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OTC opioids: Pharmacy’s dirty little secret


OTC opioids: Pharmacy’s dirty little secret

Could a pharmacist-designed mobile app help motivate people to reduce their use of OTC opioids when they’re doing more harm than good? By Richard Addy

About six months ago, I had an experience in my pharmacy that left a strong impression on me. I was busy in the dispensary, checking prescriptions, when a gentleman (I’ll call him Philip) landed in. Philip is someone I generally have a cordial relationship with. However on this day, he had what we call in Ulster a “sour bake”.

Philip wanted to speak to me urgently. I asked him to take a seat for a few minutes, as I was particularly busy. But I could sense his growing irritation at being made to wait.

When I eventually got talking to Philip, I found out that my actions had been the reason for his ire.

I’ll leave out his expletives, but this is the gist of what was said: “My partner came in here earlier with my son. You didn’t sell her any headache tablets. What’s the reason?”

“She bought another pack from us recently. Those tablets are addictive and for short term use only,” I replied.

Philip’s voice raised up a notch. “There’s no reason not to sell those tablets to her. They’re just headache tablets. I can’t believe you did that to her in front of my five year old son!”

“It’s my job to refuse to sell medication if I believe it is for inappropriate use. Also, your partner was in the pharmacy on her own today. Your son wasn’t there.”

By this point, the red mist had fully descended over Philip. He was clearly flustered – and very angry. What came out of his mouth next was a mix of threatening gibberish and confusing information about his absent son.

He ranted and raved loud enough for everyone in the pharmacy to hear and I was very relieved when he eventually stormed out.

Unusually for him, he didn’t return for many weeks. I was more than glad as I didn’t want to see him again.

Philip’s issue was that I wouldn’t sell co-codamol tablets to his partner. He was the person the tablets were intended for, I later discovered. He was addicted to them and would go round “every pharmacy in Belfast” (his words, at a later stage) to get them. Philip was confounded by the fact that I refused to sell the tablets to his partner. Weren’t they just “headache tablets” after all?

Codeine can actually cause headaches, and it has a limited analgesic effect. Its side effects include sedation, constipation and sometimes dependence.

Long term abuse of codeine-containing preparations can lead to liver damage, seizures and kidney damage. I wouldn’t wish these outcomes on Philip or anyone else.

When I next spoke to Philip, he had a different demeanour and a more pleasant expression on his face. He showed me his new prescription for buprenorphine. He had been inducted onto a substitute prescribing programme – buprenorphine being a substitute for co-codamol.

He said: “I spoke to my GP recently. When I told him about the co-codamol, he said that I was wrecking my liver, wrecking my kidneys and if I didn’t stop taking them, I wouldn’t be around to see my son grow up.”

I was genuinely surprised by this. A short conversation with his doctor was all it took for him to realise that he had a problem. His attitude had been turned around and he was now getting help for his addiction. We (his pharmacy) were back in the business of looking after his health.

As I stated at the start of this article, this episode left a strong impression on me. It reminded me that a person’s outlook can change, and sometimes it doesn’t take very much persuading.

Over the counter opioids are community pharmacy’s dirty little secret. Most pharmacists will probably have felt like illicit drug dealers at some point in their career. None more so than when selling codeine-containing tablets to a ghostly white looking person, who claims to need the medication for their unspecific back pain (or similar ailment).

I have recently started working on a technological improvement to help with this problem. I’m developing a mobile application to help to motivate people to reduce their use of OTC co-codamol and similar opioids.

The app will allow people to track their usage, educate them about the effects of codeine on the body, and provide a communication channel back to their pharmacy team, to get advice and support to reduce their dependence. It will be anonymous and free to use.

The working title is CodeineApp. I’ve secured development funding and have enlisted some pharmacies who have kindly agreed to trial it for me in a pilot programme.

CodeineApp is an attempt to do what Philip’s GP did for him. It is to nudge people to see a healthier way forward, without shaming or judging them.

As for Philip, he has been doing well on his medication. His new, positive attitude is refreshing and his general health appears to be improving. Neither of us have mentioned our earlier, heated exchange. Some things are best swept under the front door mat.

If you would like to learn more about this project, or to discuss it with me, please reach out on Linkedin.

Richard Addy is managing director of Nipharm Pharmacies in Belfast

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