An increasing number of people are presenting to treatment services addicted to codeine products that can be obtained over-the-counter, a leading general practitioner has said.
The drugs are typically used for short-term relief of mild-to-moderate pain and often sold in combination with ibuprofen or paracetamol.
However, Dr Bernard Kenny, director of addiction management in primary care with the Irish College of GPs (ICGP), said these drugs are “perceived to be safe and acceptable” but codeine is an opioid and is addictive.
“We’re seeing a quiet escalation in their use. Certainly in my own practice in the last 12 months, for new people who are previously unknown to treatment, we would have a higher proportion of people who were prescribed over-the-counter opioids so codeine with ibuprofen or paracetamol compared to heroin use disorder,” he told The Irish Times.
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Kenny said the majority of people are initially prescribed codeine for an acute pain issue, but there is a gradual increase in the use over time.
“Then the original pain subsides and people continue to use them in increasing quantities. When you’re able to get these medications without a prescription, that’s where the use really escalates,” he said.
“I can think of a number of cases where people would be travelling to three or four different pharmacies every day to source [the drugs].”
He believes the ubiquity of these drugs lead members of the public to believe they are safe for regular use, and also increases the accessibility for people with substance misuse disorders.
“From a patient and doctor point of view, we can be very slow to call it out because it’s not an illicit substance, so it doesn’t have the same negative associations in society as some illegal drugs in society would.”
The Dungarvan-based GP said due to the combination of codeine with other painkillers and anti-inflammatories, the consequences can be multifaceted.
“The addiction itself is hugely problematic. Any time people are in the throes of addiction it causes chaos and instability in their lives because of that craving and compulsion. But also, the items codeine is combined with can have physical consequences,” he said.
“When you take ibuprofen in huge quantities it can cause massive problems with the gastrointestinal tract, the kidneys and the liver. Huge quantities of paracetamol can cause acute liver injuries as well.”
Kenny was speaking during the ICGP annual conference, held in Booterstown, Co Dublin.
The Health Products Regulatory Authority (HPRA) is conducting an ongoing, confidential review of low-dose codeine products available over-the-counter in Ireland, initiated in late 2022 due to misuse concerns.
The review, which is expected to conclude this year, seeks to determine if they should be made prescription-only.
