Codeine is a highly abused substance in Ireland yet remains relatively under-documented in research studies. From a dual perspective as both a current medical student and practising community pharmacist, I note that codeine is an addiction that is often hidden under the guise of pain management, going unaddressed by both doctor and patient.  Pain is a very common complaint in primary care settings in Ireland and the UK. In the UK, an estimated 1 in 25 of primary care consultations are thought to be related to headache and 1 in 7 related to musculoskeletal pain. Opioids are commonly used in Ireland and the UK for pain reduction with codeine being the second most prescribed opiate in the UK and an estimated 640 codeine prescriptions were dispensed per 1,000 patients in 2012. A short-acting opiate-based analgesic, codeine binds weakly to opioid receptors primarily in the central nervous system, reducing nociception. It also binds to opioid receptors elsewhere in the body like the gastrointestinal tract however, accounting for its side effect profile including constipation and nausea. As well as analgesia, codeine elicits effects such as euphoria and sedation which give the user short-term experience of a ‘buzz’ or ‘calm’.

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Reader Response to IMJ Article: “Codeine Usage in Ireland – A Timely Discussion on an Imminent Epidemic” by E. McDonnell

Dear Sir,

We read with interest the article by McDonnell regarding an imminent codeine epidemic in Ireland. We commend the author for highlighting this important healthcare issue. The author outlines numerous concerns including codeine shopping, the lack of medical supervision for over-the-counter (OTC)/non-prescription codeine supply and the increase in prescribing addictive medications.

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