Dr Michelle O'Driscoll: Beware of getting addicted to Codeine

Dr Michelle O'Driscoll gives advice regarding the use of codeine
Dr Michelle O'Driscoll: Beware of getting addicted to Codeine

"These products are not suitable for everybody, particularly if there are underlying health conditions or you’re taking other medication too," warns Michelle. Picture: Stock.

HAVE you been told by a friend that Solpadeine is brilliant for a hangover? Have you heard from your sister that Nurofen Plus is amazing to shift period pain?

If these claims are true, then why, when you try to buy them, are you questioned in detail at the pharmacy? Why in many cases do they advise you to try something else first? Why are these products not more freely available?

What are they?

These products and others contain codeine. This is an opiate, which is very effective as pain relief, and plays a vital role in prescription pain management across a broad spectrum of conditions.

It is also available in some over-the-counter products. But like any treatment, these products are not suitable for everybody, particularly if there are underlying health conditions or you’re taking other medication too.

Codeine comes with a list of side effects such as constipation and drowsiness that can affect driving ability. Most importantly, it can be addictive if misused.

Risk of addiction

Codeine addiction can happen to anybody — you try the product for an ongoing issue, it works a treat, so you continue to use it past the over-the-counter three day guidance.

An Irish television documentary spoke to people who would visit several different pharmacies, and consume multiple boxes of these medications on a daily basis. Like any addiction, it affects finances, relationships and health. These medications in particular cause extra health issues because of the combination of ingredients that they contain.

You can become addicted to the codeine in Solpadeine for example, and gradually increase the amounts that are consumed when tolerance builds up. However, Solpadeine also contains paracetamol.

The maximum dose of paracetamol in a day is 1 gram every four to six hours, up to 4g in 24 hours. This equates to eight Solpadeine tablets. But if addicted to codeine, the temptation (and the reality) is that much more than eight in a day will be consumed, and this overdose of paracetamol causes toxicity of the liver which can be fatal.

Similarly, Nurofen Plus runs the risk of ibuprofen overdose. Issues with excessive codeine use should be addressed with support from your GP in the first instance, so a structured plan to gradually come off it can be put in place.

Restricted sale

Because of this risk of addiction and its undesirable side effects, the sale of codeine-based products is restricted. While some do not legally require a prescription, they are sold in a pharmacy under tighter regulations than non-codeine based pain relief.

You won’t find Solpadeine in your local supermarket, for example; you won’t even see it on display in your pharmacy. Pharmacy staff are trained to ask specific questions when it comes to the supply of these products, and it must be done under the direct supervision of the pharmacist.

You will be asked questions to determine the suitability of the product for your pain, to see whether something without codeine should be tried first, or whether it’s an issue that should be brought to a doctor rather than self-medicating with over-the-counter pain relief.

Questions you will be asked include what kind of pain the product is for, how long the pain has been there, have you tried anything yet for the pain, and do you take any other medications. Often a direct conversation with the pharmacist is advised. This extensive questioning is part of the pharmacy procedures to ensure safe supply of these products.

Alternatives

The effectiveness of other pain relief without codeine is often underestimated, and could be tried instead (provided it’s deemed suitable for you). Paracetamol or ibuprofen on their own, or alternating between them to prevent breakthrough pain, may well be recommended instead of the codeine product you requested.

Taken at their maximum recommended doses, they can be sufficient to shift many different types of pain. Often, people request the codeine product without realising what it contains, and are more than happy to try something else instead, which ends up doing a perfectly good job.

Advice

If you are subsequently supplied with a codeine-based product, the extra advise that comes with it is that it should not be used for more than three days, and to be aware it causes drowsiness.

The three day guidance applies to codeine without a prescription. If after that point, the issue has not resolved, a conversation with your doctor is the next step. Codeine is able to be prescribed for longer than three days by a doctor, but should be regularly reviewed.

While Solpadeine and Nurofen Plus are indeed effective pain relief, their over the counter supply is restricted and their use should be minimal due to side-effects and potential risks.

Issues with excessive codeine use should be addressed with support from your GP in the first instance.

Dr Michelle O’Driscoll is a pharmacist, researcher and founder of InTuition, a health and wellness education company. Her research lies in the area of mental health education, and through her company InTuition she delivers health promotion workshops to corporate and academic organisations nationally. For more see www.intuition.ie or follow her on social media @intuitionhealthandwellness

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