2069. Deputy Róisín Shortall asked the Minister for Health the information available to his Department on the extent of the problem of codeine addiction; if consideration has been given to ending the availability of the two biggest codeine products (details supplied) without prescription; the policy in respect of the provision of suboxone or methadone as a treatment; and if he will make a statement on the matter. [44276/22]

Minister for Health: Codeine is a mild to moderate opioid (narcotic) analgesic which, due to its potential for misuse, is a controlled drug under the Misuse of Drugs legislation.

As an analgesic, codeine is most often used in combination with other analgesics such as paracetamol or ibuprofen and is currently authorised in Ireland in such non-prescription products for pain relief. It is also available in single ingredient, non-prescription products, as a cough suppressant. These authorised products are available without a prescription through retail pharmacy businesses (pharmacies) only.

The Pharmacy Act 2007 and the Regulation of Retail Pharmacy Businesses Regulations 2008 require that all medicines supplied through a pharmacy must be supplied by or under the personal supervision of a pharmacist and that all non-prescription medicines supplied must be the subject of appropriate counselling.

The Pharmacy regulator, the Pharmaceutical Society of Ireland (PSI) issued guidance to pharmacists on the safe supply of non-prescription products containing codeine in 2010. This Guidance was updated in 2015, in 2017 and again in October 2019. The Guidance covers the requirements set out above and in addition contains further restrictions which apply to the supply of codeine containing medicinal products.

These restrictions include a requirement that codeine containing medicinal products are not available to the public for self-selection and should only be supplied when a pharmacist deems such a supply to be necessary and only when a non-opioid analgesic, e.g. paracetamol, aspirin or ibuprofen, has not proven sufficient to relive the patient’s symptoms. The Guidance also states that medicines containing codeine should be used for the shortest time possible and for no longer than three days without medical supervision. Pharmacists must also ensure that patients are advised of the importance of adhering to the recommended dosage and duration of use as well as the risks associated with overdose and or/prolonged use. Patients should also be counselled in respect of potential adverse reactions or side effects.

The full Guidance document, along with information on current legislative requirements, is available on the PSI website: thepsi.ie/Libraries/Folder_Pharmacy_Practice_Guidance/01_3_Safe_supply_of_Codeine_to_patients.sflb.ashx.

More recently, research has been welcomed by the PSI re the “Advice on Codeine Supply Helping to Reduce Overdoses”, please see the link below for more information.

www.thepsi.ie/tns/news/latest-news/21-06-08/Advice_on_Codeine_Supply_Helping_to_reduce_Overdoses.aspx

The National Drug and Alcohol Survey collects information on alcohol and tobacco consumption and drug use among the general population.

The most recent National Drug and Alcohol Survey (2019-2020), included questions about the use of opioid pain relievers (including over-the-counter opioids such as codeine).

The most common type of opioid pain reliever used by current users (used in the last 30 days) were over-the-counter codeine products (80.2%). 

On the most recent occasion that current users took opioid pain relievers, 62.9% obtained them from a pharmacy in Ireland without a prescription, 25.6% got them using a prescription written for them, and 7.2% got them from a friend, spouse, or relative.

The Department of Health is committed to working with relevant stakeholders in fully considering any policy changes that may be required regarding the regulation of codeine containing medicinal products.

Any potential change to the prescription requirements for codeine containing medicinal products must be supported by sufficient evidence. Based on available evidence, we will consider taking any necessary further steps to support the safe and effective use of these medicines.

With regards to the provision of suboxone or methadone as a treatment, the National Drugs Strategy commits in strategic action 2.1.14 to improve the availability of Opioid Substitution Treatment (OSTs). The HSE is leading in this action.