For many Brits, taking paracetamol is part of the daily routine. Whether it’s swallowing a couple of pills before bed when a headache comes on, taking them to mask period pains, or to avoid a dreaded morning hangover. Research demonstrates that 1 in 8 Brits are reliant on paracetamol and take it everyday.

Paracetamol is currently marketed as an analgesic and antipyretic, to be used for no more than 3 days without consulting a doctor . However, due in part to its inclusion in the WHO analgesic ladder, as well as decades of clinical experience, it is also prescribed in chronic conditions such as osteoarthritis and lower back pain
Concerns have been raised over the effects on the cardiovascular, respiratory, renal, gastrointestinal and central nervous systems

Studies also reveal the amount of paracetamol Brits consume is far too high, as 1 in 4 frequently exceed the maximum daily dosage of paracetamol, which is 8 tablets.

Approximately 25% of Brits experience chronic pain, however, evidence shows there are some extremely damaging side effects of long term painkiller use.

1. Liver failure

“Liver injury can occur with regular paracetamol intake, at or below the recommended daily dose, which is one or two 500mg tablets at a time, up to four times in 24 hours with a maximum of eight tablets in 24 hours according to the NHS.

“Studies have shown that paracetamol can damage the liver by harming vital structural connections between adjacent cells in the organ.

“In fact, unintentional overdose of paracetamol is the most common cause of acute liver failure in the UK and US4. In 2021, 227 deaths in England and Wales were due to paracetamol overdose as a result of liver failure.”

Recent epidemiological studies have identified a potential increased risk of upper GI bleeding with doses of paracetamol ≥2–3 g d–1.When combined with NSAID, the risk increased to 13.2 (9.2 to 18.9), indicating a substantial interaction

2. Heart attack

“Studies have shown that regularly taking paracetamol that contains sodium is linked to an increased risk of heart attack, stroke, heart failure and death.

“Sodium, which is one of the main components of salt, is often used to help drugs such as paracetamol dissolve in water.

“However, if a person takes the maximum daily dose of paracetamol, they would also be exceeding the 2g maximum daily dose of sodium. Research shows that regularly taking paracetamol containing sodium over a long period of time, can massively increase a person’s risk of heart attack, stroke, or heart failure, regardless of whether they have high blood pressure or not.”

One such study was a placebo‐controlled crossover study of 20 treated hypertensive patients, in whom a 4 mmHg rise in blood pressure (BP) was found when paracetamol was administered .
Given that a 2 mmHg rise in systolic BP is associated with a 7% increase in the risk of ischaemic heart disease and a 10% increased risk of stroke,his apparently small increase in BP could have serious population‐based consequences.

3. Respiratory problems

“Research shows that frequent paracetamol use can lead to a significant increase in the probability of wheezing.

“It is also associated with an increase in asthma symptoms, and the effect is greater, the more the drug is taken.”

4:Tiredness and fatigue

“One of the most frequent side effects of paracetamol is exhaustion and fatigue, due to the acetaminophen content of the drug.

“If it is taken regularly, then it’s likely a person will regularly feel tired and drowsy more of the time.”

Whether paracetamol use in the chronic setting should be restricted is doubtful, given that the alternatives are NSAIDs and opioids. Indeed, in patients intolerant of NSAIDs, their next option would be opioid medication, which comes with risks of addiction, drowsiness and fatal accidental overdose.


Opioids are highly addictive, in large part because they activate powerful reward centres in your brain. Opioids trigger the release of endorphins, your brain’s feel-good neurotransmitters. Endorphins muffle your perception of pain and boost feelings of pleasure, creating a temporary but powerful sense of well-being, which can easily lead a person to opioid dependence.

Opioids have been regarded for millennia as among the most effective drugs for the treatment of pain. Their use in the management of acute severe pain and chronic pain related to advanced medical illness is considered the standard of care in most of the world. In contrast, the long-term administration of an opioid for the treatment of chronic non-cancer pain continues to be controversial. Concerns related to effectiveness, safety, and abuse liability have evolved over decades, sometimes driving a more restrictive perspective and sometimes leading to a greater willingness to endorse this treatment.

The past several decades in the United States have been characterised by attitudes that have shifted repeatedly in response to clinical and epidemiological observations and events in the legal and regulatory communities. The interface between the legitimate medical use of opioids to provide analgesia and the phenomena associated with abuse and addiction continues to challenge the clinical community, leading to uncertainty about the appropriate role of these drugs in treating pain.

How do people fall into opioid dependence?

Opioid dependence develops after a period of regular use of opioids, with the time required varying according to the quantity, frequency and route of administration, factors of individual vulnerability and the context in which drug use occurs.

Physical and psychological dependence can develop within a relatively short period of continuous use (2-10 days). Brain abnormalities resulting from chronic use of heroin, oxycodone, and other morphine-derived drugs are underlying causes of opioid dependence (the need to keep taking drugs to avoid a withdrawal syndrome) and addiction (intense drug craving and compulsive use). The abnormalities that produce dependence, well understood by science, appear to resolve after detoxification, within days or weeks after opioid use stops. However, the abnormalities that produce addiction are more wide-ranging, complex, and long-lasting. They may involve an interaction of environmental effects – for example, stress, the social context of initial opiate use, and psychological conditioning – and a genetic predisposition in the form of brain pathways that were abnormal even before the first dose of opioid was taken. Such abnormalities can produce craving that leads to relapse months or years after the individual is no longer opioid dependent.

There are several risk factors for opioid dependence
• Having an opioid use disorder.
• Taking opioids by injection.
• Resumption of opioid use after an extended period of abstinence (e.g., following
detoxification, release from incarceration, cessation of treatment).
• Using prescription opioids without medical supervision.
• High prescribed dosage of opioids (more than 100 mg of morphine or equivalent daily).
• Using opioids in combination with alcohol and/or other substances or medicines that
suppress respiratory function, such as benzodiazepines, barbiturates, anaesthetics or
some pain medications
• Having concurrent medical conditions such as HIV, liver or lung diseases or mental health

Males, people of older age and people with low socio-economic status are at higher risk of opioid dependence than women, people of young age groups and people with higher socio-economic status.
Opioid-based medicine for pain treatment

Regarding pain treatment, opioid-based medicine is still the standard course of care, and opioids can arguably provide life-saving relief for patients. But opioid misuse and dependency is a debilitating problem, with opioid use disorder affecting more than 16 million people worldwide. In England, opioid prescriptions increased by 128% since 1998, and opiates were involved in almost half (2,219) of drug-poisoning deaths in England and Wales during 2021.

The number of opioid overdoses has also increased in recent years in several other countries, in part due to the increased use of opioids in the management of chronic pain and the increasing use of highly potent opioids appearing on the illicit drug market. In the United States of America (U.S.), the number of people dying from opioid overdose increased by 120% between 2010 and 2018, and two-thirds of opioid-related overdose deaths in 2018 in the U.S. involved synthetic opioids, including fentanyl and its analogues. During the COVID-19 pandemic, a further substantial increase in drug overdose deaths was reported in the U.S., primarily driven by rapid increases in overdose deaths involving synthetic opioids.

Measures to prevent opioid dependence?

Beyond approaches to reducing drug use in general in the community, there are specific measures to prevent opioid dependence and overdose.

These include:
• Increasing the availability of opioid dependence treatment, including for those dependent
on prescription opioids.
• Reducing and preventing irrational or inappropriate opioid prescribing.
• Monitoring opioid prescribing and dispensing; and
• Limiting inappropriate over-the-counter sales of opioids.

The gap between recommendations and practice is significant. Only half of the countries provide access to effective treatment options for opioid dependence and less than 10% of people worldwide in need of such treatment are receiving it.

Opioid tolerance, dependence, and addiction are all manifestations of brain changes resulting from chronic opioid abuse. The opioid abuser’s struggle for recovery is in great part a struggle to overcome the effects of these changes. Medications such as methadone, buprenorphine, and naltrexone act on the same brain structures and processes as addictive opioids but with protective or normalising effects.

Despite the effectiveness of medications, they must be used in conjunction with appropriate psychosocial treatments.

Given the over-prescription of opioid-based pain management across traditional medicine and the (arguably) related opioid epidemic that is devastating communities around the world, medical cannabis could provide an alternative to opioid-based pathways and be used as a treatment for those struggling with addiction and substance use disorders.

Please visit htpp://panaceapainreliefclinic.co.uk for more information and contact my team to make an appointment on 01252895430 or send an email via the website and a member of the team will contact you.