ADDICTION MAY NOT be a word that people immediately associate with painkillers, but according to specialists, dependency on prescription or over-the-counter drugs is a real problem in Ireland.

Radio presenter Ray Foley brought attention to the challenges of coming off prescription painkillers on his Today FM show last week, with many listeners getting in touch with similar experiences.

He shared that he began taking prescription painkillers in April of this year and has been taking them daily for the last few months. Recently, he came to the conclusion that the painkillers have not been alleviating his pain so he decided to stop taking them.

He said that he hadn’t “slept a wink”, and he realised: “It turns out I’m addicted to them.”

What should someone do if they’re experiencing negative side effects while trying to come off a painkiller?

Colin O’Gara, consultant psychiatrist and Head of Addiction Services at St. John of God Hospital and Clinical Professor at University College Dublin (UCD), spoke to The Journal about the issue of painkiller addiction in Ireland. 

He advises people who are experiencing painkiller addiction to speak to a specialist or a trusted person as he believes “the key thing is breaking through that ceiling from what effectively is a prison of pain and ongoing addiction”. 

Pharmacist Lauren O’Reilly explained that pharmacists are available to speak with patients who want to talk about what they’re going through.

She outlined that it is tricky for pharmacists to raise the matter of painkiller addiction with a patient, given how highly sensitive the topic is, especially in a commercial pharmacy setting. 

“It is so touchy to bring it up with somebody, especially if you’re not 100% sure. We’re always just operating from the point of view of wanting to help somebody who might potentially be struggling with an addiction issue or with a pain-related issue,” she said. 

The approach to managing how to come off a painkiller can look different for each individual.

For instance, the HSE advises that if someone has been taking codeine for more than a few weeks and wants to stop taking it, they should speak to their GP first, and that the dose may be reduced gradually to help avoid withdrawal symptoms.

Long-term addiction

Over longer periods of time, painkiller addiction can become a significant problem if left untreated.

Speaking to The Journal, Dr Chris Luke, a retired emergency consultant, explained that when someone stops taking a drug that their body is habitually attached to, they can then suffer from withdrawal reactions. This can appear in the form of tremors, excessive perspiring, agitation and anxiety. 

On the subject of codeine, he referenced a problem that can develop of what he calls ‘pharmacy hopping’, where people obtain multiple packets of codeine products over-the-counter from various chemists in a locality.

He also mentioned the opioid crisis in the US, which began in the 1990s. Opioids are a class of powerful drugs used to treat severe pain. Common examples are codeine, morphine and tramadol. Moreover, illegal opioid examples include heroin and fentanyl.

“We see codeine as a weaker cousin of heroin and morphine,” explained Dr Luke, “Addiction to codeine is something that isn’t too unusual here.” 

O’Reilly explained that pharmacists don’t have access to any kind of centralised system that could allow them to see what a patient has previously purchased in another pharmacy, so are limited in their ability to detect whether someone is buying a product containing codeine from multiple locations.

Professor O’Gara said that for severe codeine addiction cases, consultants would look at a substitution plan for a patient to take an alternative drug to ease their codeine dependency.

For prescription painkiller addiction cases, he said that his team is seeing an escalation in this problem due to the availability of these drugs online.

“The internet really is very, very accessible in terms of ordering whatever pill someone wants and having it delivered,” he said. 

He also explains that some people are genetically predisposed to being addicted to opioid-type drugs. Common signs of addiction in a person are when they begin seeking maladaptive means to obtain the painkiller, usually by going online or doctor shopping.

What alternatives are there for people with chronic pain?

O’Gara said that major pain associations are researching into using non-medicinal ways such as cognitive behavioural therapy and talking therapies. 

Additionally, pharmacist O’Reilly believes in taking a holistic approach, as she said she often refers people with chronic pain cases to physiotherapists.