'I thought I had it under control' - Addiction to pain medication takes a sharp turn in Ireland

The use of opioids in Ireland has increased by approximately 25% in the last 10 years, a new study has found.

The research carried out by the Royal College of Surgeons in Ireland University of Medicine and Health Sciences (RCSI) found the prescribing of pain medications in Ireland has risen significantly over the past decade, with usage rates now outpacing those in England.

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The study highlights differences in how pain is treated in primary care in Ireland and raises questions about healthcare access, prescribing practices and the availability of non-drug interventions to address pain.

Researchers examined national prescribing data between 2014 and 2022, focusing on patients in Ireland covered by the General Medical Services (GMS) scheme – people with a medical card, representing about one third of the population – and on data from all general practices in England.

Specific medicines like codeine and stronger opioids like tapentadol and oxycodone increased by even higher percentages, while prescriptions for paracetamol rose by 50%. By contrast, England experienced declining use across most classes of pain medications during the same timeframe.

“These results suggest a growing reliance on prescribing pharmacological treatments for pain in Ireland for the GMS patients we analysed,” said Dr Molly Mattsson, first author of the study and Postdoctoral Fellow at the RCSI School of Pharmacy and Biomolecular Sciences.

“The trends raise important questions about healthcare access and the availability of non-drug options to manage pain, particularly for medical card holders who avail of public services.”

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Kelly*, a young woman from the south of Ireland, suffered a severe back injury while at work two years ago. Out of work and in extreme pain, Kelly* was prescribed codeine.

"I never had an addictive personality," said Kelly*, "I wasn't even sure about taking the codeine that was prescribed by my doctor, I thought paracetamol would be fine. But after a few weeks of taking them my mind became consumed; when could I take another one, how am I going to get more from the doctor."

Kelly* admitted that she felt so much calmer after she had taken the medication that was prescribed to her on a short term basis until her back started to feel better again.

"I wasn't sure whether the back pain was still there or it was in my head after a while.

"I thought I had it under control. I had my routine of taking it first thing in the morning then another before bed, but then I started taking extra. Another one in the middle of the day and lots of nights I would wake up from my sleep to take another one."

Kelly* said she was taking them faster than the doctor was prescribing them and before long she was going into pharmacies to get them over the counter.

"I had my friends go and get them for me too, because they will only give you one pack over the counter. My drawer at home was full of them and I remember counting them and counting the days ahead and planning how many I could take in a day. It was insane, I new something had to give."

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Kelly* said she had to slowly wean herself off of them which was "extremely difficult" but she knew this wasn't going to end well.

"I didn't want to be floating around the place anymore or relying on something that I didn't really need anymore, enough was enough."

Luckily for Kelly*, she got back to taking just two a day, her back got a bit better and she eventually went back to work.

"I'm just on the paracetamol now, and that's enough."

Professor Frank Moriarty, senior author of the study and Associate Professor at the RCSI School of Pharmacy and Biomolecular Sciences said,

“Many of these medications carry risks such as dependency which can be worsened by overprescribing.

“While medication can play an important role in treating pain, we must address issues like orthopaedic surgery waiting times and ensure Irish patients also have access to safe, evidence-based alternatives to medications. Access to data is equally vital to track how prescribing patterns evolve across this and other disease areas over time.”

*Name has been changed