For some people, codeine dependence can start innocently with a painkiller taken to treat an injury or ease everyday pain, before regular use gradually develops into dependence.
Now researchers from Ulster University’s School of Pharmacy and Pharmaceutical Sciences are leading a new three-year research project exploring how community pharmacy teams can be further supported to help people who may be experiencing dependence on over-the-counter medicines containing codeine.
The project, funded by the Northern Pharmacies Limited Trust Fund (NPLTF), will investigate how pharmacists and pharmacy teams can be equipped with practical tools, training and clearer referral pathways to identify potential dependence and help people access appropriate support.
Community pharmacists are among the most accessible healthcare professionals and already play an important role in promoting the safe and appropriate use of medicines.
Through regular contact with patients and the public, pharmacy teams are well placed to recognise concerning patterns of medicine use, provide advice and have sensitive, non-judgemental conversations with people who may need additional support.
However, pharmacists can face challenges when someone requires further assessment or specialist support, including limited or unclear referral pathways.
The new research will explore how these challenges can be addressed, building on the support community pharmacy teams already provide and helping to create an approach that is practical for pharmacists, acceptable to patients and connected to appropriate health and social care services.
Over-the-counter combination painkillers containing codeine can be effective for short-term pain relief when used as directed. UK guidance advises that these medicines should generally be used for no longer than three days without medical advice, as prolonged or inappropriate use can result in dependence.
Figures from the Department of Health in Northern Ireland show that approximately 10.4 million combination painkiller tablets were obtained by community pharmacies in Northern Ireland in 2024, an increase of 6.9% on the previous year. The figures highlight the scale of use of these widely available medicines and the importance of ensuring people have access to appropriate information, advice and support.
People experiencing dependence may not always recognise that their medicine use has become problematic, and seeking help can be difficult. Community pharmacies can therefore provide an accessible and familiar setting in which early conversations about medicine use can take place.
The Ulster University project will examine how this existing role can be strengthened and supported, with a particular focus on developing an approach that is practical for pharmacy teams, acceptable to patients and connected to appropriate health and social care services.
The project launches in September 2026, coinciding with World Pharmacists Day on 25 September, which recognises the contribution pharmacists and pharmacy teams make to improving health, supporting the safe use of medicines and strengthening healthcare systems.
Lead researcher Dr Kingston Rajiah, Lecturer in Clinical Pharmacy and Pharmacy Practice at Ulster University, said:
“Community pharmacists already have an important role in helping people use medicines safely and appropriately. Because pharmacies are highly accessible and pharmacy teams often know their patients well, they may be among the first healthcare professionals to recognise when someone is experiencing difficulties with a medicine containing codeine.
“Pharmacists already provide advice, reassurance and support in these situations. What can be more difficult is knowing what the next step should be when someone needs additional or specialist help, particularly where established referral pathways are limited.
“Our research is therefore not about replacing what community pharmacists already do. It is about working with the profession to understand how that role can be better supported through appropriate training, practical resources and clearer pathways to further care.
“We also want to make sure that conversations about dependence are approached sensitively. People may begin using these medicines appropriately for pain and only gradually find that their pattern of use has changed. Our focus is on providing support without judgement and helping people access appropriate care as early as possible.”
Andy Sprinks, a Community Pharmacist, shared his experience; he said:
“I’ve seen first-hand the challenges surrounding over-the-counter codeine-containing products and the potential harm associated with their use. Through this research, I hope to better understand the scale and nature of the problem and use this evidence to develop pharmacist-led interventions that can reduce harm, support people experiencing problems with codeine, maintain appropriate access to effective pain relief, and help pharmacy teams navigate difficult decisions around supply.”
The three-year research project, Community Pharmacy Intervention Pathways for Over-The-Counter Codeine Dependence, is funded by the Northern Pharmacies Limited Trust Fund (NPLTF). It begins in September 2026, with full results expected in August 2029.
Northern Pharmacies Limited Trust Fund Board of Directors added:
“As the funder of this research, Northern Pharmacies Ltd Trust Fund is committed to supporting work that addresses codeine dependence and helps community pharmacists identify and support patients earlier. This investment will help build the evidence needed to improve patient care and demonstrate the important role community pharmacists can play in addressing codeine dependence across Northern Ireland.”
The research will be undertaken by Dr Kingston Rajiah, Dr Aaron Courtenay and Dr Ahmed Abuelhana at Ulster University’s School of Pharmacy and Pharmaceutical Sciences.
The project is also part of the Centre for International Health Innovation & Partnerships (CIHIP) at Ulster University, which brings together research, education and consultancy expertise to support health innovation and strengthen health systems.
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Ulster University’s School of Pharmacy and Pharmaceutical Sciences is one of the UK’s leading centres for pharmacy education and research, currently ranked 2nd in the UK for Pharmacology and Pharmacy in the Complete University Guide 2026.
The School offers undergraduate study in Pharmacy and Pharmaceutical Sciences at the Coleraine campus.
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