Behind the counter of a Scarborough pharmacy, there is a grainy black-and-white photocopy of Chris Mandarino’s driver’s licence taped to the wall, with explicit instructions not to sell him any more codeine.

Four years ago, diagnosed with bipolar disorder and seeking a source of stimulation, Mandarino began abusing low-dose codeine drugs like Tylenol No. 1. He became addicted, sometimes burning through nearly 38 pills in a day and once landing himself in the hospital.

Of the thousands of tablets Mandarino has bought since 2011, most came from the Shoppers Drug Mart behind his home. So in December a “do not sell” sign went up behind the pharmacy counter — at his own request.

“I thought to myself, ‘How can I thwart this?’ ” said Mandarino, 25. “I was just, like, you know what, I’m just going to march to this pharmacy and say don’t sell this to me anymore.”

But there are more than 3,700 other pharmacies in Ontario that don’t have Mandarino’s picture tacked to their walls. These days, when his withdrawal symptoms overpower him, he just walks a few extra blocks.

“Now I’ll go to the No Frills or Walmart pharmacy that I have not banned myself from,” he admits.

Mandarino’s story illustrates the difficulty of intervening with abusers of low-dose codeine, the one narcotic Canadians can buy without a prescription — even addicts who want the system to ban them from purchasing the drug cannot easily do so.

Codeine is an opiate derived from the opium poppy and under Canadian law, pharmacies can sell eight milligrams of the drug without a prescription, as long as it’s cut with two non-narcotic ingredients and stored behind the counter.

But codeine can be addictive even at low doses, and countries like the United States have made the painkiller prescription-only. A recent Toronto Star investigation also found there had been several failed attempts to ban or restrict non-prescription codeine in Canada. These date back to 1979, when the federal government’s own appointed advisers warned the drug, which many pharmacists consider an ineffective painkiller, carry addiction risks.

Many people use this drug responsibly and do not become dependent. But when addictions do occur, the addicts tend to fly under the radar. There is no paper trail and family doctors may not realize their patients are using the drug, which can cause a “functional” addiction easily hidden from friends and family. Health consequences — for example, liver damage from the acetaminophen that is often combined with the codeine — may not manifest themselves for years or decades.

Though many addicts likely never seek help, some have turned to methadone, a “substitute drug” first introduced to treat heroin addicts. In the past three years, more than 500 Ontarians have started on methadone programs to treat non-prescription codeine addictions, according to a Centre for Addiction and Mental Health database.

Pharmacists are the sole gatekeepers of this drug, and therefore the health care provider that’s most likely to notice a problem.

“Opioid-containing products are frequently mentioned in pharmacy circles as the most commonly abused (non-prescription) products in the pharmacy,” researchers wrote in a 2012 article in the Canadian Pharmacists Journal.

Pharmacists have a professional obligation to intervene with every sale, but this is “very weakly applied,” said Phil Emberley, director of pharmacy innovation with the Canadian Pharmacists Association. In November, the Star bought 1,000 tablets from five Ontario pharmacies in just over an hour, with barely any questions asked. CBC’s Marketplace also recently visited 50 pharmacies across Canada and only 23 offered any consultation on “behind-the-counter” drugs like non-prescription codeine.

Toronto pharmacist John Greiss said many colleagues feel helpless when faced with abusers of non-prescription codeine. Addicts know how to get through the system, and pharmacists, he said, are “left to the word of the patient that is in front of you.”

For Greiss, pharmacists would be far more empowered to intervene effectively if non-prescription codeine could be monitored. If every patient’s purchase was recorded in a centralized system, then pharmacists would be able to see when the patient last bought the drug and how many tablets were given, making it much easier to identify a pattern of abuse.

Currently, there is only a patchwork of surveillance in Canada. In Alberta and Saskatchewan, for example, pharmacists can voluntarily record sales of non-prescription codeine in a centralized database. In Alberta, 318,307 “dispensation events” for non-prescription codeine were recorded in the database in 2013.

But Ontario has no requirement to record a customer’s purchasing history of non-prescription codeine, even within the pharmacy. Addicts can easily travel from store to store, accumulating as much codeine as they can carry.

“The fact that pharmacists are not responsible to record the patient’s information with the sale is asinine,” said Mark Barnes, a pharmacy owner in Ottawa. “It doesn’t make sense at all.”

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The situation has forced pharmacists like Phil Hauser to devise their own imperfect solutions. About a decade ago, the pharmacy owner in Dunnville, a town near St. Catharines, created his own makeshift monitoring system to crack down on non-prescription codeine abuse. Every time someone buys the drug, the customer’s name and purchasing details are recorded in a notebook. This information can then be shared with the town’s other two pharmacies, which also monitor sales of the drug.

Hauser said the system “paid off in spades,” allowing them to identify not only customers abusing the drug but also genuine patients not being treated for pain appropriately. But the system works best when all pharmacies participate, and in 2010 one of the town’s pharmacies changed hands and the new owners are not participating. “If we had a perfect system, we would implement (monitoring) all over the place,” Hauser said.

Ontario did introduce a centralized system for monitoring narcotics in 2012 — one that has dramatically reduced the misuse of prescription painkillers, according to a recent study published in the journal CMAJ Open.

But the system is not currently set up to capture non-prescription codeine. When asked if Queen’s Park has any plans to change this, a spokesperson said the Health Ministry “supports exploring initiatives to improve the appropriate use of narcotics” with the collaboration of other stakeholders, including the Ontario College of Pharmacists.

Marshall Moleschi, the college’s registrar, said Ontario lags far behind when it comes to drug monitoring — and not just with non-prescription codeine.

“I’d like to see a better monitoring system for all drugs,” he said. “We do not have a system in this province to capture all prescription refills … other provinces have moved that way and I think it’s time for Ontario to move that way.”

Asked by the Star for comment, a spokeswoman for the Shoppers pharmacy with Mandarino’s self-requested ban cited patient confidentiality “mandated by pharmacist ethical practice.”

“Over-the-counter medications that do not require a prescription are not tracked in the same way prescription drugs are tracked,” she said. “The store provided support for this patient’s request to the best of their ability, considering the restrictions.”

Meanwhile, Mandarino is doing his best to get his life in order. His struggles with bipolar disorder caused him to drop out of high school and he is now taking classes so he can finally graduate. He is getting top marks — “not to brag, but I have a 99.25 per cent in my math course” — and aspires to become a physics researcher.

He is also seeing several counsellors and a psychotherapist to deal with the roots of his addiction, which has made him reclusive and socially isolated. But when withdrawals kick in, leaving Mandarino agitated, impulsive and insomniac, he wishes the pharmacy counter would be an actual barrier to his access of this drug.

Mandarino knows it is up to him to overcome his addiction problem. But he also wonders: why bother regulating this drug when the system can’t even stop abusers who want to be stopped? Short of sending his driver’s licence to every pharmacy in the city, there is no way for Mandarino to be flagged as a problem user.