Do you think it's right that pharmacists should question people before giving them codeine tablets?
I do not object to being asked a genuine question regarding health and required medication.
What I do object to is who asks the question, how the question is asked, the public way in which you are questioned and the all to often lecture on why you should or shouldn't be taking this particular medication with, on more than one occasion, the assumptive attitude that you are an addict or will become one.
Just to note also that I have only ever been asked by a pharmicist once, mostly it is the sales assistant who spouts a well rehearsed, however often (not always) but often a non-knowledge based script. This is then followed by a cursory nod and often scowl from the pharmacist at a distance!
So really the topic isn't "Do you think it's right that a pharmacist should question people before giving them codeine tablets" as personally I have no objection to this....the question should be "Do you think it's right that a sales assistant desplaying no real knowledge of the product or pharmacology as a whole should question people before giving them codeine tablets?"
I have a great professional relationship with my GP practice, who know, understand and recognise I am not an addict, I display no addictive signs and prescribe the long term intermittent use of such a product as an effective relief to pain following 4 major joint surgeries.....I'm comfortable with that.
Addiction is a terrible and crippling disease - I can see not evidence that addiction is prevented by this protocol...unless you have evidence to support otherwise?
i buy neurophen plus as is helps with my back pain,panadol only takes away the pain for a hour, i do be crippled with pain also find neurophen plusvery good for all sorts of pain like sinius, headace, sore ankles,
In answer to above, why on earth are these tablets not on prescription only? The manufacturers must be so so happy, they have many people addicted and the price of these tablets are going up and up by the day. Something wrong somewhere and it cannot go on.
By codeine I presumb you mean soluable brand names Solpadeine etc. It has to STOP!
Tizzy by name and nature
In Ireland in the 1970's, Codeine Tablets could be bought over the counter in any shop or Chemist! Who was protecting the public then from those tablets then? I remember a girl at work stating to me, when I had a horrendous toothache, take a couple of Codeine and they will take the pain away!
Chemists were as educated as now, as were Government Departments, and the Dept of Health.
Definitely. It's not annoying: and it could actually help someone. It only takes seconds.
Hi there -
I don't know if there's any point jumping in on this particular discussion, but I just wanted to offer a brief overview of someone who became chronically addicted to OTC Codeine-based products.
It's a very very longstory, but it all started with a prescription for Tylex (30mg codeine / 500mg paracetamol per tablet) along with a lot of other medicattions after an eye injury.
I took these as prescribed, however ery quickly fell into a spiral of dependence. At first, a few Nurofen Plus in the morning, to alleviate the ongoing pain, then onwards to hell on earth.
Having become severely dependent on Codeine (up to 1,000 mg per day just to feel normal) and having struggled desperately to find appropriate help (being bumped from one HSE worker to another to another) I finally found a froup of HCP's who woul work with me, and took on board the severity of the position I was in.
I am now in treatment, and am trying to arrange some kind of peer support group for people similarly affected.
Please contact me at firstname.lastname@example.org if you are interested in sharing your story.
I don't see the point in the kurt attitude of some pharmacists and I really don't see the point with the new regulation. I don't get quizzed about my alcohol consumption, it's as addictive and has much more negative health effects than codeine addiction in my opinion. codeine itself is not very harmful, but the NSAIDs it's combined with can be, specifically paracetamol which is available in every shop not even just chemists. Ibuprofen while it can cause stomach problems it's no worse than alcohol misuse. I wold also say that while 8 mg of cideine in solpadeine is not very effective since the tablet is laced with caffeine to 'aid' paracetamol, nurofen plus is a substantially better pain reliever than NSAIDs alone. Anyone who thinks different doesn't understand the pharmacology of these drugs. So until alcohol and paracetamol (to a certain degree) are regulated in the same manner, I don't see the usefulness of this regulation at all. Either you have an addictive personality or you don't this regulation will not change that, and it won't stop addicts from procuring it either. Waste of time and drives down sales in a country where Pharmaceuticals is big business (albeit these specific products are not made here). Just my opinion.
I understand why a chemist has to ask if you are taking codeine. I'm on tylex at night time. I only take them if i really need them for my back pain. I take nurofen plus in the day time. I only take them if I really need them-panadol only helps for about an hour, xx
HSE Employee. You make a very valid point about purchasing codeine-containing products but there are solutions. You could ask your doctor to put your over the counter medicine on your prescription. You don't have to purchase it at the time you collect the rest of your prescription but when you need it just refer the assistant to your prescription. It would also be useful to speak to your pharmacist as you have outlined here.Then when you do require your over the counter product there should be no problem with explanation. This assumes that you go to the same pharmacist for all your medications and so develop a relationship in which there would be no 'interrogation'. By the way, the value of 16mg of codeine as a pain killer is certainly in some doubt. Most pharmacologists would claim that the addition of 8mg per tabletof codeine to paracetamol or ibuprofen does not enhance the analgesic effect so you might be better off taking straight paracetamol or ibuprofen at the full dose.
Its been a while since I joined this debate, obviously little has changed in that time.
There seems to be a little confusion between a product being patented and trademarked. As others have already pointed out its unlikely that products like Solpedine can be patented and their patent ended as their ingredients have been around for far too long for any company to be able to claim a patent on them. What they can do however is Trademark familiar names like Solpedine and Nurofen, its these brand names drugs that are all more expensive then their generic counterparts which contain the exact same components and subsequently do the same job. The Minister of Health frequently claims to save us large amounts of money by buying these generic drugs every so often, there's no reason why the average consumer shouldn't do this too.
Its clear that drugs containing small amounts of codeine, typically 8mg, can be bought over the counter, sometimes. However its also clear that these same drugs also have the potential to be abused, and a minority do this. So the question is how to limit access to these drugs from those who would abuse them and allow access to them for others?
The easiest answer is to require all codeine based drugs to have a prescription signed by a doctor. Needless to say, while this will defeat all but the most determined addict, it will also remove a relatively mild painkiller from everyone else's ease of access too. I imagine the drug manufacturers won't keep making a product that they can't sell either.
Right now the best solution put forward is for everyone who wants the tablets to present their case to the pharmacist and he/she will decide if they are warrented. Personally I don't like it, I discussed this before so I won't repeat myself.
I have several medical problems, I have to take a lot of drugs, and yes I am in pain most of the time. Sometimes it can be quite bad and Solpedine wouldn't be strong enough so my doctor prescribes other drugs for those occassions, but I don't want to be taking them when I don't need them and if I can get away with something milder like Solpedine then I'd prefer to have access to them. If someone, maybe like me, would wish to have access to Solpedine on a regular basis, have a genuine reason and not want to be interrogated every time, why not get some sort of card or proof from their GP to say this? A card could be presented to the pharmacist to prove, yes I have a reason to ask for this product and leave it at that. The pharmacist would be satisfied, if the card was presented with another form of identification so it couldn't be passed along, that the holder has a reason for the codeine and the card holder would be satisfied that they're not interrogated. I realise this may not suit the consumer who may buy the occassional pack but its the best I could come up with.
Second Chance. I am replying to you because maybe others are reading your posts and I cannot allow certain errors to be unanswered.
Error 1. Nurofen does NOT contain codeine and that is why your daughter can buy them on demand. Nurofen Plus contains codeine and BY LAW a pharmacist supplying this product has to satify herself/himself that the patient is aware of what they are taking.
Error 2. Solpadeine was never under patent and it could not be because the two drugs it contains (paracetamol, codeine) have not been under patent. Maxalief is a copy of Solpadeine brought out by an Irish company and is somewhat cheaper. Incidentally there are many paracetamol/codeine combinations on the Irish market but because the codeine level is higher can only be obtained by a doctor's prescription.
My mistake, I meant to say Neurofen in my first paragraph) it contains codeine and she was never received the third degree about taking them.
As for patend ending, there was most certainly a patent on Solpadeine and until it ended only then could the likes of Maxilief come on the market.
Honestly, no need to reply to this I shant be reading it.
Second Chance. I don't understand your point about your daughter in the first paragraph.
In the second paragraph you mention about patents running out. There is no patent or never was on products like Nurofen and Solpadene. These products, as do numerous others, contain the two main pain killers which can be obtained over the counter (paracetamol, ibuprofen). If these two products were ever patented it is back in the mists of time. As for codeine, this goes back to the 19th century. You query whether or not pharmacists were doing their job. I don't know, but the amount of posts on this thread seems to suggest that the public don't want them to do their job.
I can't add anymore to my previous post. Don't watse your money on products that have no therapeutic advantage over the cheaper simpler medicines.
Hello John, My daughter came home on many an occasion over the years with Ibrufen for use in the relief of period pain, I have no reason to disbelieve her (this came up in conversation after reading an article on codeine containing meds) my daughter is in her mid thirties and a solicitor so, is quite sensible.
John! these codeine containing meds were sold freely by pharmacists for many years, does that mean that the paramacists were NOT DOING THEIR JOB up to the point of PATENT ENDING and Maxilief coming on to market at less expensive price etc. but I should be directing this query to a Pharmacist!
Second Chance. You seem to be making statements which are untrue. All products with codeine are controlled BY LAW. The pharmaceutical companies which market these products eg pain relievers, cough mixtures etc. would much prefer if these items were on open sale. They would prefer if these items were in supermarkets on big special offer stands. Making money is their thing. The Irish Medicines Board remit is to protect the public from unscrupulous selling of dangerous drugs. In many countries codeine products are strictly by prescription only.
The other thing to be borne in mind is that these multi drug painkillers have sub-therapeutic levels of codeine so they are a waste of money. If anyone wants a painkiller there are two on the Irish market which can be used safely. The first is paracetamol (panadol etc.) and the second is ibuprofen (nurofen etc). If you have a pain go to your pharmacist and get advice in the best pain reliever for your type of pain (ibuprofen for muscular pain), the best dose and the best price. The big brand names mentioned in this post are also the most expensive.
Children! please calm down and stick with the issue. I would really appreciate
if my question above could be answered after all it is staying with the question in
I will ask once again, why are other medicines containing codeine given out freely
namely Neurofen, (not sure if that is the correct spelling) also cough medicines ?
I still think all this started because of the patent ending and another coming in on
taking part of the business.
The irony. I was answering questions truthfully, but you decide to get personal. So who's the rude one? Anyway, I don't debate with anon users, it's pointless.
And the rudeness continues. I sincerely hope I nor any of my familty have to deal with Jamie.
Not sure if you're the same "anonymous", it's hard to debate with someone who doesn't have a username. You seem to be forgetting this is a public messageboard, not a consulting room.
As someone who does deal with the public, I thankfully have the professionalism not to refer to them as "idiots" and anyone doing so whose job (or part of their job) is to inform or educate is behaving in a highly questionable, not to say inappropriate manner, in doing so.
People are idiots. In a job where you have to deal with the general public you'll soon realise that there's a massive percentage of idiots out there.
So now it wuld appear that we have healthcare professionals - who, presumably are meant to help and advise, referring to people as "idiots"??
Ok, I'm only writing this because so many people here seem so misinformed about the subject. Firstly a pharmacist(like myself) is actually a healthcare professional, we have less prescribing powers but in fact pharmacists know much more about pharmacology of drugs ie the metabolism, excretion etc than doctors actually do, a doctor is used for disease diagnosis and prescribes a drug, if we feel for some reason (such as interaction with another medication) that the drug is contraindicated we will phone the doctor and ask if they would stil like it dispensed, the reason for this is so that if something were to happen to a patient then we would have done all the possible things within our power as pharmacists to ensure we uphold our duty of care to the patient. In response to the previous comment, ALL codeine containing products are kept out of view of the public, and all are subject to the questioning regimen set in place by the HSE in order to discourage potential abuse. I would personally like them all to be put on script mainly so I don't have to listen to people accuse me of attempting to withhold the medication. And just as some idiot mentioned earlier that it's your right to be allowed the codeine medications, that is in no way the case, the law is that the pharmacist must be satisfied that the patient is aware and knows the dangers of taking too many etc, incidentally the codeine in solpadeine is actually a subtherapeutic dose, meaning there is not enough in it to affect your pain but there is enough to cause withdrawal symptoms such as headache. Anyway by law, if a pharmacist decides that the person is not taking the medication correctly or is abusing it then they have a right to refuse it, this also goes to whoever says "it's my right to have it, now give me my solpadeine", in this case a pharmacist is legally allowed to say that they may feel they are being intimidated into selling the drug and refuse to sell it, I mean do u really want a pharmacist who'll give out whatever they're asked for juts because someone read something on the Internet nd suddenly think they're healthcare experts?? That's ridiculous in the extreme, I wouldn't go hammered drunk into a pub and demand a pint cuz it's my right, I'd b kicked out and rightly so. Most people think it's some sort of conspiracy to make them spend money on a doctor, but these are exactly the same people who'd b the first to take legal action against u if they didn't get what they want or if heaven forbid a dispensing went wrong. Now when I go sell solpadeine and nurofen plus when people answer the questions correctly, they could easily be lying to me, it's not up to me to determine whether they are lying because if they lie to get it, guess what, legally they've only themselves that they can hold responsible, I've done my job to the best and most legal ability required by law, it's up to them to heed the advice. Incidentally I do consider people claiming it's for something embarrassing to be a form of intimidation and would proceed with extra caution in such a case. So jus for informations sake, it's not the pharmacists fault that these laws were passed, if anything most pharmacists were happier before because this legislation actually reduced sales and profit margins so we lost money from it. If u want to blame someone, blame your health minister.
I understand you Anon. but you are missing my point, there are other pain relief tablets on the market readily available over the counter with the same amount of codeine and you will not be questioned on those. I am not going to advertise the tablets, you check it out. Its all got to do with drug companies and money, they don't care about us.
why are these codeine based medicines are not put on a prescription basis only? Do you really want to needlessly shell out sixty euro every time you need a tramol? Oh wouldn't GPs love that? But I'm afriad the rest of us don;t have that kind of money to throw away.
Can anybody tell me why these codeine based medicines are not put on a prescription basis only?
When these solubable codeine based tabs were introduced to the market, they were recommended willy nilly, and no doubt there were great for pain relief, but it seems when the patent expired and another company produced a less expensive equivalent the the pharmacies started querying each customer, I wonder why, what do you think?
Yes, I know a lot of people who go straight for the tablets with codeine without trying ones without it. Its terrible because these views are passing down to their children. People don't recognise the danger associated with using stronger pain killers for all ailments- at least the pharmacist can tell them because people rarely read the patient information leaflets in the drug boxes.
Yes since codeine causes addiction.
I've only seen the debate today but I know it's something that has irritated me no end since this ruling came into being. I have no problem with the chemist dispensing these tablets and warning about the possible consequences, but that is not what many (not all) of them do. You are questioned and dictated to, probably in front of a crowded shop. Mind you that alone should put you off buying codeine for life. No matter what pain you're in. And that is why most of us are there in the first place - pain relief. And to try and tell me that paracetamol on its own is just as good, you've never been on the receiving end. Codeine is addictive but then paracetamol can be very dangerous if taken in sufficient doses but I don't see anything being done about that. Limit it to 24 pack. One pack in how many chemists? And yes, I do think pharmacists are on a 'power trip'. At one time they stayed at the back of the shop and dispensed. Now they are up front and are dictating. Sometimes even if you have a prescription, and on the other hand they say go to your Doctor and get a script. This can be a very expensive packet of Solpadeine! And do you seriously think all users have a medical card and are ripping off the system? Stereotyping?
Yes people do abuse codeine and I'm sure many other drugs, but what about alcohol and tobacco. Is anyone on standby at the local corner shop and off-licence/pub to fend off would be purchasers? Of substances that have been clinically proven to be seriousley detrimental to health to the point of death for decades. No I don't think so. Where billions of €uros are involved the nations 'health' is forgotten about.
Yes I do use Solpadeine, occasionally. I find it a very efficient painkiller. As admitted by my own chemist, (a gentleman) for his hangovers! Years ago my Doctor told me they were the safest painkillers to take with my many other medications. Safe maybe, but not easy. Thanks for giving me the opportunity for getting that off my chest!
You seem like a very resonable person iknow.imgood and, frankly, a breath of fresh air. I don't have any problem with anything you've said here, Solpediene has always been sold in pharmacies and to change that would be foolish, not that there's any question of doing that. It is of course frequently abused, take Carol the previous poster who mentions someone who takes a stunning 90 Solpediene a day. This would also involve 90 doses of paracetamol a day, as the maximum recommended dose is 8, 90 would be lethal.
I agree that there is a relatively small amount of codiene in these tablets and the addictive quality of them was a bonus to manufacturers, lets give them the benefit of the doubt and say they were'nt designed that way. But they are still painkillers, and available over the counter, or so we're led to believe. Not every pharmacist is reasonable, as I've described I've met one who has a problem selling me Solpediene, and even Ibruprofen. I don't mind anyone having a bad day, but when it stretches into a bad year its a problem and it goes against my nature to report him, as has been suggested, when I've found a solution, of sorts.
You have to remember that just as you want the public to realise a significant amount of people abuse codiene based medication, there are more who don't and who legitimately have a right to buy it. Buy it, not have it prescribed on Medical Cards and have the taxpayer pick up the bill. That said, I have absolutely no idea how anyone can distinguish between the two and I don't envy your role.
iknowimgood, you are a pharmacist NOT a doctor, so unless you know all the details of each and every case and have all the doctors reasoning and knowledge on each one, then you cannot possibly say with any accuracy that doctors prescribe "ridiculous" amounts of these. Clearly they have no choice if patients are going to get what they need without being obstructed by pharmacists as the cases below have obviously showm.Unless you have all the medical training of a Dr you cannot possibly advise that "the dr should prescribe paracetamol only". Do you think you know better then them now. If a patient only required paracetmol then there would be no need to attend a Dr and pay 60 for it - which people do not do lightly, Nor indeed would there be much need to go to a pharmacy either as they can be obtained in a supermarket. Even a cursory glance over the posts before would cleary show that paracetamol most certainly does NOT work in every case where codeine is needed - if it did then obviously there would be no need for codiene and no need for patient to attned a Dr to get perscrioptipon for it which they clearly do.
I presume if you are so concerned about those whon are addicted that you did your professional duty and referred them to a Dr - yes? Tho it certianly says a lot when you refer to those attending your pharmacy as "wallies" who make you laugh. So you say post about how neccessary the legislation is and how you apparently know more thab doctors and then blatantly say you refuse a sale and never have??? What thha is your point exactly or indeed gthe poin tof having such legislation?? It is you who is laughable I'm afraid.
This debate amazes me, it has been running for months now. I am a pharmacist and sell solpadeine every day of the week. Whether people understand this, the basic fact is that solpadeine can only be sold in pharmacies. Thats because, they are only licensed to be sold under the supervision of a pharmacist because these can cause harm and they are not smarties. This medicine is regularly abused and I have numerous people that take this everyday and can't stop it (+dont want to) due to withdrawal side effects etc-insomnia, irritabiity, withdrawal headaches etc. Can people just except that whats happening now is they are been sold correctly now and were been sold casually before. Doctors prescribe ridiculous amounts of these now and the taxpayer picks up the tab on the medical card+dps system- the dr should prescribe paracetamol only-the codeine amounts are so little in solpadeine their pain relieving properties are not augmented, just the codeine makes them addictive-well designed+with caffeine, the manufacturers knew exactly what they were doing!!. At the end of the day, i find it very humorous that people think we are on power trips when it comes to refusing the sale of this drug. To be honest, it is a complete waste of my time+i find the whole situation laughable. A regular solpadeine addict said "you just dont want me to feel well, i dont have pain but i take these every day to give me a pick me up and i feel great"! Sums it up really, he doesn't know that he is addicted. He doesnt care that he abuses them+we are blue in the face advising wallies like him. I never refuse a sale and never have. I provide the information and they can take it on board if they want otherwise I sell it everytime-boxes of 12 if i suspect misuse. Pubs dont refuse alcohol to alcoholics and i dont refuse on the grounds that they are mature adults that make decisions for themselves.
Hi , Its Carol again,
I know a young man addicted to Solpadeine at the moment, he is taking 90 of them a day!! Has nobody ever thought that maybe these pharmacists CARE about people getting addicted? I think Solpadeine should be sold on prescription only as they are so very addictive!!.
As the pharmacist refused to call the GP both for your daughter and for you and had an issue with selling you a non-controlled drug such as ibuprofen then he is acting in a highly unprofessional manner and I presume you both reported him? Yes?
Indeed doctors are human but they have had extensive medical training, which if that cannot rid them of their embarrassment abvout either nudity or periods I would question why they would choose to enter such a profession in the first instance as they clearly have such a mental block about aspects of it which in thieir professional capacity they will have to deal with if they are to treat theior patnets in a proper manner. My neighbour greatly dislikes cats - hence she choose not to become a vet.
As I've already said my daughter and I are patients of the same medical practice and use the same pharmacy, this is the same pharmacist, and previously when my daughter asked for Solpadeine he simply refused to call her GP when asked to do so. I can't say why, I don't know, but he has a reputation for doing this so it's reasonable to believe he won't call my GP when asked to do so either. If he had an issue selling me Ibuprofen I wasn't even going to ask for Solpadeine and hope he'd maybe call my GP.
As you may have gathered from my name I work with many doctors and the concept of "a doctor being embarrassed by nudity" is not so ridiculous as it sounds, they are human and are just as capable of embarrassment as the rest of us. I even remember a very capable doctor once who was terrified of the sight of blood, he was never going to make a surgeon, but was a good doctor never the less. Wearing a white coat does not somehow stop someone from experiencing the perfectly normal human faults and failings. We're all human, some more so than others.
Yes nurses, paramedics, radiographers etc are medically trained in their disciplien as well. Agreed you are not a patient of any of them unless you cross paths in a professional capacity and in the case of the pharmacist you did cross paths in a professional capacity and just as your D advised, you could have had him call your Dr at which point he would have been informaed of any medical information pertinent to your request.
Yes, some people tend to be embarrassed at some things but a medically trained pharmacist being embarrased at an entirely normal everyday biological occurence?? That would be rather like a doctor being embarrassed by nudity really wouldn't it.
Yes I understand that severe period pain and/or endo can warrant Solpediene, and given that no-one can say who has these, or when, then the pharmacist cannot dictate along these lines but is restricted to specific criteria when selling codeine containing medications.
"Pharmacists are medically trained", really? If this arguement is true then so too are nurses, paramedics, radiographers etc but I am not a patient of any of them either, unless we cross paths in a professional capacity, in which case they will have my file available to them and know everything medically relevant about me.
People are human not robots and we do tend to be embarrassed at some things, some more so than others, my wife's friend simply exploited a pharmacist who does appear to be delicate and sensitive. Previous posts said severe period pain and/or endo (something I will never experience) is something that can warrant Solppediene, but who is to say who has these, or when? The pharmacist must trust the customers honesty or go down the road of interrogation and, as human nature comes into the equation, some customers will be less than honest.
I was speaking to and being served by the pharmacist, who was relucant to serve me, in the past while dealing with my daughter he refused to call her GP so I was reluctant to down the same road. I never asked this man for Solpediene, even though my GP told me to, the only painkiller I bought was Ibuprofen.
My last post appears to be in bold type, I don't know why.
HSE, pharmacists are medically trained. For one to become embarrassed about a perfectly normal functuon which happen to 3 billion people on a regular basis of half their lives, they would have be one extremely delicate and sensitive pharmacist. So you choose not to speak to the pharmacist, why then did you not ask them to ring your Dr, as your Dr suggested.