A few weeks back, myself and the hubby decided we’d take a much needed break from all the running around in work and so on the Friday, we jumped in the car with the kids, not minding the oncoming four hour road trip because we knew we’d be able to relax at the other end of the journey. Upon arrival, I was in great form to see our beautiful holiday destination but as soon as I started to get out of the car my mood took a bit of a downturn- my good old knees started giving out their usual creaks, which were then immediately followed by darting pains up my legs.

Now I know at 34 years of age, I am younger than most to suffer from psoriatic arthritis, but to be truthful,  I have learned not to let it get the better of me. I have also learned that the best way to prevent a massive build up of pain is to take my medications as soon as I get the pain – and not wait until it’s too late! So off I went to the boot to get my medications out of the bag, only to realise to my dismay, that I had forgotten to bring them with me!

Immediately, I started panicking.  How would I get through the weekend with no pain relief? And as soon as I started thinking about how I would access the medication that I would need, I started getting anxious.

Was it because I had no prescription? No.

Was it a drug I couldn’t get as it had to be ordered in advance? No.

Was it a Sunday and the pharmacy were closed? No.

So why the panic?

Because the drug I use to help give me pain relief is a well known and well advertised over the counter medication, commercially known as, Solpadeine.

(If you’re a pharmacist or have ever tried to buy codeine based drugs recently you will now know why I was concerned!)

So I found myself en route to a nearby pharmacy and just as I got out of the car, my husband seized the moment and quickly asked would I pick up a packet of cigarettes for him in the shop beside the chemist. Now he knows I hate the thought of him smoking considering he had a stroke only one year previous [aged 42] but I reluctantly agreed because to be truthful I wasn’t going to start nagging about it while we were on our much needed break away. And I was already anxious and in pain so I didn’t need any more unnecessary tension!

Sighing as I got out of the car, I decided to face my fears and chose to go to the pharmacy first, with that usual thought in my head “brace yourself!”

I knew I was going to get bombarded with personal questions, and only if answered correctly, would the transaction then be completed with the complimentary delivery of an educational safety lecture on the risks of codeine. I continued to wait in the queue, and the more I started thinking, the more my palms were sweating; the more my heart started racing, and the more I started thinking of what to say to the pharmacist.

I honestly stood there feeling guilty of a crime; that I hadn’t committed.

I started thinking would I just ask for paracetamol on it’s own because so many people are given this long term and with no hesitation. But I knew it wouldn’t have the same effect on the pain. Anyway, with paracetamol being the most dangerous element of this drug combination for my liver, wasn’t the codeine just putting on an additional risk for me getting possibly addicted, becoming irresponsible and overdosing on same?

Thinking about this, I knew myself well enough to know that I would never put my life at risk and so vowed to follow through on my request for pain relief.

As I got to the top of the queue, a young bubbly member of staff came over to me. I smiled back at her but I knew her expression was going to change quite drastically when I requested my choice of pain relief.

I was right.

Her smile disappeared, she lowered her tone and got very serious as she asked me what I needed it for. Other customers quickly looked away, but noticeably, still listened in. It was in this moment as she asked me politely what I needed it for, I felt the presence of societal judgement come upon me and without thinking, I blurted out – “It’s for my period!”.

It was now this poor girls turn to look away in embarrassment and she quickly mumbled the standard warnings that she was taught to deliver to customers who requested codeine based medications. As she took them out from underneath the counter and put them in a brown bag for me, I really felt awful for both her and myself for having to go through this process just to ensure that I firstly wouldn’t have pain over the weekend and secondly wouldn’t die of liver failure in the process. She was only doing her job.

I honestly hadn’t meant to embarrass the poor girl – I just wanted to get out of there as fast as possible and I knew I had reacted this way because I was simply embarrassed. I quietly thanked her, paid her, said goodbye and turned to leave.

At this point, I then remembered that I had to go to the shop for my husband to get his cigarettes. Filled with relief that that ordeal was over, I walked over to the shop and calmly asked the shopkeeper for 20 Purple Silk Cut.

She then handed me my change & casually handed me one of the most lethal drugs ever created – without query, question or caution. 

As I walked over to the car, it hit me that something was not right about what had just happened. Upon walking into the shop, I recognised that I had no fears about asking for the cigarettes – knowing the most I’d get asked about was the weather (unfortunately I don’t get asked for ID anymore!)

Yet, in the pharmacy, for pain relief, it was a completely different scenario.

There and then, I wished the shopkeeper would question my husband every time he had to get cigarettes, the way the pharmacist had me, for codeine. 

While both nicotine and codeine are highly addictive substances, this is where the similarity ends.

One has some medicinal benefits. 

The other does not have any medicinal benefit. 

One is advertised on television and radio.

The other is not allowed to be advertised anywhere.

One, taken as directed, does not put one’s life in danger. 

The other, no matter what dose, puts lives in danger, always.

As with all drugs – there are risks. But with some, especially those which have no medicinal benefits – the risks can be detrimental. Cigarettes have to be one of the most fatal drugs on the market, with no proven medicinal benefits, and yet people still choose to smoke. Even after all the packaging is removed; all the advertisements are taken out of shops; the ghost of a kind and brave man, Gerry, talks about the terminal effects cancer has on him and his family – people still choose to smoke.

What drastic measure is it going to take to actually change the behaviours of a smoker?

What would happen if a shopkeeper put a customer through the same rounds of questioning for codeine – every single time they went to buy cigarettes?

Shopkeeper…[changes expression drastically and asks in low tones…]

“Do you know why you’re smoking?”

“Do you know smoking can [and now choose depending on customer…]

  • Give you bad skin, hair , nails, teeth
  • Makes your clothes and breath smell bad
  • Take 10 to 15 years quality years off your life – breathlessness etc.
  • Increase risk of life threatening diseases like cancer, infertility
  • Have a poorer quality of life, fitness and health
  • Be a bad role model for your family and friends/children
  • Cause you to go without nice things because you waste money on cigarettes
  • To lose control over your life – smoking can dictate your daily routine.
  • Increase the work you have to do to keep your home and car clean.
  • Decreases the quality of the air in your home for your family and friends
  • Reduces self-esteem/ impact on how you deal with the daily stresses of life.
  • Make you die before you’ve done everything you’ve wanted with your life

I’m sure the shock factor if this did happen would be astounding. 

I can tell you, if people were asked these questions every time they went for cigarettes, they would soon start reconsidering their requests – like I had done. The feelings evoked in me that day – embarrassment, guilt, fear –  were very negative and I definitely would not want to go through it every single day.

But I completely agree that it is the right thing to do.

Every person taking any addictive substance that can potentially lead to long term side effects or cause irreversible damage, should be advised to on it’s possible dangers. The pharmacists have our best interests at heart and that lovely staff member was doing her job, the way she was taught.

But I do not feel that this should just be limited to codeine or similar drugs in pharmacists – it should be implemented in all substances (especially those with no medicinal benefits) such as alcohol and cigarettes.

I believe if our nation were truly behind the challenge to create behavioral change in smokers – this method could be an option.

But in the real world, when there is the possibility of money to be lost locally or nationally, the challenges to create change in this area are nearly impossible. I think, even if a business case showed significant financial/time/life savings for health services due to a reduction in tobacco related illnesses because of an initiative like this, that it still would never happen – even if the savings were higher than turnover of sales of tobacco!

I do think there is a lot being done to tackle the smoking issue but I truly feel a lot more needs to happen. I am now nine years off the cigarettes myself and it took a lot of effort for me to give up. My husband was forced to quit last year after his stroke, but unfortunately it was just too easy for him to start again.

And I would like to see this changed.

I don’t know how it can be done, but I do know, that if you make someone feel guilty, embarrassed, afraid, sad or irresponsible a lot of the time they will want to stop associating with the thing that caused it in the first place.

As for my choice of pain relief  – I never promote codeine to anyone as a first choice of medication – it is highly addictive substance. I do however always promote the fact that we should always take our medication as prescribed, and on time – and not wait until the pain gets so bad it can’t be managed efficiently. I will always also promote the conversation between patients and health professionals about their medications and whether they work or not.

Pharmacists and other health care professionals are there to help us, not make us worse. But we have to be honest with them, to help them make the best decisions too.

There are of course so many more treatments that don’t involve medications at all and I would look into these too – I myself attend and run self management programmes for instance, and they can help put us in different mind sets about our pain or chronic conditions.

At the end of the day, we’re all here to either get better or help get someone better, and so we all must play our part in being part of the solution, not the problem.

For more information on quitting smoking: https://www.quit.ie

For more information on codeine: http://www.thepsi.ie

[Note: For any medical professional /patient who may want to know why I take this drug. For me, codeine and paracetemol taken together works better than anything else I have tried. As well as my arthritis, I also suffer from long term bradycardia and asthma. Unlike my children, who take Methotrexate and Naproxen  for their own Juvenile Arthritis, I am much more limited in what I can take. Many of the heavier arthritic drugs like Arcoxia, just make me feel way sleepier than codeine does (bradycardia already causes this!) and it can’t be taken with my angina. Anti- inflammatory’s cause me to be wheezy. Because of this, we found a treatment that works – I get steroid injections into the joint from my rheumatologist, as the need arises, and I take codeine with paracetemol [i.e. Solpadeine], if required, 6 hours apart, twice a day at most- thus providing all the relief I need, without having any diverse side effects that impact on my daily life in a negative way. This combination works for me, right now, but I do not promote or recommend it to anyone else  – each of us are individual and that’s why we need to talk to our health professionals about same!]

One Reply to “Codeine and Cigarettes. Why it’s easier to smoke than get pain relief…”

  1. Here are a few comments from readers via my social media platforms:

    Tim Delaney [Head of Pharmacy at Tallaght Hospital]

    “I do feel for you but also for the community pharmacists of Ireland who are left to police these stringent rules that were imposed upon them by a pharmacy regulator that they perceive takes a rigid and punitive approach towards any transgress ion of the rules – and thereby robbing them of the chance to exercise professional judgement. There is a widely held belief that the regulator uses mystery shoppers who are instructed to visit pharmacies and tell personal stories in an effort to persuade pharmacists to break the OTC supply of codeine rules…..resulting in Fitness to Praise hearings with fines and reprimands. Many pharmacists regard this as entrapment and therefore ethically dubious. But it does engender fear, hence any stranger seeking to purchase OTC codeine in an Irish community pharmacy is likely to receive the kind of treatment you did. Here is a link to a relevant review. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3603170/ The author said: “In relation to policy, this review confirms that there is a problem in a number of countries but concerns about what is being investigated – whether this is misuse, abuse, dependency, addiction or pseudo-addiction – coupled with a lack of systematic data on the scale of the problem make appropriate and proportionate policy-based interventions difficult to consider. There exists a tension between making OTC medicines available to individuals to increase their access to medicines and enabling them to self-manage conditions and accepting that there is some degree of risk of such products being misused or abused, with potentially serious consequences for some. Raising awareness of potential problems of OTC medicines, as the recent response in the United Kingdom has illustrated in terms of making purchasers aware of the possibility of addiction, would appear a prudent response. But whilst this may arguably warn those using products for the first time, for those with an existing problem, more support may be needed in the clinical pathway.”

    Gerry Askins [M. Director at Fridge and Freezer Services Ltd.]
    “I have been there done that and agree with everything you have said Olive. Those tabs are the only thing that do it for me also.”

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