Serious risk from codeine-containing medicines were not being spelled out clearly enough in product information, according to a report from the Irish Health Products Regulatory Authority (HPRA).
The HPRA is currently leading an EU investigation of the controversial combination painkillers following research on serious adverse reactions, including fatalities, for people who had developed dependence on the drugs.
A report said in addition to well-known “toxicities” from the anti-inflammatory products in the over-the-counter medications, there was also a risk of severe kidney damage from long-term use.
It detailed the development of “severe hypokalaemia in the setting of renal tubular acidosis” following continuous use or misuse of the codeine medications.
The report said this was a “new concern” that had not been properly reflected in product information for codeine and ibuprofen combination drugs.
It said the condition appeared in patients where there was “prolonged chronic abuse” as a result of a dependence that had developed.
The HPRA said healthcare providers needed to be alerted to the risk and to raise patient awareness of “the potentially clinically significant consequences of codeine addiction”.
Refugees fleeing the war in Ukraine complained this year of dire conditions in their accommodation in Ireland with mice infestations, damp causing their children to fall ill, black mould, and heating only being turned on for a couple of hours each day.
A log of issues from the Department of Children and Equality reveals how some people were being housed in what appeared to be an “old maintenance room” with a constant foul smell.
Residents there said they could not even open the door to air it out because the exit led directly out onto a street.
There were two complaints about an infestation of mice while another wrote about how their accommodation was very damp with heating being “hit and miss”.
A summary of the person’s letter said: “Construction work has been happening daily on the premises. The management attitude towards residents is not nice or welcoming. Hygiene standards are low.”
Another explained how they were being served “rotten” food but that they were still being forced to pay for it.
When residents said they were not willing to continue paying, the management “threatens to evict them”.
Multiple Ukrainian refugees said their children were becoming ill due to the quality of food they were getting with “stomach aches” and other issues.
Another wrote about unacceptable conditions with residents in tiny rooms that were only separated by plywood.
One entry in the log said: “Bad living conditions with constant humidity and black mould everywhere. This is causing some residents to become sick. Request to move.”
Damp was a problem for another resident who said once the weather became cold, the floors were soaked with condensation that had got into wardrobes.
“The conditions are not safe for children who often become sick,” said the complaints log.
An expert group set up to look at over-prescribing of drugs said serious patient safety concerns arose with difficulties in getting access to the prescribing history of doctors who were subject to complaints.
Minutes of group meetings said complaints about doctors required a “piecemeal trawl” of individual pharmacy records which could be time-consuming, expensive, and insufficient.
Concerns were also raised over how difficult it was to get solid data on the extent of private prescribing of benzodiazepines, and other addictive drugs, including sleeping tablets.
One meeting was told: “It was reiterated that it is very difficult to get a clear picture of private prescribing without a centralised record and the urgency of resolving the issue was flagged.”
It said a campaign needed to be undertaken to get prescription of certain addictive drugs in Ireland at least back to international averages and to “reign in the outliers”.
The meeting also heard that a lot of people come out of hospital on “sleeper” tablets they had never been on before admission.
Challenges in helping patients who had been on benzodiazepine drugs for years, especially the elderly, were raised.
It said it might be a better approach to start with patients who had been on the medications “for months, rather than years”.
“Two of the aims of the group are encouraging doctors not to initiate these medications and also reducing the number of chronic users,” a meeting heard.
The minutes also flagged how use of “chronic pain medication” could lead to addiction with particular issues with opiates, over the counter codeine medications, and the drug pregabalin.
A meeting was told that there was a serious issue in the UK and Eastern Europe with illicit fentanyl – a powerful opiate – that needed to be monitored.
The easy availability of over the counter codeine medications was highlighted with a “pattern of young women (age 15-34) purchasing high levels of these drugs”.
It was suggested that this could be due to period pain but the meeting heard that despite restrictions on buying codeine medications, it was easy for people to simply travel from “one pharmacist to another” to get around them.
A meeting also heard how the power of the pharmaceutical industry in Ireland was “huge”.
Minutes of that meeting said: “It was agreed that we need visibility on what is coming into the country.”
It said while doctors knew certain drugs could be addictive, patients did not, and that perhaps packaging should more explicitly state the risk of dependency.
The minutes said: “It was agreed that it can be much easier to prescribe pain relief than not to, as not doing so is more time consuming and requires spending longer with the patient and sometimes providing alternatives.”
Another meeting heard about the “aggressive promotion” by drug companies of certain drugs for pain after an operation.
It was told that opioids were given “far too easily” and that better access to pain clinics would be a better development for patients.
The minutes said: “There was a discussion around the importance of educating patients regarding the risk of addiction to opioids, and concern that Ireland could go down the same route as the US regarding opioid addiction.”
In a statement, the Irish Medical Council – who released the records – said they had been part of the overprescribing group since 2019.
The group’s chair, Dr Margaret O’Riordan, said “[We have] been working with the HSE, the Department of Health, the Pharmaceutical Society of Ireland and the medical profession over the past number of years to consider the issue of overprescribing, and particularly overprescribing of benzodiazepines and z-drugs [sleeping tablets], in this country.
“The Medical Council recognises the challenges medical practitioners face in regard to the prescribing of such drugs, and by joining with our stakeholders, aim to reduce initiation and overprescribing of these drugs in the interest of patients, and to support prescribers in adherence with guidelines.”
Employees at one local authority were earning up to €33,000 in overtime with significant shortcomings in how the extra work was being accounted for.
An internal audit looked at 550 overtime transactions and found that 20% of them, worth €23,083, did not indicate the start or end time of hours worked and could not be verified correctly.
For another 66 claims – valued at €12,362 – the timesheet gave no explanation of what the overtime was even being claimed for at Dún Laoghaire Rathdown County Council.
Another 25 transactions, together worth €3,741, did not include the hours being claimed for and therefore could not be tested for accuracy by auditors.
Across an eighteen-month period, 232 waged employees were paid a total of €1.247 million in overtime with the top ten payments ranging from €17,650 to €27,359.
A further 62 salaried employees of the council were paid a combined €449,322 in overtime during the same period.
The top ten highest payments in that category of worker ranged in size from €14,518 to €33,334 with some people earning up to 64% on top of their “basic annual pay ranges”.
The audit also found that in some cases, employees were signing off on their own overtime sheets.
An analysis of 550 transactions found 61 cases – worth a combined €10,795 – where the claimant themselves had signed off on the timesheet.
For another fifty of the claims examined, the timesheets did not have “appropriate approval”, meaning they had not been signed off by a supervisor or foreman as required.
Twenty five of the overtime claims did not have any sign-off at all, but the €4,885 claimed on them was still paid out by the council.
These findings were considered “high priority” by the auditors Mazars with a further six medium priority findings also made by the firm.
Conditions at Ireland’s chief diplomatic outpost in Washington DC had become so bad that staff felt they could not hold events, or even meetings, there.
Peeling paint, bubbling plaster, flooring and carpeting that was past its useful life, and a range of other issues including security risks had made for a “very poor working environment”.
A review of the chancery building in the U.S. capital also said “major concerns” had arisen with the mechanical and electrical systems, which were at “end of life”.
The confidential report said: “The poor working environment … already identified in the last review (2012) has deteriorated significantly in the interim, with numerous issues, including health and safety, and security concerns, clearly in evidence throughout the building.”
The department has since leased another building in Washington DC as they make plans for an improved chancery and residence for the Irish Ambassador and his team in the United States.
The mission review also detailed how the air conditioning system at the chancery had failed for an extended period during what can be sweltering conditions in the summer in the U.S. capital.
“This is a cause for concern as we move into the summer period once again,” said the report.
“Regrettably, because of the multitude of concerns, the Embassy team had to come to the view that it was no longer possible to hold events, or even meetings, in the Chancery.”
Eight babies at one of the country’s busiest maternity hospitals developed a potentially dangerous infection that is resistant to multiple antibiotics.
The outbreak of S.capitis at the Rotunda Hospital meant the infants had to be isolated or nursed with strict contact precautions in the neo-natal intensive care unit.
Results showed that the eight infections, all discovered last year, were related and were likely due to “cross transmission”.
In an internal report, the Rotunda said dealing with the outbreak had been challenging due to “staffing and infrastructural deficits” at the hospital.
It said the “opportunistic pathogen” had been identified as a cause of infection in maternity and paediatric hospitals in France, the UK, Belgium, and Australia.
The report said it was resistant to “multiple antibiotics” and that babies infected needed to be treated with an “adequate spectrum of activity” to deal with it.
The Rotunda alerted neighbouring maternity and paediatric hospitals asking them to review old samples to see if the infection was present.
It said that thirty samples submitted by four different hospitals – three in Dublin and one in Munster – had “revealed relatedness between isolates from different hospitals”.
The report said it appeared the S.capitis clone was “endemic” in neo-natal units but that the origin of it was still unknown.
“The clone identified is not the [type] reported elsewhere, but appears to be a predominant Irish clone which will require more extensive studies,” it added.
Irish Water received nearly 1,800 complaints last year including 474 from people claiming they had got sick due to water quality issues.
There were also 479 who contacted the utility, which has recently rebranded as Uisce Éireann, to say that discoloured water was flowing out of their taps.
Another 28 complaints were logged from customers who said there was a funny odour from their drinking supply while 82 said their water tasted strange.
Nearly a third of the complaints, 557 in total, were about water outages where no supply was available at all while 15 people contacted the utility to complain about drinking water restriction notices.
There were also 57 gripes from people about boil water notices, where they had been informed that their tap water was not safe to drink.
Overall, 1,790 formal complaints were logged with Uisce Éireann with at least 200 recorded in each of August, September, and October, the three busiest months for complaints.
Gardaí were paid more than €205 million in allowances last year, including boot allowances, Gaeltacht allowances, and payments for serving in the ministerial pool of drivers.
Almost a third of the money – or €73.2 million – was paid out in a Sunday allowance to more than 13,500 members, for an average of around €5,400 per person.
Another €43 million was paid out in rostered night duty to more than 13,000 members, with the average payment working out at just over €3,200 for each member.
There was also a payment of around €18.9 million in public holiday allowances, shared between over 13,360 individual gardaí.
Annual premium payments worth €12.47 million were paid as well to 13,804 different people according to figures released under FOI.
Boot allowances totalling €2.1 million were paid to more than 14,000 individual gardaí, each worth about €150 per person.
There were also a variety of uniform allowances paid, which together came to a cost of around €2.9 million, the garda figures showed.
Other more specific payments were made to gardaí in particular jobs with €3.57 million paid in a “detective allowance” to 4,879 different gardaí.
There was an “availability allowance” paid to 318 members, which came to a combined €2.18 million, or around €6,900 per person.
Instructor allowances totalling €2.16 million were paid out to 408 gardaí, while 3,440 members shared €1.875 million in a “plain clothes allowance”.
Payments totalling €960,000 were paid to 82 gardaí for working in the minister’s pool, providing driving and security services to officeholders.
Gaeltacht allowances cost €789,859 and were paid to 194 members serving in Irish-speaking regions, or an average of €4,071 per person.
Other payments made last year included €712,661 in transport allowances, €615,119 in overseas allowances, and €487,821 in a “scene of crimes allowance”.
Under FOI, Cabinet records cease to be exempt five years after the meetings have taken place.
This upload of meeting minutes covers the period July to December 2017 discussing a range of issues from the Grenfell Fire in London to ambassadorial and military appointments.
More than two hundred people made formal complaints about their NCT last year including their brakes failing immediately after a test, “spurious” results, and a wheel that broke off just two weeks after going in for a roadworthiness check.
The Road Safety Authority said there had been an average of around seventeen official complaints each month in 2022 with frustration also growing about recent delays in scheduling a test.
In one case, a motorist said their car had gone through its NCT – yet two weeks later “the wheel broke off my car while driving”.
In another, a person said they had taken their wife’s car for a test and immediately after they left the centre, the brakes of the car would not work.
They wrote: “We travelled 400 metres up the road to a crossroads and when I tried to stop the car, the brakes failed.
“Fortunately, I managed to bring the car to a halt without hitting anyone. I returned to the NCT centre where the car was inspected. The technician was baffled and could only offer the explanation that the emergency brake test had broken the brake calliper.”