“I Could Switch Off The Agony”: Women & Their Relationship With Co-codamol

The day before Rachel*, 30, went to get fitted for a hormonal coil in 2022, the nurse advised her to take co-codamol an hour beforehand (usually painkillers like paracetamol or ibuprofen are recommended). Co-codamol is a painkiller that contains 500mg of paracetamol and either 8mg, 15mg or 30mg of codeine — the latter, as many people know, is classified as a “weak opioid” and can be addictive. It’s one of the strongest painkillers you can get legally in the UK without a prescription, though only the lowest strength can be bought over the counter (OTC). Rachel went to buy a box and was warned by the pharmacist that she shouldn’t take the tablets for more than three days in a row. With the first dose, she felt sleepy, relaxed and experienced some relief from anxiety about having the coil fitted. The coil fitting went by without much pain. The painkillers had worked — but Rachel still had a near-full box of co-codamol at home.

“I decided to take a dose again for a severe headache a few weeks later,” Rachel remembers. “I’ve always experienced very bad headaches, which paracetamol and ibuprofen have zero effect on. Usually I have to go to bed with a cold flannel and sleep it off. This time though, taking co-codamol completely cured my headache. It was incredible. I could switch off the agony.” Rachel began to rely on co-codamol, taking it once a fortnight, sometimes more often, to fight off headaches caused by work stress. “I kept making a mental note to stop eventually but I was reluctant to stop when I was regaining so much time that I would otherwise have spent in bed in agony. I never felt addicted but the knowledge that it was an addictive substance nagged at me. I can see how it could become addictive — being able to turn off pain that feels like it has no other cure is an amazing feeling.” 

Around 18 months into taking co-codamol, Rachel noticed the painkiller no longer worked for her. “I assumed it meant I’d developed a tolerance to it. It would only make a slight dent in my headache, or it wouldn’t help it at all.” She decided to stop taking it. Soon after, she changed jobs and her headaches became less frequent. “But now, when they do occur,” she says, “I find it disheartening that there’s little I can do about them.” 

Rachel bought her pills OTC but prescribed co-codamol is the second most dispensed painkiller in England after paracetamol, according to data from 2023, when over 15 million packs were prescribed. While there isn’t much data on OTC sales, according to one study spanning 2013 to 2019, the UK ranked fourth out of 31 countries for sales of OTC codeine products. In 2023, the International Narcotics Control Board estimated that the UK was the third largest consumer of codeine globally.  

There’s no concrete data that shows whether women use this particular drug more than men, but women in England are almost twice as likely as men to be prescribed opiate painkillers. In a world where women's pain is routinely dismissed, downplayed or misdiagnosed due to institutional misogyny, women are left to play doctor, desperate for a solution. As we know, women experience an absence of pain relief options: for chronic illnesses, during birth control procedures and cervical health exams. Gynaecology waiting lists have doubled in four years and research into agonising conditions like endometriosis pales in comparison to research into other illnesses. Women are often a second thought when it comes to issues of pain, addiction and drug abuse. Women’s bodies still aren’t understood.

It’s unsurprising, then, that anecdotal evidence suggests many are choosing to self-medicate, turning to co-codamol in an effort to live their lives more fully. On TikTok, co-codamol abuse is seen as unserious, with young women joking about feeling high on it or more drunk if taken with booze (a hard no), while others cry on camera as they share stories of being turned away from pharmacies. Co-codamol as a form of pain relief isn’t the problem — when used as directed (for up to three days in a row), it’s safe and effective. The problem is in the lack of guidance and education about the painkiller, and the dearth of alternative options for managing painful long-term conditions. Women all over the UK — like those we’ve spoken to at Refinery29 — are relying on it, whether they know the dangers or not. 

Stephanie Bray, 30, from Kent knows how addictive codeine can be, after finding herself in a cycle of taking OTC co-codamol day and night to alleviate pain caused by endometriosis. Like many people living with endometriosis, her symptoms were misdiagnosed for nine years. The condition was finally confirmed after Stephanie underwent emergency surgery for severe pain and inflammation. “The paramedics gave me the highest dose of morphine they were legally allowed to administer and I was still passing out from the pain, that’s how bad it was,” she recounts. Stephanie was already taking co-codamol by this point. “Normal painkillers didn’t touch the sides. At first I would use it as a last resort. I learned that it would numb the pain enough to cope and it also made me sleepy. I would wake up usually when the pain flare was over and this led to me taking it more regularly, from a couple of times a month to weekly.” 

Like Rachel, Stephanie noticed that the tablets didn’t work as well as time went on. She needed to access stronger doses not available OTC. “Family members undergoing medical treatments would give me their higher dose co-codamol and again I was finding it worked wonders for my pain,” she says. “It was my only coping mechanism to function normally. I was becoming depressed and I would use it to numb not only the physical pain but the mental pain as well. If I couldn’t sleep, I would use it to fall asleep. If I ran out, I would become distressed and panic.” With hindsight, Stephanie sees she was addicted. Living alone made it easier to hide the extent of her daily habit. Today, under the guidance of her doctor, she uses co-codamol once a month, if that, and it works as well now as it did when she first took it. After going to the GP to get help with her pain and reliance on co-codamol, she was prescribed amitriptyline, an antidepressant, which can help ease chronic nerve pain. “It helps my day-to-day pain management,” Stephanie says. “Once this kicked in I found myself reaching for other painkillers much less often.” Alongside amitriptyline, she uses heat pads and hot water bottles for minor pain, keeping them “dotted all over the house”, and a TENS machine. Stephanie is no longer addicted to co-codamol. 

Even in less severe cases, the risks are high. Rachel was told by a doctor that her frequent OTC use “should be” fine. However, she was also warned not to take co-codamol for more than 10 days a month because one of the possible side effects of regular use is hyperalgesia, which is increased sensitivity to pain — the very thing people take the medication to reduce. “Over time, opioids can alter how your nervous system processes pain signals. Instead of dulling pain, excessive use can increase pain sensitivity by amplifying pain pathways in the brain and spinal cord,” says Dr Babak Ashrafi from Superdrug Online Doctor, an online GP. This explains why many people say co-codamol no longer works after a while. Deborah Grayson, pharmacist and founder of Practice With Confidence, says this is a physiological response. “Codeine is an opioid, and the more the body’s opiate receptors are stimulated, the more receptors it makes, so you need more medication to take away pain,” she says. She calls this a “codeine ladder”. Grayson says many people climbing this ladder end up getting “opiate headaches”, which isn’t widely known. “The only way to get around that is to remove the opiate and let the body reset.” On top of this, because of the paracetamol in the tablet, overdosing increases a person’s risk of paracetamol poisoning. This can damage the liver and kidneys, and can even be fatal.

Because of the risks linked to drug abuse, co-codamol has been a cause for concern globally for years. Long-term use can negatively affect people’s mood and fertility. The MHRA, the UK’s governmental drug regulator, decided in 2009 to reduce the size of OTC co-codamol packs to 32 pills and to add warnings to consumers that the pills should not be taken for more than three days in a row. This year, the regulator took another codeine product off shelves and made it prescription-only: codeine linctus (a syrup used to treat dry cough), which has long been used recreationally and referred to as “lean” or “purple drank”. Elsewhere in the world, Australia banned OTC sales of low-dose codeine products in 2018, as has the US, Japan and Germany, due to abuse concerns. In the UK, co-codamol comes with a warning that it can be addictive and should only be used short-term unless a doctor has advised otherwise. But warnings are easy to ignore when alternatives are scant.

Pharmacists of course have a responsibility to keep an eye on who is buying co-codamol without a prescription and to stop selling it to someone if they are asking for it too frequently. The loophole, as we all know, is simply to go to a different pharmacy. When this happens, even the most cautious pharmacist can’t do anything to help. Grayson knows this only too well. “If you’ve got an active pain and you’re taking co-codamol to respond to the pain, that’s okay,” she says, “but what we find with people who have chronic pain is it becomes pre-emptive. That’s where the risk of addiction becomes much more pertinent. People take it to pre-empt pain, rather than as a response to it.” Grayson has seen people combining co-codamol with Nurofen Plus to get more codeine (which Nurofen Plus contains) — anyone doing this is advised to see a GP and pharmacists should refuse to sell them the products. In Grayson’s experience though, the level of warning that staff give customers varies from pharmacy to pharmacy, and having a full conversation about the risks of codeine seldom happens due to lack of time. Kate Blazey, executive medical director at WithYou, a drug, alcohol and mental health charity, hears from patients who take it to manage chronic pain and develop ongoing problems as a result. “Opioids like co-codamol can lead to dependence, which means you could experience physical withdrawal symptoms when you try to stop or cut back.” 

Even with all this risk, it’s understandable that many people still see co-codamol as an answer to their pain — because often it feels like the only answer. Twenty-eight-year-old Jessie* from London feels “at a loss when it comes to painkillers”. She’s been to NHS doctors countless times complaining of intense period pain and is still looking for help, exploring all the avenues she can think of including costly private tests. Jessie believes she likely has endometriosis but she is one of 630,000 people the BBC recently estimated are stuck on gynaecology waiting lists. The toll this has taken on her mental health is noticeable, not to mention the physical pain she’s living with daily, which has worsened with time.

While caught in this state of limbo, Jessie has given co-codamol a try on and off over the last eight years. Once when she bought it at a pharmacy, she was handed a leaflet on the risks of addiction. “It felt like such an extreme statement over something I was using for period pain management, but it also made me understand the level of pain I was experiencing,” she says. Co-codamol reliably helped her very painful periods at first but eventually ceased to have much effect, as the other women R29 spoke to experienced. “The fact I no longer have a failsafe painkiller is distressing,” Jessie says. She is experimenting with different holistic approaches, including CBD balms and different nutritional plans, but so far nothing has cut out the agony. “There are still days where I'm stuck in bed with a hot water bottle, wishing I had medication to help,” she says. Co-codamol provided short-term relief but long-term, what is Jessie to do? The decision shouldn’t be more co-codamol.