RTÉ Prime Time Undercover filming reveals pharmacies not following guidelines on codeine sales

Tonight (Tuesday October 4) in a special report, RTÉ’s Prime Time goes undercover to discover how widely guidelines to control the sale of codeine over-the- counter in pharmacies are being followed.

Prime Time visited eighteen pharmacies and not one adhered to all the guidelines around the sale of over-the-counter codeine medicines.   

The pharmacies visited were spread across three different counties. Prime Time was sold codeine painkillers in each of the 18 pharmacies. The programme bought 408 tablets over three days from the pharmacies they visited.     

After reviewing undercover recorded footage an expert in codeine misuse Dr Michelle Foley from the School of Health Sciences at the South East Technological University of Waterford said it was “very worrying.” She added that she was “not at all confident that the guidelines ae being adhered to.”  

Dr Michelle Foley: 

“Codeine is an opioid medication that is used in the treatment of mild to moderate pain. It can also be used in the treatment of cough. Its addiction potential is quite strong. It is an addictive medication because it belongs to the same group of opioids, such as heroin. So, it is very addictive." 

Over the last decade there has been a 47% increase in the number of people treated for problem codeine use. Dr Foley has done extensive international research into codeine misuse and dependence, she said: “There needs to be much tighter regulation within pharmacy if they are to continue to sell this product over the counter.”  

Since August 2010, the Pharmaceutical Society of Ireland, the pharmacy regulator, has stated that all pharmacists must fully comply with its guidance on the safe supply of codeine medicines such as Solpadine, Nurofen Plus and Feminax. 

Since then, pharmacists have been required to directly supervise sales of the medication; question customers to assess if it’s the most appropriate treatment; and ask if they have tried an alternative non-codeine painkiller.  

Pharmacists are also meant to warn customers that codeine combined with paracetamol or ibuprofen has the potential to be harmful in overdose quantities or if used for a prolonged period.  Customers should be told not take it for longer than three days.  

Dr Foley said: “The three-day warning is really important because if the pain is unresolved within those three days, then the person does really need to go and see a GP.”  

Twelve of the pharmacies visited undercover by Prime Time gave the three-day warning but most did not explain why it was important to stick to this. In fact, only one pharmacy told Prime Time that codeine is addictive.  

Three out of the 18 pharmacies did not give the three-day warning at all, and a further three said that it was for ‘short term’ use only but didn’t specify for how long.

In one pharmacy, the only advice Prime Time was given was to take two tablets up to three times a day, preferably after food.  Two hours later, the programme returned to the same shop changing their appearance slightly and was sold a second box of Nurofen Plus on the repeat visit – with no questions asked or advice offered at all.  

After viewing the footage from all 18 pharmacies Dr Foley said:

“There was some attempt in some of the pharmacies to adhere to the guidelines, but none of the pharmacies that we saw in that footage actually ticked all the boxes in relation to the guidance that has been supplied to them from the regulator.”    

Medical Director of Smarmore Castle Private Clinic Dr Hugh Gallagher, told Prime Time: “The issue of codeine dependence is a significant concern to me, and I do regularly treat people with this problem.”  

“What you find is that they will traverse a wide area, going to multiple pharmacies and determining which pharmacies are perhaps easiest to acquire them from the story that they need to tell in order to get them but the problem with that is that it begins to dominate their whole lives.”  

Watch ‘Caution, Contains Codeine’ on Prime Time Tuesday October 4 at 9.35pm on RTÉ One and RTÉ Player. Produced by Lydia Murphy and reporter Conor McMorrow.