine addicts can "meet" and gain strength to beat their addiction.
Lance

I don't know what happened to them Simon

Thanks for the heads up.

It turns out they were actually doing 48 tabs a day or 614.4 of codine. I ment low level in terms of the type we are more used to at a drug project where we see people taking grams of Heroin IV, its subjective though you're right.

I have seen a couple of clients with similar Nurofen Plus addiction problems and have prescribed Subutex with some success.

I suspect that it is a more common problem than we realise, and by shopping around users can accumulate very large quantities of medication.

In fact if you search on the topic on the internet you will encounter the mythology that the tablets can be split down the middle to remove the ibuprofen 'half'. Whilst this may have been the case at one time (have seen reports of this from Australia, but was not aware of this when I worked over there). To my knowledge the UK tablets have always been mixed and not in two parts.

Regards,

Ian Guinan

This message has been edited. Last edited by: IanGuinan,

Dear Ian,
With the amounts of people we have posting on the codeinefree site we can definitely see it is not just a handful of people.
I am aware of some people who have seemingly been under-dosed with an over the counter problem I guess most is due to people not being able to equate doses.

I have a client who was taking similar levels of codine (20+ co-codamol tablets a day). She has recently completed a home detox. She did this without being prescribed subutex of methadone but recieved symptamtic relief from our home detox nurse who visited her daily.

My client is now prescribed naltrexone through her GP.

If you would like further details please email me.

I think it's such an unrecognised problem and as Lance has previously mentionned we need to be filling in yellow cards.
I remember as a Student Nurse a few years ago err ok more than a few years ago, seeing people die from overdoses that for some people who are addicted to this stuff take on a daily basis.
We have done detox with lofexidine for some patients addicted to over the counter stuff but some are using so much and really cannot stop without some substitute.

I would say ultimately your best conversion would be from NF+ to dihydrocodiene , if that failed then look at subutex or methadone. There would be absolutely no reason to consider diazepam, unless they were having hyper tension rebounds from abrupt withdrawal symptoms.

Many people go through the time consuming process of washing out the Codiene from the Paracetemol or Ibuprephen and then many people say, they become as habituated to the anti inflammatories as they do the pain killer.
I been through this one myself, which progressed to a nasty heroin habit. The reason for popping the pills daily are easy to justify until we lose why we took them in the first place as, the pain of trying to digest the drug becomes the primary purpose for continued use of the OTC's.
Is it justifiable for the pharmacy to continue selling box after box to daily purchasers of the drug. In saying that; I would alternate about 5 different chemists, so each pharmacy would develop the assumption i was taking a box a week.

The flushes are horrendous and severally underestimated or recognised by support services.





I

Here is an article in today's Daily Mail I was asked for a few quotes.
http://www.dailymail.co.uk/pages/live/articles/health/h...c=GOOD%20HEALTH&ct=5

Hi Simon
really good to see this being brought to the public's attention in such a sensitive (for a tabloid!) way. It reminds me of old benzo campaigns. Which brings me to the only beef I have with the article - that of perpetuating the myth that temazepam is an antidepressant!

The 'learned symptom'-reward cycle with non-opioid analgesics is new to me but makes sense - very interesting! Thanks

I did point that out about Temazepam but it was too late. I too was very interested about the non-opioids and going to get in touch with the chap in the article. I wonder if the only safe thing to do is chew willow bark ?
We had over a 1000 hits to the site yesterday so it's definitely raising awareness. I think the bit about me now wanting these made POM's was cut and the fact that i'm sure most people can take them without any problem.

Interesting that the Robbie Williams in rehab for addiction to prescription drugs is all over the papers today. Will probably raise awareness about this often forgotten client group.

I was not aware of the requirement to fill out yellow cards in this group of patients - so now have a few cards to fill in!
Have been involved in substitute prescribing with quite a number of OTC dependent patients - Gee's linctus, codeine linctus and nurofen plus. The best outcomes have been with titrating across to Subutex and then reducing - along with all the normal non prescribing interventions.
The "cold turkey" inpatient treatment mentioned in the newspaper article seems a bit "heavy"?
David

I was asked to talk about this (Robbie Williams, OTC meds)on BBC radio Wales yesterday, luckily I didn't get the message until after the programme had gone out.

Jim,
Funny that the Codeine-free site was asked by a red top to do an interview about that too. It wasn't thought appropriate.

About 4 years ago, I noticed one of my collegues popping a few NF+ 2 a day. One day I asked her for a few, about 3 months later I was popping 20 to 30 a day. After about a year I had about 5 chemists I was alternating to get my boxs of NF+. To get a proper hit I would wash the little buggers down and then strain the codiene through. Not long after I got bored of the side effects of the non essential coctails included in my little legal codiene treats and headed for a full blown heroin and methadone habit. I think alot of people go through hell with NF+. Thats not to say i think they should be restricted, on the contrary I think unadulterated codiene pills should be readily available to save peoples livers from all the crap we have to endure when seeking a proper pain killer... Call me dumb or dumber

Banksy,
Difficult one isn't it altering a preparation to reduce the harm caused by some people abusing an Over the counter drug. It would almost endorse it and i'm not sure that if people took ever increasing doses of codeine that would solve this problem.I think it may well be better to raise awareness and prescribe drugs that are available to treat opiate addiction. I'm sure the majority of people take over the counter drugs sensibly and I cannot see any case for making them prescription only.

Sorry, we had to delete the last post as it contravened forum rules. Please can members bear in mind that is is not a forum for people to receive medical advice. In this particular instance probably the best forum to visit would be http://www.codeinefree.me.uk/