Ireland is seeing a spike in opioid deaths as prescriptions rise by over 50 per cent

Data from 2011 to 2021 also shows that the number of codeine tablets being dispensed in Ireland has increased by a massive 87.

It comes as addiction experts warn that more and more people are becoming dependent or addicted to painkillers, with many getting the drugs over the counter or online.

“We are now seeing an increase in the use and abuse of painkillers due to their availability,” said Professor Colin O’Gara, Head of Addiction Services at St John of God Hospital, Stillorgan, Co Dublin.

“The internet has fundamentally changed access to all kinds of pills.

“People and our patients can access all kinds of medicines on the internet and that’s just the reality.

“In terms of painkillers, there’s the internet route, a street route, and then the other route, which is prescriptions.”

the Irish Independent conducted an analysis of prescriptions written for the most commonly prescribed opioid-based drugs, fentanyl, oxycodone, tramadol, morphine, codeine and hydromorphone.

The analysis relates to pills distributed under the three main public drug regimes – the General Medical Services Scheme, the Drug Payments Scheme and the Long-Term Illness Scheme.

Together, these systems cover nearly 70 percent of the population.

The figures for the total population are likely to be higher as the data provided do not include items dispensed outside of community drug systems when the prescription has been privately paid for.

The combined data from the three programs shows that doctors in Ireland prescribed 5,989,714 oxycodone tablets in 2011.

In 2020, that number rose to 9,338,182 tablets, an increase of 56 percent.

Data for 2021, available only from January to November, shows that 9,234,282 oxycodone tablets were distributed nationwide. December issuance data will likely lift this number above the 2020 total.

Oxycodone is a semi-synthetic opioid loosely related to morphine, originally based on elements of the opium poppy, which is also used to make heroin.

In 2011, doctors in Ireland wrote prescriptions for 524,906 codeine tablets.

In 2020, that number rose to 983,687 tablets, an increase of 87 percent.

Opioid pill dispensing had been steadily declining since 2016 but picked up in the first year of the pandemic, when almost a million more pills were prescribed compared to the previous year.

In 2016, a total of 38,388,513 tablets were dispensed across all three systems. This fell to 36,748,419 in 2017, to 36,022,142 in 2018 and increased slightly to 36,043,083 in 2019.

Figures for 2020 show that 36,920,720 tablets were distributed, an increase of nearly a million from the previous year.

The largest volume of opioid medications prescribed in 2020 was tramadol, with 18,473,842 pills dispensed across all three schemes. Tramadol was the most commonly prescribed drug in all years from 2011 to 2019.

A few years ago, the former State Pathologist for Northern Ireland warned that not enough was being done to tackle the abuse of tramadol – which he branded a “big killer”.

Professor Jack Crane called for the substance to be reclassified as a Class A drug, saying it was just as dangerous as heroin.

Prescription opiates are a class of drugs that relieve pain, slow breathing, and have a general sedative effect. They are also highly addictive.

The most commonly prescribed opiates in pharmacies are tramadol, oxycodone, fentanyl and codeine.

according to dr Hugh Gallagher, a general practitioner specializing in addiction medicine and medical director of Smarmore Castle, an inpatient rehabilitation facility in Ardee, Co Louth, there has been a steady and growing problem related to codeine in recent years. “The majority of people who come to me (with a painkiller addiction) get codeine pills.

“You’re typically self-sourcing, which wouldn’t be reflected in your prescription stats. They go to numerous pharmacies and maybe get some online,” said Dr. Gallagher.

“That would be by far the most common scenario.

“They look at people taking Solpadeine or Nurofen Plus. I ask them how many pills they basically take in a day. It’s either 12, 24 or up to 72 tablets.”

The case of a 39-year-old woman who died after taking over-the-counter medication was raised in the Dáil last month. Laura Newell reportedly died after complications following bowel surgery to cope with the damage caused by painkillers.

She had been taking codeine painkillers because she had undiagnosed endometriosis at the time, said independent TD Marian Harkin.

Prescribing and over-the-counter use of codeine-based analgesics has come under increased scrutiny in recent years.

Tighter regulation of codeine dispensing in pharmacies has pushed codeine use out of the undergrowth and into the doctor’s office.

Ireland’s Medicines Management Program reported a 208 percent increase in codeine prescriptions between 2006 and 2016.

dr Gallagher, who also works for the HSE addiction services at a methadone clinic in Ballymun, Dublin, said prescribing guidelines on opioids, including codeine, are “very clear”.

“One in four people has a chronic pain problem,” he said. “About 80 percent of these are non-cancer patients.

“There is a difference between cancer pain and non-cancer pain. There are certain medications that should be used in acute situations and at the end of life, and opioids are one of those medications.

“Anyone would have to be cautious about prescribing them for long-term non-cancer pain.

“I would question non-cancer pain as to why it is being prescribed permanently and would be concerned that it is inappropriate and guidelines may not be followed.”

A 2019 report named Ireland as one of six countries where the number of opioid-related deaths has increased significantly. The Addressing Problematic Opioid Use in OECD Countries report found that Ireland, along with the US, Canada, Sweden, Norway and parts of the UK, had seen a “surge in overdose deaths” from the drugs.

The report said there is a “growing global health and social crisis fueled by illicit drug trafficking and overprescribing by doctors.”

In Ireland, the death rate from an opioid overdose increased from 41.1 per million in 2011 to 43.5 in 2016.

According to the report, prescription opioid drugs are a significant part of the problem.

“The impact of pharmaceutical manufacturers on pain management was seen as significant, conducting marketing campaigns aimed primarily at physicians and patients that downplayed the problematic effects of opioids,” it said. According to Prof. O’Gara, many patients are unaware that they are addicted to painkillers.

“The problem with addiction is that the person can suffer from it and have absolutely no idea that they are suffering from it,” he said.

“It can cause a bloodbath for people and families because the individual doesn’t see these signs and symptoms because often there aren’t any.

“It can be subtle in the early stages, but in the later stages with strong painkillers it can be very obvious. People can be heavily sedated.

“With codeine, people think, ‘That’s eight milligrams of codeine. What harm can you really do with that?’ If you take 72 of these pills in one day, you’re going to be very sick.”