ADDICTED TO LEGAL SUBSTANCES

THE crumpled ?10 note clutched in her shaking hand, Andrea McKay shudders
as she feels the effect of the drugs beginning to wear off. She hands over
the money, rips the wrapping from the packet she is given and gulps down a
handful of the pills it contains.

McKay has driven more than a hundred miles, but not for a meeting with drug
pusher in a dingy squat. Instead, she has travelled halfway across Scotland
to make a purchase that is perfectly legal.

The 51-year-old business executive from Glasgow is one of a rising number
of Scots who are addicted to over-the-counter medicines. She has just
bought a packet of pain-killers at a high street chemist.

For most people, cough medicines and pain-killers provide welcome relief
from a cold or a bout of the flu. For others their use is more than
temporary and they find themselves hooked on the pills and liquids for years.

Once the addiction has taken hold, going without the medicines can lead to
a harrowing array of withdrawal symptoms, including depression, mood
swings, headaches, nausea and constipation. In some cases the addiction can
even kill by causing fatal epileptic seizures.

The medical consequences of becoming hooked are also significant. While
short-term effects are similar to those suffered during withdrawal, in
longer term addicts these can intensify into Chronic Daily Headache
Syndrome and chronic constipation, or even cause gastrointestinal disorders
and ulcerative colitis.

'I'm treating someone on 32 painkillers a day. He is addicted to the
opiates in them. The paracetamol is severely damaging his liver'

McKay, who has asked for her name to be changed, has previously only
revealed her addiction to her husband. She has been hooked on the
codeine-based pain-killer Cocodamol for three years.

"I can't buy the medicines where I live because my husband has begged our
local pharmacist not to sell them to me any more," explained McKay. "I
drive all over the country, to Ayr, Stranraer and Alloa, to get Cocodamol.
I can't tell my GP because he plays golf with my husband and it would just
be too embarrassing."

McKay's situation is unusual but not unique - she is just one of an
estimated 10,000 people in Scotland who are addicted to over-the-counter
medicines (OTCs). The problem has a low public profile compared to illegal
and prescription drug addictions but that is because most addicts are too
embarrassed to admit their problem. And yet the most recent survey on the
problem shows that Scotland is one of the worst affected areas in the whole
of the UK. Only London was found to have more addicts than Strathclyde,
principally due to the fact that it has a much larger population.

What is unusual about this trend is that, unlike stereotypical 'junkies'
who lose their job, family, and even home, OTC addicts are generally well
heeled, middle class people who enjoy positions of prestige in society.
Whilst drugs like heroin and cocaine are taken with full knowledge of the
risks entailed, the majority of people who become dependent on painkillers
and cough medicines do so initially to treat a genuine medical complaint.
They end up enjoying the benefits so much they find they cannot stop.

The social mapping of OTC addicts makes for interesting reading. Two thirds
of sufferers are women, mostly 20- or 30- something housewives whilst men
are generally 20 years older and enjoy executive or professional positions.
Having access to a car would also seem to be a crucial factor since most
addicts find themselves banned from their local pharmacist and have to
spend an average of ?1,250 a year travelling a total of 4004 miles to get
their fix.

David Grieve from Dumfries is an ex-addict, who at his worst was downing 90
bottles of cough mixture a week.

He set up Over-Count in 1994 to help fellow sufferers and he has his own
theory as to why Scotland has such a problem. "Part of it could be the
Scottish weather," he said, "which means that people are more vulnerable to
coughs and colds. People take them to help with pain but because they also
make them feel good they keep taking them. And because the tablets are not
on prescription, people don't realise how dangerous they can be."

The most commonly abused substances are those which are based on codeine,
which is an opiate. Some 10% of the medicines are converted to pure
morphine in the brain. Taking eight tablets of certain over-the-counter
pain-killers in one day means ingesting the same amount of morphine as a
heroin addict would absorb from shooting up once a day.

Dr Brian Kidd, a consultant psychiatrist with the Community Alcohol and
Drug Service in Forth Valley treats a number of OTC patients. He says this
form of addiction is in some ways more dangerous than more common cases of
drug abuse.

"The thing that people become addicted to is the codeine in the drugs, but
the problem with pain-killers is that they contain paracetamol as well. I'm
treating someone at the minute who is on 32 pain-killers a day. He is
addicted to opiates in the tablets but the paracetamol is severely damaging
his liver in a way that purer opiates wouldn't."

Kidd contends that part of the problem lies in society's attitude to drug
taking. Because of a general aversion to drug addicts, most are loathe to
admit they require similar treatment and few admit themselves to support
clinics without a considerable amount of encouragement. Advisable though it
may be to seek help from any qualified health practitioner, time
restrictions and a lack of understanding on the part of GPs means that a
trip to the local doctor is generally unfruitful. The solution, he says, is
in a better system of public information.

Some drugs groups believe that ambitions to raise public awareness have to
be kicked off by the pharmaceutical industry itself. Over the last 10 years
over 50 substances have been switched from prescription to over the counter
sales and at present not a single chemist medicine carries a warning of
dependency on the packet.

But the Proprietary Association of Great Britain, which represents UK
pharmaceutical manufacturers, claims printing a warning on the box would be
effectively informing and encouraging people to experiment with the
medicines in new ways.

The Committee for the Safety of Medicines says the current regulations on
over-the-counter medicines are sufficient and there is no need to tighten them.

Meanwhile, Alison Strath, chairwoman of the Royal Pharmaceutical Society in
Scotland, said that even if the figure of 10,000 sufferers in Scotland is
accurate, it represents a small proportion of the population to be classed
as a serious problem. "I don't think it is anywhere near the scale of
alcohol or cigarette addiction in this country. Even the misuse of
controlled drugs such as heroin is a bigger problem."

She is particularly concerned about the danger of scaring off those who
would use the products in a safe and beneficial manner and argues that most
people are capable of knowing how to take medication safely without
becoming addicted. The need to lighten the burden on GPs and the advantages
of self treatment are seen to outweigh any action in the name of so few.
She contends that the current practice whereby pharmacists are aware of the
'danger' medicines and are encouraged to look out for potential abusers is
effective enough to help those in trouble.

The British Medical Association on the other hand, recognises this to be a
real and worrying problem. The chairman of the BMA's Scottish council, Dr
John Garner, said he was disappointed with the lack of information that is
made available to both GPs and patients alike.

"Misuse of over-the-counter drugs is becoming more common," he said. "GPs
are aware that certain drugs can induce dependence and, along with their
colleagues in pharmacy, provide advice to patients regarding managing their
medication. However, we are disappointed in the progress made to date by
the government in providing information to GPs and patients to raise
awareness of this problem."

At the moment relatively few drug support services deal with OTC addicts in
Scotland and many GPs do not have an established method of detection or
treatment.

As with most addictions the dependencies are both physical and
psychological and addicts have to undergo a full detox programme in order
to become 'clean ' again. The Over-Count charity offers a three-stage
programme which involves noting down how many drugs you take in one day to
become aware of the extent of the problem, changing your way of life, and
gradually weaning yourself off the medication. Other drugs clinics
prescribe the sort of detox programme well known for the treatment of other
drug users.

Abruptly eliminating the drug from the system can be extremely dangerous. A
Solpadeine addict for example, could suffer from what is known as "Status
Epilepticus" which is similar to an epileptic fit except that once the fit
takes hold, it gives way immediately to another and another, and can result
in death.

For many of course, the best cure lies in prevention. Some people want to
see a system of registration with pharmacists whereby you can only obtain
certain medicines from one single pharmacist who is then able to monitor
your consumption. Others believe that only a tighter regulation on the
types of medicine that are readily available will have any significant
effect. Yet others feel an effective solution would be to withdraw all
medicines from places such as supermarkets and petrol stations.

Being banned from all the pharmacists in her area didn't stop Andrea McKay
from feeding her addiction. It simply meant she had to go further afield
for the 60 tablets a day on which she relied.

She is now down to 36, and the back pain which kick-started her dependence
has gone, but the damage done to her liver and stomach have yet to be
determined.