Codeine addiction 'epidemic' after 208pc rise in use
Addiction to the painkiller codeine is "an epidemic verging on eruption and should be recognised now," according to an article in the Irish Medical Journal.
Emma McDonnell, of the Graduate Entry Medical School, University of Limerick, said there was a 208pc increase in prescribing codeine between 2006 and 2016.
It is also available in some over-the-counter products and it is difficult to monitor if a particular patient is "codeine shopping" - travelling to different pharmacies to get it.
"Without medical supervision, a large proportion of the Irish population is self-medicating with codeine and many have unknowingly developed an addiction," she wrote.
"Those who suffer from a codeine addiction often tell how their relationship with the drug started so innocently in the quest for pain relief in a medical consultation and they had little to no understanding of the truly addictive nature of the drug.
"Often when pain has been fully resolved, the shackles of an opiate drug have bound an unassuming victim and withdrawal symptoms have become unbearable.
"Withdrawal symptoms include chills, constipation, nausea, insomnia, sweating, anxiety, lacrimation [tears] and muscle aches. In short, a truly horrible experience that is relieved only by succumbing to the drug again.
"Rebound headaches are also very commonly encountered by patients misusing codeine."
The current recommended treatment for codeine dependence is Suboxone.
Ms McDonnell said the problem of self-medicating with codeine could possibly be reduced to some extent if the drug's legal status was changed to prescription-only as has been done recently in Australia and Italy, removing the possibility of its availability over the counter.
"Although this could put further pressure on doctors to prescribe codeine, having prescriber involvement may unveil otherwise covert addictions," said Ms McDonnell.
"The introduction of screening tools for codeine addiction may also be a useful intervention in combination with improved medical training on prescribing addictive medicines and managing addiction.
"The possibility of reducing the quantity of codeine prescribed nationally could be considered, especially in patients with a previous history of taking medications with addictive potential or those uninformed and at risk."
Medication addiction could perhaps become a routine question when eliciting medical history from a patient, listed the same way as a medication allergy, to remove the social taboo associated with addiction and improve communication of such information between patient and prescriber, she added.
The establishment of a central monitoring system could help to keep track of the number of people being prescribed and purchasing the drug.
This could provide vital information on the true consumption of codeine in Ireland and better enable policy and public health decisions to be made to combat it.
Being aware of the ease with which one can buy codeine online is important too, she added.