Abby Johnson was in agonising pain from gallstones, so when her GP prescribed codeine, she took it without a second thought.

But within a year the 35-year-old was so hooked on the painkiller that she would use her month’s prescription – 240 tablets – in just three days.

She would then trawl local pharmacies to buy more.

“I was also purchasing them from various online pharmacies, spending hundreds of pounds monthly, which led me into debt,” shares Abby, a former GP practice manager residing in Gloucester with her two sons, now aged 14 and ten.

The issue was that her body had grown so accustomed to codeine that it required increasing amounts, and without the drug every 12 hours, she experienced severe withdrawal symptoms. “My anxiety levels would skyrocket,” recalls Abby. “I’d suffer from intense flu-like symptoms, with watery eyes, a runny nose, and abdominal discomfort.”

But the codeine – an opioid drug – also made her feel sick, so she barely ate. Her weight dropped to 7st 7lb, too slim for her 5ft 5in frame.

Additionally, she struggled with dreadful insomnia, leaving her utterly drained. “I used to drop the boys [then aged 12 and eight] at school, return home, and sleep all day,” Abby explains. She resigned from her position due to lack of focus, opting for a part-time administrative role, but frequent sick days ultimately led to her dismissal.

At that point, Abby finally sought assistance and is now gradually attempting to rebuild her life while combating her codeine dependency. However, many others find themselves in similar predicaments.

Abby Johnson, 35, became so hooked on codeine that she would use her month’s prescription – 240 tablets – in just three days

Codeine is an opioid drug, which can be highly addictive even though codeine is regarded as a weaker opioid

Since sharing her experiences on social media, Abby has been contacted by hundreds of others with similar stories as a result of codeine dependence.

“I believe there is a silent epidemic of codeine abuse in the UK being overlooked, and no action is being taken,” Abby asserts. Experts concur, with some advocating for a ban on the over-the-counter sales of the drug.

Codeine is part of the opioid family, including drugs like tramadol, oxycodone, and fentanyl. Although considered a milder opioid, it remains highly addictive.

Packets of the drug must carry warnings that it can become addictive within as little as three days. That’s because it is metabolised into morphine in the body, producing a feeling of euphoria.

Codeine is supposed to be reserved for short-term, sudden (i.e. acute) pain – such as post-operative pain, or in palliative care for cancer patients – because, as well as being highly addictive, the evidence shows it doesn’t work for chronic pain (defined as pain that lasts more than three months).

The drug can cause side-effects such as cardiac arrhythmias (irregular heartbeat), confusion, constipation, dizziness, abdominal cramps and drowsiness.

And, like any opioid painkiller, it can depress breathing. Data published by King’s College London last week found there were 50 per cent more opioid-related deaths than had been officially recorded between 2011 and 2022 – this includes illicit drug use, but also accidental overdoses.

France banned over-the-counter codeine sales in 2017, following a review of opioid misuse and addiction; as did Australia in 2018, after rising rates of codeine-related dependence and death.

Hannah Cade, 29, was taking liquid morphine for severe endometriosis and says ‘the side-effects of the opioids were awful – I felt drowsy, and constipation was a big problem’

‘There has been a decrease in prescribing opioids but it’s been relatively modest,’ says Roger Knaggs, a professor of pain medicine at the University of Nottingham and chair of the British Pain Society

In the UK, as Dr Alison Cave, chief safety officer at the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) explains, tighter controls around codeine have been brought in – recently, for example, codeine linctus (found in cough medicine) was changed to prescription only. Yet over-the-counter sales of codeine in the UK are now among the highest in the world, with the fourth highest average sales out of 31 countries, according to Oxford University figures published in the journal Drug Safety in 2022.

Another study from Oxford, in 2023, found that 4.75billion doses of codeine were sold over the counter between 2013 and 2019 via 83 different products – with an average 17 doses per head of population.

Professor Sir Sam Everington, a GP in east London, is among those who believe over-the-counter codeine sales should be banned.

‘The problem is GPs don’t know if a patient is buying large amounts of codeine. Unless a pharmacist lets them know informally, there is no official system for monitoring this,’ says Professor Everington, the incoming president of the Royal College of GPs, taking up the role in November.

It’s not just over-the-counter codeine causing concern. While the number of prescriptions for opioids – such as codeine, co-codamol, liquid morphine, tramadol and fentanyl – have come down since 2019, they are still being prescribed in huge numbers, with over 5.5million prescribed them, according to NHS Business figures.

‘There has been a decrease in prescribing opioids but it’s been relatively modest,’ says Roger Knaggs, a professor of pain medicine at the University of Nottingham and chair of the British Pain Society.

And he says that while the message is getting across – slowly – about not prescribing opioids to new patients for non-cancer-related chronic pain, there are still substantial numbers on them long-term.

As Professor Sailesh Mishra, a consultant in pain management and anaesthesia at the Royal Victoria Infirmary in Newcastle, explains, there is only a very limited role for opioids in managing chronic, non-cancer-related pain. ‘Even then, the dose of opioid has to be carefully decided after a risk-benefit assessment – and the effectiveness of the medication needs to be assessed at regular intervals,’ he stresses.

When Abby’s GP first prescribed 30mg codeine tablets to be taken up to four times a day in the summer of 2022, to alleviate the pain caused by her gallstones, it was supposed to be a stopgap until her gallbladder could be removed. But Abby became hooked almost instantly.

‘Aside from the pain relief, I grew to like the way they made me feel – more relaxed and chilled,’ she says.

‘I had been warned that they could be addictive and were meant to be just a short-term measure, but I was in so much pain I felt I had little choice but to take them.

‘I took them every day at the maximum dose for two months, until my operation to remove my gallbladder.’

And after her surgery in November 2022, Abby was again prescribed 30mg codeine tablets – six a day – for two weeks, to help with post-surgical pain. Whenever she tried to stop, she was hit by symptoms such as restless legs, sleeping problems and nausea – common symptoms of withdrawal.

‘I felt terrible, so I bought codeine over the counter,’ recalls Abby. ‘Soon I was buying a box of 32 30mg tablets a day from multiple pharmacies.’ Three months later, in February 2023, Abby began suffering from abdominal pain and was prescribed co-codamol (30mg codeine with 500mg paracetamol) while she underwent investigations.

She also started to buy codeine from multiple online pharmacies. Abby says: ‘I’d buy boxes of NurofenPlus [containing codeine and ibuprofen] at £12 each and codeine from online pharmacies at £100 for 100 tablets. Sometimes, I’d be taking 70 codeine tablets a day. I didn’t tell my doctors as I was so ashamed.’

Within a few months she was taking 224 tablets of the prescribed codeine a month, the maximum prescribed dose, but her tolerance was increasing.

‘I lied to my doctor that I was still in pain and was then prescribed the stronger liquid morphine, as well as codeine for breakthrough pain. The GP kept prescribing it.’

Abby continued like this for more than two years. No one questioned her being on the drugs for so long, nor did anyone suggest she cut back her dose. And all the while, her health and life were slowly falling apart.

And as codeine can become less effective over time, as in Abby’s case, it can easily become an entry drug to even stronger opioids.

A clampdown on opioid prescribing was brought in after prescriptions doubled between 1998 and 2018 – with a growing awareness of their risks.

Professor Knaggs said opioids were more widely prescribed after some small-scale trials in the 1990s and early 2000s suggested they may be of benefit – a finding subsequently overturned by larger, longer-term studies.

‘Let’s put it this way,’ he says, ‘we have a substantial number of people who continue to take opioids without necessarily getting much benefit’.

Not only do they not get much benefit for long-term pain, there is some evidence the drugs may increase pain sensitivity, alongside the risks that come with taking strong opioids.

In 2020, Hannah Cade’s boyfriend Marc found her ‘blue and struggling to breathe’ after she accidentally overdosed on liquid morphine and codeine – drugs she had been prescribed for severe endometriosis, where womb-like tissue grows elsewhere, in her case around the bowel, bladder and pelvic ligaments.

Hannah, 29, who lives in Beeston, Nottingham, with Marc, 33, a motor industry buyer, has been taking prescribed codeine and liquid morphine on and off since 2017.

‘I was very strict – only taking the liquid morphine at the point when I was literally screaming in pain to start with,’ says Hannah.

‘But as my pain increased, I took it every day. The side-effects of the opioids were awful – I felt drowsy, and constipation was a big problem. I had to give up working in marketing and took a part-time job in retail, but I had to leave as I was having dizzy spells and being sick at work.’

But after her accidental overdose she was discharged from hospital without anyone ‘talking to me about why I was taking so many painkillers’, she says.

Rather than querying her doses, her GP kept prescribing the drugs.

Hannah recalls: ‘In 2024, I was prescribed oxycodone – a much stronger opioid. I took it for six months. It made me feel numb and spaced out – but it was very good at relieving the pain.

‘I wanted to come off it as I began feeling depressed and suicidal. My doctors said I could reduce my dose slowly, but they wouldn’t say by how much or over what time scale – and I needed that support.

‘It took me nine months to gradually reduce my dose and come off it. It was absolute hell. I suffered nausea, fatigue and pain all over the body – like the aches you get with flu, but ten times worse.

‘I’m now on 30mg codeine twice a day, paracetamol every four hours and then 10mg morphine tablets once a week before my period and every day of my period.

‘I’d like to come off opioids completely, but when I talk to doctors, I feel judged. I’m scared I’m going to be on them for the rest of my life.’

A significant proportion of people taking opioids struggle with crippling symptoms that are caused by the drugs themselves.

Eighty per cent of people prescribed opioids experienced at least one problem as a result, and more than a third (35.7 per cent) feared they were dependent or addicted, according to a survey by Nottingham University of ten general practices in the East Midlands, published in the journal Pain Reports earlier this year.

But Professor Knaggs points out that painkillers are not the only option.

He says there are strategies that can help with pain, such as staying physically active, getting good sleep and cognitive approaches such as CBT or mindfulness – as well as educating patients that pain does not always relate to tissue damage.

Professor Everington believes the NHS should offer more social prescribing, such as free swimming, gardening, golf, walking in nature and community engagement groups.

‘Social prescribing has certainly changed the way myself and my colleagues practise, because we now have alternatives to drugs to offer our patients including those who have long-term pain,’ he says.

As well as suffering physically, Abby worries about the effects her opioid addiction had on her children.

‘I made sure they were clean and fed, but I wasn’t there for them emotionally, which I deeply regret,’ says Abby. ‘My mum had to step in to help.’

Being sacked in October last year was the final straw and forced her to seek help.

She has entered a supported withdrawal programme at a drug-dependency service using opioid substitution therapy, group therapy and counselling.

‘I’ve been on the programme for ten months and am now down from a daily 12mg tablet to 6mg and have got my life back,’ says Abby. ‘I’m under a mental health team and picking up the pieces of my life.’

She has now launched an online petition calling for a national database of over-the-counter codeine sales to be set up.

‘I think this is really important as no one seems to have any idea of the scale of the problem.

‘Opioids are so freely prescribed and for too long. People need to be told they don’t work for long-term pain and that they can ruin lives.’