People in Britain are huge users of over-the-counter (OTC) painkillers. Last year, we approximately spent £865m on them, the highest amount on record. We use them because they work and, for most people, they are considered safe medicines that can be purchased without a prescription. Whilst most OTC painkillers are used responsibly by those who take them, some can be misused. This can lead to dependence and addiction, particularly on painkillers containing opioid ingredients such as codeine.

Due to this, UK regulators and the NHS have repeatedly warned about the risk of dependence associated with codeine-containing medicines.

 

What Are Over-the-Counter Painkillers?

OTC painkillers are medications that you can buy over the counter at pharmacies or in shops without a prescription.

Common OTC painkillers available in the UK include:

  • Paracetamol: Used for general pain and fever
  • Ibuprofen: Used for inflammation
  • Aspirin: Used to treat mild pain and for anti-inflammatory purposes
  • Combination products: Medications that contain a low dose of codeine with paracetamol or ibuprofen, such as co-codamol and Nurofen Plus

Standard analgesics (painkillers) contain no opioids. At the same time, combination products include codeine, an opioid, which is available in lower strengths from UK pharmacies without a prescription for short-term use and limited quantities.

 

Can You Get Addicted to Over-the-Counter Painkillers?

Some over-the-counter (OTC) painkillers can be addictive and lead to dependence, particularly those containing codeine or dihydrocodeine, which are in the opioid family. UK safety reviews have highlighted concerns about addiction to OTC codeine medicines.

Paracetamol and ibuprofen are not considered addictive but can still cause harm if misused.

Addiction does not occur immediately; it builds on dependence, which is a consequence of tolerance.

  • Tolerance: A person needs higher doses over time for the same effects.
  • Physical dependence: Due to building tolerance, the body adapts to a drug. Withdrawal symptoms may occur if use stops suddenly.
  • Addiction: A person continues to use a substance, despite harm, losing control over their usage.

 

Which Over-the-Counter Painkillers Can Be Addictive?

Over-the-counter painkillers most commonly associated with dependence are those containing codeine, including Co-codamol, Nurofen Plus, Solpadeine and Syndol. Medicines containing dihydrocodeine also carry a risk of addiction.

Codeine is an opioid and works by binding to receptors in the brain, reducing pain signals and increasing dopamine release, which is linked to pleasure and reward. It can become habit-forming, and codeine addiction can develop because repeated use can lead to tolerance and dependence, even when taken therapeutically.

Eventually, higher doses may be needed to gain the same effects, and your body comes to crave the increased dopamine levels. If you stop suddenly, withdrawal symptoms can occur, which leads people to continue to take medication to avoid them.

 

Why Do People Become Dependent on Painkillers?

Painkiller dependency, such as codeine and co-codamol addiction, can happen for many reasons. Many people may begin taking painkillers for legitimate reasons before dependence gradually develops.

Factors that can contribute to painkiller dependency include:

  • Chronic pain conditions
  • Long-term use
  • Increasing tolerance
  • Self-medication for emotional distress
  • Anxiety and depression
  • Difficulty accessing alternative pain management strategies

 

What Is the Difference Between Dependence and Addiction?

Dependence and addiction are different, but very much two stops on the same road.

Physical dependence is when your body adapts to the presence of a substance, needing it to function normally and going into withdrawal if you stop.

Addiction is the next step forward, bringing in a psychological dependence. Not only will you experience cravings, but you will also lose control over your substance use and compulsively take it, despite the harm it is doing to yourself and others.

You can be physically dependent, taking medication as ordered, but without tapering off properly, your body will react and go into withdrawal. It’s a simple fact of biology. If you do not suffer from cravings and have no compulsion surrounding your medication use, then you necessarily don’t meet the criteria for addiction.

 

What Are the Signs of Over-the-Counter Painkiller Addiction?

Many who would benefit from going to a prescription drug rehab are unaware that they need to. Addiction can sometimes remain hidden for long periods because those suffering become masters at hiding it, are functioning relatively well or are in denial.

It’s vital to know the signs of OTC painkiller addiction to get help sooner rather than later, as the problem will only escalate over time.

Signs of OTC painkiller addiction include:

  • Taking medication for longer than recommended
  • Increasing the dose without medical advice
  • Visiting multiple pharmacies to obtain medication
  • Feeling unable to cope without the medication
  • Cravings
  • Anxiety when supplies run low
  • Continued use despite negative consequences

 

How Does Codeine Addiction Develop?

Codeine addiction develops when repeated opioid use alters brain reward pathways, increasing unnaturally produced dopamine levels and reducing natural pain management.

As time goes by, tolerance develops as opioid receptors become less responsive, so higher doses are needed for the same effects of pleasure and pain relief.

There has been much UK research into highlighting concerns about OTC codeine misuse and dependence. Studies have found that codeine dependence is closely linked to regular abuse of the medication, exaggerating symptoms to get a prescription for codeine and pharmacy shopping to obtain more painkillers.

 

What Are the Risks of Long-Term OTC Painkiller Misuse?

Many dangers of prolonged painkiller use can have long-term consequences.

Risks include:

  • Liver damage from paracetamol-containing products
  • Stomach ulcers and gastrointestinal problems from ibuprofen
  • Kidney damage
  • Chronic headaches caused by medication overuse
  • Opioid dependence
  • Mental health difficulties

 

What Happens When You Stop Taking Codeine?

Prolonged use of codeine causes your body to become used to its presence, naturally producing less pain and mood-regulating chemicals. When you suddenly stop, your nervous system becomes overstimulated and tries to correct itself, bringing on a range of withdrawal symptoms.

Codeine withdrawal symptoms include:

  • Anxiety
  • Restlessness
  • Sweating
  • Flu-like symptoms
  • Insomnia
  • Irritability
  • Cravings

Withdrawal can make it difficult to stop without support because it can be uncomfortable, and relief feels like an easy solution to stop the symptoms. Without support, many people relapse.

 

Can You Become Addicted Even If You Follow the Instructions?

Yes, some people can and do develop a painkiller dependence even when taking medication exactly as prescribed. Despite initially taking medication exactly as directed, you may begin to take more to feel the pain-killing effects.

This can be especially true for opioids, even if you do not misuse your medication. Your body becomes used to opioids in your system, and you experience withdrawal when you stop. This could lead you to continue to use opioids as a “safe” level, even if you no longer need them.

There aren’t that many completely “safe” medications. There are always risks with how your body reacts to them, how they will interact with other medications you are taking and how prolonged use can affect your health.

 

How Is Over-the-Counter Painkiller Addiction Treated?

Effective treatment has to treat both the physical and psychological aspects of addiction, providing you with a solid platform from which to start recovery.

At Ocean Recovery, we offer a comprehensive treatment programme that includes:

  • Medical assessment: We assess your specific needs, creating a treatment plan that is right for you.
  • Managed reduction or tapering : Stopping abruptly can be medically dangerous; in some cases, a gradual reduction is needed.
  • Detoxification, where appropriate: Becoming physically clean allows your body to start healing.
  • Residential rehabilitation: Going away for treatment can be beneficial, removing you from toxic people and places.
  • Counselling and therapy: A combination of group and individual therapies helps you better understand your addiction and learn healthier coping strategies.
  • Relapse prevention strategies – Learning how to recognise and deal with triggers will help you through recovery, long after you have completed rehab.
  • Aftercare support: Engaging with recovery afterwards is important. Aftercare offers you the chance to attend regular support meetings and build a recovery network.

 

When Should You Seek Professional Help?

There comes a point when you need a helping hand. Asking for help is not a defeat, but the best step forward you can make.

Signs that you need professional support include:

  • Failed attempts to stop
  • Experience withdrawal symptoms
  • Escalating use of painkillers
  • Health issues due to painkiller use
  • Painkiller use is affecting work, finances, or relationships

 

Get Help with Over-the-Counter Painkiller Addiction Today

If you’re worried that your painkiller use is becoming difficult to control. For confidential advice and support, contact Ocean Recovery today.

John Gillen - Director at Ocean Recovery

John Gillen - Author - Last updated: June 12, 2026

John is one UK’s leading professionals in the addiction recovery industry. Pioneering new treatment techniques such as NAD+ and ongoing research into new therapy techniques such as systematic laser therapy, John is committed to providing the very best treatment for people throughout the UK and Europe. During his extremely busy schedule, John likes to regularly update our blog section with the latest news and trends in the industry to keep visitors to our site as well informed as possible on everything related to addiction treatment.