Ireland has one of the highest rates of over-the-counter opioid sales, a new study of dozens of countries has found.
years of research conducted at the University of Oxford across 31 countries across Europe, Africa, Asia, America and South America, Ireland has the second highest per capita sales of painkillers without a prescription containing codeine. Only South Africa buys more.
Codeine is most commonly found in painkiller tablets, including period pain and migraine tablets, as well as some dry cough liquids and cold and flu tablets.
The problem was highlighted earlier this month after the death of a young woman who became addicted to painkillers.
The family of Laura Newell (39), a mother of two, who died in January at Sligo University Hospital, have called on authorities to make over-the-counter painkillers harder to buy.
She first started using painkillers because she had undiagnosed endometriosis and died of complications and sepsis after bowel surgery.
Her family say she became addicted to codeine, as ibuprofen damaged her body, and her death was raised in the Dáil.
Products such as Solpadeine and Nurofen Plus, which contain codeine, are sold without a prescription in Ireland, although the pharmacist is required to ask about its use. Products do not require a prescription but are not available for unlimited self-selection.
But drug activists have during the last years expressed concern about going back and forth between pharmacies to buy multiple boxes of codeine-based painkillers.
Research reveals that people in Ireland buy almost twice as much over-the-counter codeine as the UK or France.
South Africa sold 36 average dosage units per person, followed by Ireland with 30 average dosage units per person. The UK had just over half the consumption rate of Ireland at just over 17 dosage units, while France recorded 20 dosage units per person.
The countries examined in the study included Argentina, Belgium, Brazil, Bulgaria, Canada, Croatia, Estonia, Finland, France, Germany, Greece, Ireland, Italy, Japan, Latvia, Lithuania, Mexico, the Netherlands, Poland, Portugal, Romania, Russia, Serbia, Slovakia, Slovenia, South Africa, Spain, Switzerland, Thailand, United Kingdom and United States.
The study’s lead author, Dr Georgia Richards, points to several factors linked to high codeine use in Ireland.
“The high sales of codeine in Ireland are likely due to ease of access, an aging population with increasing rates of chronic pain, and a lack of training and education,” Dr Richards said.
She said Ireland had nearly double the number of pharmacies compared to the UK and US.
In 2016, Ireland had four pharmacies per 10,000 people, while the UK and US had two per 10,000 people.
She said the general public may not be aware of the addictive properties of codeine, which belongs to the class of drugs known as opioids.
“Access to over-the-counter products may lead an undocumented proportion of the Irish population to unknowingly develop codeine addiction or dependency and ‘shop around the pharmacies’ for multiple packs of codeine”, she said.
The study, which has just been published in the Drug Safety Journalperformed the retrospective observational research using electronic point-of-sale data from the human data science company IQVIA.
Dr Richards said this was the first study to look at trends in codeine sales in Ireland.
The researcher said a number of steps could be taken to reduce codeine use, including switching codeine to prescription-only and improving data collection, quality and monitoring, as well as than increased awareness.
More than half of EU countries do not allow the sale of codeine over the counter. In recent years, France and Australia have reclassified codeine as prescription-only, which has reduced the use and harms of codeine, according to Dr. Richards.
Ireland recorded the highest average public expenditure at €8.58 per person, followed by the UK with an average of €2.86 per person over the six-year period from April 2013 to March 2019.
It shows how much more Ireland spends on over-the-counter codeine compared to other countries, as the country’s spending is about three times the second biggest spender, the UK.