A 29-year-old woman asks for co-codamol tablets; she has purchased co-codamol multiple times in the last two weeks from different staff members and appears irritable. What is the most appropriate course of action?

• A. Refuse the sale, explain concerns about codeine overuse and dependence, and offer to refer her to her GP
• B. Suggest trying a non-codeine analgesic instead
• C. Advise she can purchase more to ensure pain relief
• D. Do nothing

Answer: (A)

Recognize signs of potential misuse of an opioid-containing product and act to safeguard the patient. When someone seeks co-codamol repeatedly in a short period and shows irritability, it raises concern about dependence or misuse and the risk of harm from both codeine and the paracetamol component. The most appropriate response is to refuse the sale, explain concerns about codeine overuse and dependence, and offer to refer her to her GP for assessment and management. This approach prioritizes patient safety, prompts clinical evaluation for possible dependence, and allows for a safer pain-management plan or withdrawal support if needed.

Explaining concerns and offering a referral also helps prevent further supply that could worsen dependence and reduce the chance of exceeding paracetamol limits. Alternatives without codeine may be discussed later, but the priority is to address potential misuse and involve a clinician who can provide appropriate care.