What is Codeine
Codeine is a type of opioid, which is a class of narcotics known to have the potential for dependence. It is available in liquid or solid forms and can be used alone or with other active pharmaceutical ingredients. When used according to the guidance of a health professional, codeine-containing medicines are considered a relatively safe option for treating minor pain or suppressing non-productive coughs. However, codeine can also produce euphoric effects, which can lead to continued use and pose a risk of developing tolerance and dependence.
Codeine is classified as a controlled substance under international regulations outlined in the 1961 Single Convention on Narcotic Drugs, with its use monitored by the International Narcotics Control Board. SAHPRA issues permits for the import and export of codeine-containing products. Cough syrups containing codeine are regulated under Schedule 2 and Schedule 3 of the Medicines Act. Without a prescription from an authorized prescriber, these products can only be dispensed by a registered pharmacist or a post-basic pharmacist's assistant under the direct supervision of a pharmacist at a licensed pharmacy.
As a medical student and practicing community pharmacist, I have observed that codeine abuse is a significant issue in Ireland, yet it is not well-documented in research studies. Codeine addiction often goes unnoticed as it is frequently disguised as pain management, and both doctors and patients tend to overlook it.
Pain is a prevalent concern in Ireland and the Australian primary care settings. In Australia, about 1 in 25 primary care consultations are related to headaches, and 1 in 7 are related to musculoskeletal pain. Opioids, including codeine, are commonly prescribed for pain management in Ireland and Australia. Codeine is the second most prescribed opiate in Australia with an estimated 640 codeine prescriptions dispensed per 1,000 patients in 2012.
Codeine, a short-acting opiate-based analgesic, binds weakly to opioid receptors primarily in the central nervous system, thereby reducing nociception. It also binds to opioid receptors in other parts of the body, such as the gastrointestinal tract, leading to side effects like constipation and nausea. Besides providing pain relief, codeine can also induce euphoria and sedation, giving users a short-term experience of a 'buzz' or 'calm.'
In Irish law, codeine is categorized as Schedule 5 under the Controlled Drug Regulations, making it available over the counter in pharmacies under the supervision of a pharmacist. However, despite these safeguards, codeine-containing analgesics are among the top-selling products over the counter in Irish pharmacies.
The easy access to codeine for patients may weaken the legislation. Ireland has a high number of pharmacies per capita; however, there are fewer pharmacists per pharmacy, potentially leading to less time for patient consultations due to high workloads.
Buy codeine in Australia online may make it difficult to monitor patients who may be 'codeine shopping' by visiting different pharmacies to purchase codeine. Additionally, it can be challenging for pharmacists to identify unsuitable codeine sales if patients provide plausible explanations for their pain and show no apparent signs of misuse.
The issue at hand has resulted in a significant portion of the Irish population resorting to self-medication with codeine, inadvertently leading to the development of addiction. It raises the question of whether the prescribing practices in Ireland need to be reevaluated. During the Irish College of General Practitioners Annual Conference in 2018, Professor Denis Cusack reported a notable surge in the prescribing of certain addictive medications for medical card holders from 2006 to 2016. Particularly, there was a striking 208% increase in codeine prescriptions during this timeframe. This substantial rise in codeine prescriptions within general practice underscores the urgency to identify and intervene in cases of codeine misuse, especially since patients are typically better known to their GPs than to hospital doctors, where opiate prescriptions are often initiated.
Moreover, the long-term effects of codeine addiction are especially concerning. Patients, whether initially prescribed or self-administered, often find themselves unwittingly falling into addiction after seeking the drug for legitimate pain relief purposes. The deceptive nature of their growing dependence on codeine becomes apparent only after the resolution of the initial pain, as they realize the severity of withdrawal symptoms and the rapid increase in drug tolerance. These withdrawal symptoms include chills, constipation, nausea, insomnia, sweating, anxiety, lacrimation, and muscle aches, amplifying the suffering endured by those attempting to break free from the grip of codeine. Additionally, the prevalence of rebound headaches among codeine users further complicates the landscape of addiction, as highlighted by an audit of the Dublin Neurological Institute Headache Clinic in The Mater Hospital Dublin in 2011, which revealed that over half of the patients in the study experienced medication overuse headaches, primarily due to codeine misuse.