Prescription opioid use rises more than 10% under Ireland's medical card scheme

News analysis · 28 September 2026. This article discusses population-level prescribing data. Opioids have legitimate medical uses, including acute, cancer and palliative pain. Population trends cannot determine whether any individual prescription is appropriate.

Estimated consumption of opioid pain medicines under Ireland’s General Medical Services scheme increased by more than 10% between 2018 and 2025, according to a new RTÉ Investigates analysis of HSE data.

The finding is significant because opioids can be highly effective medicines for some types of pain — but they also carry risks including dependence, tolerance, sedation, constipation and overdose.

The important point, however, is not to jump from:

“opioid use increased”

to:

“opioids are being prescribed wrongly.”

The data cannot tell us that on its own.

What it can tell us is that Ireland is using more opioid pain medication under one of its largest public drug schemes than it was seven years ago — and that makes the pattern worth examining closely.

What exactly did RTÉ find?

RTÉ Investigates analysed HSE data covering medicines reimbursed under the General Medical Services (GMS) scheme, which provides medical-card holders with access to prescribed medicines subject to the scheme’s rules.

Its analysis found that estimated opioid pain-medicine consumption increased by more than 10% between 2018 and 2025.

That is a measure of consumption across the scheme.

It should not be read as meaning that:

• 10% more people are taking opioids;
• every individual patient is taking a higher dose;
• 10% more prescriptions were written;
• or inappropriate prescribing increased by 10%.

Those are different questions.

Why the distinction matters

Drug-utilisation studies often use a measure called a defined daily dose, or DDD.

A DDD is a standardised research unit developed to help compare medicine use across drugs, strengths and populations.

It is useful for tracking trends.

It is not the same thing as the dose that a particular patient should take.

For example, two countries could have the same number of people receiving an opioid but different estimated consumption if doses, strengths or treatment durations differ.

That means the RTÉ figure is best understood as:

the overall volume of opioid medicine being consumed under the scheme has increased.

It does not identify why.

This is not a completely new trend

Irish research has already shown changes in opioid prescribing over a longer period.

A national study of strong-opioid prescribing among GMS patients found that prescribing prevalence increased from 14.43% in 2010 to 16.28% in 2019.

The increase was largest among people aged 65 and over.

The same research found that prescribing patterns changed considerably between individual medicines.

For example:

• tramadol remained the most frequently prescribed strong opioid in the study period;
• oxycodone prescribing increased substantially;
• tapentadol increased sharply from a low base;
• while tramadol prescribing prevalence declined over time.

So the story is not simply that every opioid is being used more.

The mix of opioids being prescribed has also changed.

A more recent study shows the same complexity

A 2025 study looking at analgesic prescribing in Irish primary care between 2014 and 2022 found that the proportion of GMS-eligible patients dispensed any opioid increased from:

19.7% → 20.8%

over the period.

But again, different medicines moved in different directions.

Among the most commonly used opioids:

• codeine increased from 12.8% to 14.9%;
• oxycodone increased from 1.2% to 2.1%;
• tramadol decreased from 7.3% to 5.4%.

That matters because a headline measure of “opioid use” can conceal important shifts in the specific drugs being used.

Why are opioids prescribed?

Opioids are not inherently inappropriate medicines.

They have established roles in areas including:

• severe acute pain;
• pain after some operations or injuries;
• cancer pain;
• palliative and end-of-life care;
• and selected other situations where the expected benefits outweigh the risks.

The harder question is long-term opioid therapy for chronic non-cancer pain.

The HSE’s Medicines Management Programme notes that evidence supporting long-term opioid treatment for chronic non-cancer pain is limited, while harms can accumulate with continued use.

That is why appropriate prescribing involves more than deciding whether a medicine reduces pain in the short term.

Clinicians also need to consider:

• function and quality of life;
• dose;
• treatment duration;
• side effects;
• other medicines;
• risk of dependence;
• and whether treatment is still producing meaningful benefit.

What are the main risks?

Opioids affect receptors in the nervous system and can reduce the perception of pain.

But they can also produce several clinically important effects.

Tolerance

Over time, some people may need a larger dose to achieve the same effect.

That does not happen to everyone in the same way, but it is one reason long-term therapy requires review.

Physical dependence

A person taking an opioid regularly can develop physical dependence.

That means stopping suddenly may trigger withdrawal symptoms.

Physical dependence is not automatically the same thing as addiction, but the two concepts are often confused.

Sedation and impaired alertness

Opioids can cause drowsiness and impair concentration.

The risk can become more important when opioids are combined with other sedating medicines or substances.

Breathing suppression

At sufficiently high exposure, opioids can suppress breathing.

That is one reason overdose can be fatal.

Constipation and other side effects

Constipation, nausea and other adverse effects can become important in long-term treatment.

For older patients in particular, sedation can also contribute to falls and other complications.

Does this mean Ireland has an opioid crisis?

The new data does not establish that.

There is an obvious temptation to compare any rise in opioid use with the experience of the United States.

That comparison needs care.

Different countries have different prescribing practices, healthcare systems, drug markets and patterns of illicit opioid use.

Ireland’s data should therefore be assessed on its own terms.

What the evidence supports saying is narrower:

opioid consumption under the GMS scheme has risen, and previous Irish research already showed increases in strong-opioid prescribing and major shifts between individual drugs.

That is enough to justify continued monitoring.

It is not enough to conclude that Ireland is following the same trajectory as another country.

The GMS data also has important limitations

The GMS database is extremely useful because it captures large numbers of prescriptions dispensed through the scheme.

But it is not the whole Irish population.

Historically, GMS patients have included a higher proportion of:

• older people;
• people on lower incomes;
• and people with greater healthcare needs.

Those groups may have a different burden of chronic illness and pain from the population overall.

The data also records dispensed medicines.

It generally cannot show whether a patient actually took every dose, whether the medication worked, why it was prescribed, or whether the clinical decision was appropriate.

Those are major limitations when interpreting population-level prescribing figures.

Age may be part of the story

Older adults are particularly important in opioid data.

The 2010–2019 Irish study found that strong-opioid prescribing was highest among women aged 65 and over, and the largest increase in prevalence occurred in the older age group.

That could reflect several legitimate factors.

Older populations have more:

• osteoarthritis;
• cancer;
• fractures;
• surgery;
• neuropathic and musculoskeletal pain;
• and multimorbidity.

But older adults can also be more vulnerable to some opioid-related harms.

That makes regular medication review especially important.

The bigger question is not simply how many opioids Ireland uses

A raw national total can only tell us so much.

The more useful questions are:

1. Which opioids are increasing?
2. Which patient groups are receiving them?
3. How long are people remaining on treatment?
4. How often are high doses being used?
5. How often are opioids combined with other sedating medicines?
6. Are patients receiving regular reviews?
7. Are non-drug and non-opioid pain treatments accessible when appropriate?

Those are the questions that distinguish appropriate pain treatment from potentially avoidable harm.

Pain treatment itself is the other side of the story

There is a danger in discussing opioid harms without discussing pain.

Chronic pain can be debilitating.

Poorly controlled pain can affect:

• sleep;
• mobility;
• employment;
• mood;
• independence;
• and overall quality of life.

The goal of safer opioid prescribing is therefore not simply to prescribe fewer opioids.

It is to ensure that the right patient receives the right treatment for the right reason, at an appropriate dose and for an appropriate period.

For some people, that can include an opioid.

For others, different medicines, physiotherapy, exercise, psychological approaches, procedures or multidisciplinary pain care may be more appropriate.

What should someone already taking an opioid do?

Do not stop a long-term opioid suddenly without medical advice.

Abrupt discontinuation can cause withdrawal symptoms and may destabilise pain control.

If someone is concerned about their treatment, the appropriate step is to discuss it with the prescriber or pharmacist and review:

• why the medicine was started;
• whether it is still helping;
• current dose;
• side effects;
• other medicines;
• and whether alternatives or a gradual change should be considered.

That decision is individual.

Population statistics cannot make it for you.

Why this new data matters

The most important part of the RTÉ analysis is not the precise percentage increase.

It is that it extends an already-observed Irish trend into more recent years.

Research covering the previous decade had already shown:

• increasing strong-opioid prescribing prevalence;
• particularly high prescribing among older adults;
• large increases in oxycodone and tapentadol;
• and a changing mix of medicines even where some drugs declined.

The latest HSE data suggests opioid consumption remains an issue worth watching rather than a trend that simply disappeared.

Ireland does not need to assume the worst.

But it does need good data, careful prescribing and regular review.

For readers looking for evidence-led health coverage rather than alarmist headlines, see the latest articles on the Compound Health hub.