All inpatient records between 1 April 2007 and 30 April 2008 were retrospectively reviewed, and 20 patients were identified as having a diagnosis of either harmful use of OTC opiate or dependency. These patients represented 0.6% of all patients admitted during that period, and 4% of all patients diagnosed with mental or behavioural disorder due to psychoactive substances. Of the 20 patients, 70% had a diagnosis of opiate dependency and 30% of harmful opiate use. In addition, all but one (95%) had a diagnosis of co-morbid psychiatric illness. Codeine was the opiate misused in all 20 cases, and all cases reported using a combination-type OTC opiate, that is, codeine with paracetamol (e.g. Solapdeine) or codeine with ibuprofen (e.g. Nurofen Plus). Fifteen patients received treatment for opiate withdrawal.

 

Some of the other main findings of the study were:

·         The mean age of the 20 patients studied was 49 years;

·         13 were female;

·         13 had a history of harmful use of or dependency on alcohol;

·         8 had a history of harmful use of or dependency on benzodiazepines;

·         16 reported daily use;

·         4 reported chronic pain;

·         7 relapsed within six months;

·         15 obtained the drug over the counter;

·         5 obtained the drug over the internet.

 

Although the numbers in the study were small, the high rates of polysubstance misuse and co-morbid psychiatric illness among the cases reviewed are consistent with the findings of similar research internationally. The authors note with concern that the average reported amount of codeine taken daily was high (261mg), and suggest that this is likely to have been an underestimation. They point out that, to ingest such a large amount of codeine in the form of an OTC product, an individual would have to take correspondingly large daily doses of the combination compounds, usually paracetamol or ibuprofen, which greatly increased the risk of side-effects or overdose from both products. The authors suggest preventative measures, such as reducing the number of tablets per pack and placing an additional health warning on packaging. They state that any move to make OTC opiates prescription-only needs to be carefully considered, taking account of the increase in pressure on GPs and the reduction in patient autonomy that such a move might cause.

 

In May 2010 the Pharmaceutical Society of Ireland published guidelines2 on the safe dispensing of OTC opiate products; these products can now be dispensed only under the supervision of a pharmacist.

 

 

1.   Thekiso T and Farren C (2010) ‘Over the counter’ (OTC) opiate abuse treatment. Irish Journal of Psychological Medicine, 27(4): 189–191.

2.   Pharmaceutical Society of Ireland (2010) Non-prescription medicinal products containing codeine: guidance for pharmacists on safe supply to patients. Dublin: Pharmaceutical Society of Ireland. Available at www.drugsandalcohol.ie/13191