When little pills become a big problem


PILL-POPPING PERIL  Strong opiate-based painkillers, both over-the-counter and prescribed, come with serious addiction and overdose risks.

Andrew O'Brien

‘A spoonful of sugar makes the medicine go down’. So sang Mary Poppins and the Banks children. While everyone’s favourite nanny wasn’t drugging the kids, the idea of masking the taste of medication with something more pleasant is an old one that works for humans and animals. I once worked with a colleague who claimed to only be able to swallow tablets with a mouthful of Coca-Cola. It struck me as being somewhat counterproductive, but if there’s no other way of getting them down, what can you do?
Occasionally though, the medicine goes down too readily and becomes its own, far bigger issue. I refer to medication addiction, specifically opioid addiction.
By definition, an opioid is a compound that resembles opium in its physiological effects and addictive properties. By far the best-known opioid is heroin, but for the sake of this article we’ll be talking about opiate-based medications, which are strong painkillers.
Opioid painkillers include codeine, morphine, tramadol, fentanyl and oxycodone among others. They work by binding to opioid receptors in the brain, spinal cord and even the gastrointestinal tract, and are used to treat pain, with side-effects including feelings of pleasure, relaxation and contentment.
Historically, opioids were prescribed for moderate to severe, acute pain, often for patients who were either waiting for, or recovering from surgery. The prescriptions were typically short, giving the patient enough relief to get through the worst of the symptoms before less strong, but less risky, pain relief was introduced.
In recent years, particularly in the US – but in Ireland and many other countries as well – the rate of opioid prescription has increased. It has been reported that Irish prescriptions for oxycodone increased by more than 50 percent in the nine-year period from 2009 to 2017, while overall opiate prescriptions increased by about 20 percent.
Why have prescriptions gone up so much? There is no simple answer, but several factors have been cited.
The high cost of healthcare in the US, combined with the relatively low cost of medication means that people are more likely to seek or receive medication that relieves pain than seek further investigation or treatment to genuinely fix their symptoms. There have been suggestions that the long waiting times for elective surgery here in Ireland have contributed to the rising numbers. There are claims in the US that drug manufacturers and distributors, as well as certain pharmacies and doctors, have colluded to increase prescriptions and sales of opioids.
I remember hearing reports of addiction to painkillers years ago, and wondering what the fuss was all about. Let’s start with some stark numbers. It’s estimated that almost 200 people die every day from opioid overdoses in the US – that’s over 70,000 people a year. The cost to the American economy for treatment over the last 20 years is beyond $100 billion, while a further $12 billion is estimated to have been lost due to the decline in addicts’ employability and career prospects.
While the figures for Europe in general and Ireland in particular aren’t quite as terrifying, the aforementioned increase in prescriptions could point to a worrying trend. The fact that Ireland has the third-highest rate of drug-related deaths in the EU suggests that there is, at the very least, potential for such problems to increase here.
On a positive note, the move in 2010 to restrict sales of codeine-based medications such as Solpadeine and Nurofen Plus saw a 33 percent reduction in codeine-related overdoses in Ireland over the last decade. It appears that overdoses could be reduced further by restricting access even more.
The Princess Alexandra Hospital in Brisbane reported a 50 percent reduction in cases of codeine overdose in the 12 months after Australia’s Therapeutic Goods Administration made all codeine medications prescription-only. In their report, the authors also pointed out that there was no related increase in overdoses of other opioids in the same period.
While we can put some blame on the system and argue over whether restricting access to certain medication works, it is also worth considering patient attitudes to medication. For example, an audit of the Dublin Neurological Institute Headache Clinic in The Mater Hospital Dublin in 2011 found that 52 percent of the cohort of 200 patients suffered from medication overuse for headache, with the majority overusing codeine or paracetamol. The patient’s preferred medication was at least contributing to their symptoms.
It goes without saying that addiction is a complex issue. All we can hope is that awareness, monitoring and policy decisions on behalf of government, the HSE and doctors in general, as well as sensible decision making by patients, combine to stop what is currently a relatively small issue here becoming an American-sized problem.

Andrew O’Brien is a chartered physiotherapist and the owner of Wannarun Physiotherapy and Running Clinic at Westport Leisure Park. He can be contacted on 083 1593200 or at www.wannarun.ie.