Are you an accidental, over the counter opiate addict?
Popping a pill or two on a daily basis can end up leading down a slippery slope, writes Andrea Smith
I preferred the soluble kind; they would effervesce and quickly give me a safe, fizzy feeling
Centre stage: Stefanie Preissner author and star of the play, 'Solpadeine Is My Boyfriend', has confronted her problems with the painkiller and dramatised them in her successful one-woman showWHEN she told me that lots of her work colleagues take antihistamines at night to help them sleep, my friend didn't bat an eyelid. And why would she, when she takes them too? Another woman I know pops tablets designed to relieve pain on a daily basis. There's nothing physically wrong with her, but they keep her calm when the stresses of juggling her part-time job in sales and three children threaten to overwhelm her.
They're just OTC medications, so no harm, these people reason – it's not like they're shooting up in the street, or buying regular lines of cocaine, is it? Wrong!
Every year in Ireland, a surprising number of people are admitted to hospital for OTC opiate addiction, and despite efforts to create awareness in recent years, it remains one of society's hidden little secrets. In addition, between 1998 and 2007, codeine was implicated in the cause of 90 fatal poisonings in Ireland, either alone or in conjunction with another drug.
Popping OTC pills is a scenario that comes as no surprise to playwright and actor, Stefanie Preissner (25) author of the play, 'Solpadeine Is My Boyfriend'. She has first-hand experience of being in thrall to the intoxicating effects of OTC pain relievers, as for several years, she used them to assuage her emotional pain.
"Looking back, I wasn't dealing too well with stress," she says, revealing that moving from her home in Cork to study at the Gaiety School of Acting in Dublin in 2008 was a shock to her system.
"The course was very intense, and I was surrounded by people who were my friends, but with whom I would ultimately be competing for roles. I was really struggling at that time, and now I see that what was actually happening was that I was entering a major depressive episode."
Prior to this, Stefanie had only taken OTC painkillers for headaches, hangovers and menstrual pain, but quickly noticed that in tandem with relieving her physical symptoms, they also had a positive effect on her emotional well-being.
She wouldn't have been alone, as in 2007, more than 100 Irish pharmacists were surveyed, and 94pc believed an average of four of their customers per day were addicted to the codeine-based products they were trying to purchase.
"The tablets brought about an overwhelming sense of calm in me," she says. "I'd wake up groggy in the mornings, and would take them to make the day a little easier. I didn't think there was anything wrong with it, because if you were in a room with 10 people and asked if anyone had any painkillers, at least three people would produce them.
"At one point, I was taking six to eightper day. I preferred the soluble kind. They would effervesce, and quickly give me a safe, fizzy feeling."
The theatrical Stefanie was born in Munich to a German dad and Dublin mother, but her parents separated early on. She returned to Ireland with her mum Bernie when she was two, and they settled in Mallow.
Having completed Spanish and drama and theatre studies at UCC, she moved to Dublin at 21 to embark on the Gaiety course, while working part-time at a youth theatre in Cork.
Once her course ended, the already fragile young woman embarked on the actor's reality of waiting on the phone to ring. With nothing else to do, she went to a café and started to write her first play, 'Our Father', which ended up doing really well. It enjoyed a sell-out run in Dublin and a national tour, but even as it was soaring, its writer was beginning to crash.
Once its run at the Dublin Fringe Festival came to an end, she spent four months at home, "with the duvet over myself."
"While the play was running, I kept the smile on, but I didn't recognise the darkness coming in," she says.
Stefanie was diagnosed with depression in 2011, but didn't take the prescribed anti-depressants until a few months later, when her beloved grandfather died. It took a few weeks for their effect to kick in, but once it did, it gave her the space to see what she was doing to herself with her abuse of Solpadeine.
She researched it, and realised that it contains codeine, a short-acting opium-based drug that belongs to the same family as heroin and morphine.
International research has shown that while codeine-based analgesics are the number one medication that people abuse, products containing dextromethorphan (cough suppressant), diphenhydramine (anti-histamine) and pseudoephedrine (decongestant) have also been identified as ones that are misused.
Laxatives are another high-risk product, as they are attractive to people with eating disorders.
In an effort to tackle the problem, The Pharmaceutical Society of Ireland published guidelines in May 2010 on the safe dispensing of non-prescription products containing codeine.
This means that they are now sold under the direct personal supervision of the pharmacist, who is required to assess the appropriateness of the product for the customer.
Needless to say, the new rules didn't go down well with a lot of people.
"There was a Facebook group set up, where people would advise each other of the best places to buy the medication without too many questions," says Stefanie. "Users would post things like, "The blonde-haired woman who works Wednesdays and Thursdays in X pharmacy gave them to me no problem."
While doing well on the anti-depressants, Stefanie continued to write, although her personal circumstances were difficult. Between relationship problems and the fact that her rented house burned down around Easter 2012 due to an electrical fault. Thankfully she wasn't at home and her housemates escaped safely.
However, the writer lost everything she owned in the fire, which devastated her, and she and her housemate went to live with her grandmother in Castleknock for eight weeks.
"I was so grateful that we survived, but after that, I had to cope with the aftermath," she says. "I had nothing to wear, no records or paperwork, and all of my personal things were gone."
While struggling with her personal issues, the funny and intelligent girl had a new idea for a one-woman play, written and performed by herself, and based on her newfound knowledge of OTC medication misuse.
Thus 'Solpadeine is My Boyfriend' was born, and while the soluble painkiller taken by the principal character is fizzing to a liquid state in a glass of water, her romantic relationship and mental health are also dissolving.
Stefanie has put a lot of herself into the play, and says that the difficulties she encountered have informed and enlightened her work. Once it was adapted for radio, with the help of director Gina Moxley, she was surprised to find a universal reaction to its themes. The play now boasts being RTE's most downloaded podcast to date.
"People have been contacting me from all over the world," says Stefanie, incredulously. "I didn't know that it was going to be as big as it was. Now that I've seen the response to the play, I realise that so many people have this problem."
"It's a huge problem worldwide," agrees Dublin pharmacist, Mary O'Boyle. "Codeine is an opioid that is highly-addictive, so while it is fine for short-term use, we are seeing a huge number of people who are addicted and don't realise it.
"People often think that prescription and OTC medication safer than illegal ones, but that's only true when they are taken exactly as prescribed and recommended by the manufacturer, and for the purpose intended. There have been great strides made in recent years, but despite the vigilance of pharmacists, some people go to great lengths to buy codeine-based medication, even travelling to different shops and pharmacies or buying online.
'You can easily spot them, as they will usually ask for the product by name, and can get very defensive when asked questions. And, of course, continued use induces physical and psychological dependence, which means that when people stop taking it they can experience withdrawal symptoms that include anxiety, headaches, nausea and flu-like symptoms. It's a vicious cycle."
Stefanie addressed her own addiction by weaning herself off gradually, and now only takes the medication for genuine physical pain. It's an important distinction, she says, because many people who think they have a pain in their head actually have one in their heart.
"Codeine targets the pain receptors in your brain and numbs them, but when you're overdosing on it, you're using it to numb the wrong kind of pain, and that one won't go away," she says. "I'm a real advocate of speaking out on mental health issues, because you're not going to help people if you don't. There is such a stigma around depression, and now that I'm coming out the other side of things, I think it's important to talk about it."
Life is good for Stefanie these days, as her play is on a national tour and is in demand abroad, and she says that she is open to love, challenges and new adventures. Still young, she has learned how best to handle her problems, to avoid seeking solace in a glass of fizzing pain medication.
"My problem was more around anxiety than anything else," she says, "and these days I talk to my housemates or my therapist about my problems, which really helps. They have been amazing.
"Life is busy and hectic, and I have to take the time to stop and check on myself. I know the black feeling, and if it comes back, I won't try to be strong for as long again."
'Solpadeine Is My Boyfriend' travels to the Half Moon Theatre, Cork, May 14-18; Village Arts Centre, Kilworth, May 30; The Schoolyard Theatre, Charleville, May 31; Moby Dick Festival, Youghal, June 1; Aras Eanna, Inis Oirr, June 8; Project Arts Centre, Dublin, June 11-15; and Mermaid Arts Centre, Bray, June 22. solpadeineismyboyfriend.com