“40”

“40”

One man’s honest, frank story of addiction to Nerofen pain killers, the depths it brought him and the courage he required to overcome it…A powerful read.  Are we discussing enough the problem of addiction to Pain Killers?

“40”. As soon as I said it, I could instantly feel my lip begin to quiver and I began that futile fight of trying to hold in an emotional outburst, that I knew I was coming out whether I liked it or not. I am not exactly sure why that outburst came, because in my mind I envisioned it being much more rational, even clinical. But alas, sitting in that hospital bed, in front of a nurse I didn’t know, I began to cry like a newborn. Like the tower of Babel crashing down, my tower of delusion crumbled on that hospital bed.

“40” was an answer to the question the nurse asked me. That question? “How many Nurofen Plus tablets are you taking a day?”. You see, for the longest time I had hidden a vicious addiction to the over the counter painkiller. So how did this confession come about? In April 2015 I was hospitalised with a pretty intense kidney infection. And whilst in the hospital, I had inadvertently found out, via a blood test, that I had a bleeding stomach ulcer that had come very close to killing me.

Straight away, I knew what had caused it. I knew it was the Nurofen Plus. I had had a stomach ulcer for quite some time because of my addiction to the pills, I just never knew how bad the situation was. Especially because the pain from the ulcer had subsided in the months leading up to my hospitalization. Little did I know however, the pain had subsided because the ulcer was bleeding quite badly, and the blood had formed a “lining” of sorts in my stomach that blocked the irritation caused by the excess acid.

Before I go on, at this stage I think I should outline what exactly is Nurofen Plus and why it can be so dangerous. Nurofen Plus is an over the counter painkiller with two main ingredients; ibuprofen and codeine. Ibuprofen is a simple anti inflammatory. But codeine belongs to a class of drug called Opiates. The opiate family of drugs all originate from the poppy and include other “interesting” drugs such as Heroin and Oxycodone. Opiates work by blocking pain receptors in the brain and inducing a warm calming feeling. And it is that warm calming feeling that people become addicted to. And while codeine is significantly less powerful than its cousins, I can assure you it is plenty addictive. Which is a problem in itself, because you will simply take more and more to get the desired effect. And when I say more, I mean 10-15 times higher than the daily recommended dose. 

So how did I get addicted in the first place? Like most people, it started with legitimate pain. After a workplace accident a few years back I have suffered with sciatica. Sciatica is one of those ailments that can sometimes cause no pain, and sometimes cause significant pain that can be debilitating. So to combat that pain, I started to take Nurofen Plus, as directed. But another problem with opiates like codeine is that your body builds up a tolerance to the effects quite quickly. So in order to get the same benefits you need to take more and more. So when I started out taking only 6 a day (which is the recommended dose), it soon started to increase. I’d start waiting and taking all 6 together to maximise the effect. Then I’d take an extra 2, then 4 and so on.

Then I discovered that at higher doses (for me starting when I’d take 12-14 at a time), not only did it block pain, but I would get that warm fuzzy feeling that opiates deliver. But, again, after a while 12-14 pills at a time stopped delivering that kick as my body started to tolerate that dose. So what does any aspiring addict do? I started taking exponentially more. I went from 12 to 18, to 24, to 36, 48  at a time. And I do mean at a time. I would take 4 handfuls of 12 washed down with water. Then I’d just wait for that to kick in and I would be in my own little opiate induced world. Sometimes, even 48 wouldn’t be enough for me. On those days, I may take another 12 on top, bringing it up to 60 pills at a time. Other times I would buy Solpadeine (which also contains codeine) solubles, dissolve 8-10 in a pint glass and use that to wash down the 48-60 pills of Nurofen plus.

That was my daily consumption from when I went to university in 2010 until I was hospitalised in 2015. And to be honest, for a long time, things were going good. The pills helped with the stress of college, and I really loved the sensation. And I mean I loved it. As someone who has struggled with anxiety and OCD all of my adult life, to have a chemical solution felt amazing. But it does not last forever.

Often people talk about opiates “wrapping you up in a warm blanket”, and they really do. The problem is you feel so good you ignore the disaster they turn the rest of your life into. I have had friends addicted to alcohol and illegal drugs. And despite the tragedy their lives became, they had full self-awareness of that tragedy. People who are drunk all the time, know its not normal, same with people addicted to cocaine. But with opiates like codeine, they make you actively want to change what normal is. It becomes your best friend, your family, your life. And you will make room for it regardless of how it affects you or others.

By my last year in college, I was a functional mess. I was thankfully still able to graduate with a 2:1, but my life was a mere distraction to my full time occupation of pill seeking. Because you can only buy one pack at a time in a pharmacy, and because local pharmacies became suspicious, I spent every single day on expeditions to various pharmacies around Dublin buying Nurofen Plus. Every single morning I got up, I knew I had to find at least two pharmacies that day to get my fix. Every day I’d be taking the Luas to Dundrum or Tallaght, or I’d be taking the bus to Ballyfermot or Crumlin or walking for literal miles to find pharmacies I hadn’t gone to recently.

As you can imagine, the effect it had on my social life was profound. I became, for a lack of a better term, a selfish prick. And to this day I struggle with the guilt of what I put my family and friends through. When I couldn’t get to a pharmacy because I was in withdrawal or too embarrassed to face the same pharmacist again for like the 100th time, I’d manipulate and harangue my father to go to the pharmacy for me. I knew if I kept at it, he would eventually go for me, despite the fact he has arthritis in both knees. Believe me, I feel so bad now for doing it, but at the time I just wanted the pills, and I didn’t care.

I have always been an introvert and tend not to willing to make many new friends, so the friends I have are like family to me. They have always stood by me (and continue to, thankfully), and I just treated them like crap during my addiction. From never keeping appointments, to reacting to their concern with derision and lies, to just being an antisocial, self absorbed, detached, narcissistic, nihilistic, temporary psychopath. And I don’t use the word psychopath loosely. I mean I took on psychopathic characteristics. I completely lacked empathy for others, was willing to use people I considered my friends, and I never did anything to be a friend for them either. I also got a perverse pleasure in being able to con doctors and pharmacists into getting more pills. And because I became so lacking in empathy for others (especially others I knew but didn’t consider friends), I’d become laser focused on their weaknesses and exploit those weaknesses for my own amusement, because I was in such emotional chaos at the time. Such was my behavioural changes at the time, one of my best friends told me recently that he had just assumed I was going to die. Not that he wanted that at all, he was deeply upset by it, and had done so much to help me, but he just considered it a matter of time. Looking back at that time now, it breaks my heart how nasty I was, and I’m not ever sure I can repay my friends and family, or apologise. All I can do is state how grateful I am that they all stood by me.

Yet, as bad as my social life was by 2015, it had nothing on my health. The continued use of Nurofen Plus caused me to get a very painful stomach ulcer(because of the ibuprofen), that bled a few times. Nurofen Plus also decimates Iron levels in your blood, so I was always tired and very pale. Then there was the kidney infections, not to mention terrible skin, and teeth erosion caused by the excess stomach acid. It got to a stage that eating became such a painful nightmare that I would often only eat soft foods such as creamed rice and mash potatoes. Yet the pain never really subsided, unless (ironically) I had taken Nurofen Plus, or as previously mentioned, the internal bleeding created an artificial lining.

Of course, I was completely in denial about this, until I was hospitalised. The doctors knew something was causing this bleeding ulcer and wanted to know what. Plus, after two days in hospital I was in withdrawal, so hence my teary eyed confession to the nurse on the third night. (and such was the shame of admitting, I significantly minimized the number I was taking, by saying I was only taking 40 a day) She was so helpful and understanding, and she helped me be able to explain it to the doctors, who were also very understanding. I needed an endoscopic cauterization of the ulcer, a blood transfusion and long term iron supplementation. I got off the codeine by via medically supervised taper was and also given an appointment with a pain specialist for my sciatica. I had a new outlook, and attitude. I left the hospital a week later promising myself I would never take Nurofen Plus again.

Two days later, I was back taking the Nurofen Plus. I managed to keep it relatively under control for about 5 months and was thankfully able to be best man at my friends wedding in Poland. (Truth be told, had I not been hospitalized when I was, I would have been in no state to even get on a plane.) But by the end of 2015 I was back taking about 48 a day.

Then in the August of 2016 my uncle had a massive heart attack and a stroke. He was in a vegetative state until he died in early 2017. My family is very small, so I was very close to my uncle. And when he died, shit got real, as the kids say. I just stopped caring at all. I was taking 24-30 tablets in the morning when I woke up, then another 48 in the afternoon. Sometimes more. Actually often more. I remember saying to myself one day during this period; “Tony, you are going to die if you keep this up” and almost immediately afterwards saying “So what, everyone would be better off without me”. It’s not that I was suicidal, it was that I had become content with the concept of my own demise.

And I had good reason to think I was going to die. My ulcer returned, I stopped taking the iron supplements because they hurt my stomach when mixed with the Nurofen, (as if I was going to stop taking the Nurofen), and a deathly pallor again hung over my face. I was getting out of breath walking to the shop, quite simply, I was playing with the house’s money, and I did not care. So, what then was it that finally woke me up?

Well, one day I was watching Youtube and I came across the lectures of famed Canadian psychologist Jordan Peterson, and I became enthralled. He was speaking about how the quest for meaning in life begins with truth. Being true with yourself. Recognising that we are all deeply flawed people, that life has a great deal of suffering attached. Yet people still go on. They don’t “find” meaning, they forge meaning from the chaos of life by standing up straight, taking responsibility for themselves, and trying to make society better by being a better individual. For the first time, probably ever, I was not overwhelmed by the concept of life. It started to make sense. As I watched more and more of his videos, I thought to myself; “Ok, instead of just giving in to this addiction, I owe it to myself to try at life”.

So, at the end of July 2017 I just stopped taking the pills. I was expecting such a sudden cessation to instigate a fairly nasty withdrawal. But I knew it was something that needed to be done, because I finally wanted a chance at life. And to my surprise, it wasn’t that bad. Don’t get me wrong, it wasn’t a holiday in Benidorm, but it was certainly manageable. I think people often build up the severity of withdrawal in their own minds (which I firmly believe is one of the last insidious tricks opiates play to prevent people from stopping). After about 3 days, I felt a lot better. Eventually the ulcer subsided and the tiredness and pallor associated with iron deficiency left me when I resumed taking the supplements. By August I was ready to “have a go at life again”. I started spending time with my friends again, I built a much better relationship with my father, and found a job (this job) that again gave me a sense of purpose.

It became clear that much of the “depression” I was feeling was actually caused by the codeine. It turns out that there is science behind the connection between depression and opiates. There is a chemical neurotransmitter in the brain called dopamine. That chemical is responsible for helping you enjoy life,by identifying positive things in the world that make life better. For example, when you eat a nice meal, a small amount of dopamine is released, or when you achieve something after really trying (thus giving a chemical foundation to the concept of “meaning”)When you abuse opiates like codeine, they cause a massive release of dopamine (hence the warm fuzzy feeling). But that means for every other aspect of life the dopamine is totally depleted. So the only thing you can “enjoy” in life is ever increasing consumption of the opiates.

Thankfully now, the balance is restored, I no longer seek that massive wave of dopamine, instead finding enjoyment in other things as previously mentioned. But I know codeine, like all opiates is never something you truly “forget”, so I have taken steps to prevent further relapses in the future. I take every conservative approach to maintaining good back health from stretching, to walking, to warm baths. I also began to see a psychologist so as to attain the tools required to deal with anxiety is a productive way, as opposed to just seeking to overwhelm my negative emotion with chemical solutions. It’s been a challenging road, but for the last 8 or so months things have been going very well for me and I will do everything in my power to continue to take positive steps.

I’m not sure why I felt the need to write this article, but I did. On one level, it was my opportunity gain closure on that part of my life. I could never have dreamed of putting all this information out there if I was still actively taking the pills. On another level, it is my opportunity to express gratitude to the people in my life who stood with me to the end gate of this chapter in my life, when I needed them most. But I think most importantly, I want this article to be a warning. A warning not to be seduced by the legality, ease of access, and seeming effectiveness of painkillers like Nurofen Plus. It is like taking a luxury limo straight to hell. The ride is enjoyable, but the destination is not where anyone wants to be.

Right now, addiction to otc painkillers doesn’t get the attention it deserves, but it is a ticking time-bomb. It is estimated that in the UK and Ireland, tens of thousands of people are addicted to Nurofen Plus and Solpadeine. Of course within that population some people have less severe addictions than others. Regardless, so long as people remain addicted, their likelihood of getting serious health problems remains very high, not to mention the effect they can have on your social life and mental health. If you think you are struggling with such an addiction, talk to someone about it. Even though not much is known about such addiction, my experience has been that doctors and pharmacists are really helpful and non judgemental. There are also lots of addiction services in the community more than willing to help, if you think that is the best approach for you. Even just telling a friend or family member can be an important first step.  Can it be embarrassing to share? Absolutely. But if you don’t share, and don’t face up to it, you will probably die, quite miserably too.