Mixed reaction to codeine clampdown

YOU can’t have failed to notice it.

For the past month anyone attempting to buy popular over-the-counter painkillers from a pharmacist such as Nurofen Plus or Solpadeine will have been faced with what can be politely termed as a lecture on the potential dangers of the medications.

An array of facts on usage, questions on whether you have travelled to another store recently to purchase the same type of drug, queries on your medical history and inquisitive looks will potentially mean the prospect of leaving with a lower dosage than planned, or no product at all.

The situation may feel unnecessary, and at times it is undeniably frustrating, but the long-term benefits of such a defensive posture from pharmacists far outweigh any minor, short-term difficulties.

Every year, dozens of people either die, are dangerously harmed or become addicted to painkiller medications with powerful ingredients such as codeine, a controlled drug which in the wrong dosage is lethal.

The situation, which involves medicines obtainable without a prescription, is one pharmacists and other health specialists are determined to end. At the start of August new regulations were implemented ordering 1,700 pharmacies and 4,500 pharmacists to store all non-prescription, over-the-counter painkillers away from view and to grill anyone seeking the medications to ensure they were what the person really needed.

The new rules, which are connected to the 2007 Pharmacy Act, mean, despite the fact products containing controlled drug painkillers like codeine are not available by prescription only, pharmacists can advise alternatives or refuse to provide them if they feel the medication is not needed or could be misused.

Just as importantly, pharmacists – who from November 1 must have a private area to discuss the positives and negatives of the medications for each person – are also obliged to personally inform any buyer of the dangers of mixing them with other drugs, going over the recommended dose or using the product too regularly.

Earlier this week, Cork City Coroner’s court heard two reasons why such stringent new rules are needed. On Tuesday, city coroner Dr Myra Cullinane returned a verdict of death by misadventure in the case of 50-year-old Terence Walsh, from Killala Gardens in Knocknaheeny, who was found to have accidentally overdosed on Solpadol – a medication which contains both codeine and paracetamol.

Mr Walsh, who was found by his son, Tony, in the family sitting room on April 7, had a blood paracetamol level of 213mg – almost double the 160mg fatal range starting point – and 2.9 micrograms per millilitre of codeine in a lethal spectrum that activates at the 1.6 micrograms per mil.

He is believed to have overdosed when he failed to adhere to the recommended dosage.

A similar accidental death was also heard this week by the same coroners court involving 38-year-old Paul Twomey, a talented chef, originally from the nearby Churchfield Gardens and who once cooked for the British royal family, who was found in his backyard with a fatal level of the painkilling drug Tramadol in his system.

Similar cases have also been reported in Dublin and Galway coroners courts in the past year.

Preventing such tragedies, explained the Pharmaceutical Society of Ireland’s (PSI’s) head of communications, Kate O’Flaherty, is the key reason for why the new regulations are being implemented.

“This is about the safety of patients,” she said. “When people hear words like ‘over-the-counter’ and ‘non-prescription’ they may think the medication is harmless, but that is not necessarily the case.

“Every medication has risks and people need to be made aware of them.”

Despite the value of the policy shift, the new rules are not endorsed by all groups, with the Irish Pharmaceutical Healthcare Association (IPHA) – the organisation which represents drug company researchers and manufacturers in this country – claiming the regulations are excessive.

The Irish Pharmacy Union (IPU) has also described the move as a “mixed blessing”, as while it creates an extra layer of safety for the public, it leads to an increased workload for staff in the facilities.

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