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Pharmacists express concern over addiction to pain relief

Regulations around the sale of products containing codeine were introduced in 2010. Pharmacists heard that up to one in three adults may be suffering from chronic pain, which can affect quality of life.

Image: Kirsty Wigglesworth/AP/Press Association Images

UP TO ONE in three Irish adults may be suffering from chronic pain, while addiction to pain relief medicines is a massive concern in Ireland, pharmacists have warned.

Catriona O’Riordan, a pharmacist from Cork and National Pharmacy Conference (IPU) executive committee member, spoke at the IPU’s annual conference in Galway at the weekend.

O’Riordan noted:

Chronic pain does not command significant attention but it is a debilitating condition, which can seriously affect the quality of life of a sufferer.

She continued that pharmacists have to be “sensitive to the risk that a patient may become dependent or even addicted to pain relief medication”.

Dr David O’Gorman, Consultant Pain Specialist at University College Hospital and  director of the Centre for Pain Research at NUI Galway, said that pain management “affects patient satisfaction, quality of life and health care costs”.

He said that pharmacists:

should not underestimate the impact their approach has on all three of these influences when a patient presents for advice on the most appropriate form of pain relief for their symptoms.

Codeine use

In August 2010, new regulations under the Pharmacy Act 2007 were introduced around the sale of codeine products. The Pharmaceutical Society of Ireland, the pharmacy regulator, explained that safety concerns around the misuse of non-prescription medicinal products containing codeine were “well established” (PDF).

Codeine is a narcotic analgesic and if people consume it in excess of the recommended dose they can become tolerant or dependant on it, and may have withdrawal symptoms when they stop using it, said the PSI.

It said that consumption of quantities over the recommend dose also carries the risk of other adverse effects. There is also a risk to consuming excessive quantities of ‘combination’ products containing codeine and paracetamol, aspirin or ibuprofen.

Pharmacists were advised that the pharmacist should only supply non-prescription ‘combination’ products when they are satisfied that the medicine “is the most appropriate therapy available at the time” and in the best interest of the patient.

Products such as paracetamol, aspirin or ibuprofen “should be used first in line with pain protocols” while codeine-containing medicinal products should be supplied as ‘second line’ products.

Pharmacists were told they have to fully advise patients of the correct use and the risks contained in using the non-prescription product containing codeine.

Cardiovascular screening

The conference also heard that pharmacists were warning of a rise in heart disease, which is now responsible for more than a third – 36 per cent – of all deaths in Ireland. Pharmacists said that the country “is facing a crisis in heart disease” and called on the Government to introduce a national cardiovascular screening service.

The IPU said its members were “willing and able” to front an extensive nationwide screening campaign for cardiovascular disease.

Bernard Duggan, a Dublin pharmacist and chairman of the Community Pharmacy Committee, told the conference that around 10,000 people die each year from cardiovascular disease, which also causes 22 per cent of premature deaths.

Duggan said that screening for heart disease and other chronic diseases through pharmacies “could directly reduce the number of deaths from heart disease each year in Ireland.”

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