The use of over the counter (OTC) codeine-based analgesics in Ireland is high despite codeine’s known misuse and abuse potential. Codeine misuse and abuse is an internationally recognised problem but quantifying the scale is challenging due to its availability without a prescription. The effects of codeine that lead to its misuse and abuse are typically initially discovered through legitimate pain management. However, the factors that influence positioning and transitioning on the continuum of codeine use in pain management within the general population are unclear. The aim of the current study was to explore the factors that influence positioning and transitioning on the continuum of OTC codeine use in pain management. The study consisted of two phases: 1. a cross-sectional study with community pharmacy professionals (n=25), to explore their views and experiences on their interactions with codeine consumers in pain management; 2. a longitudinal qualitative research study consisting of four interviews, at 6-months intervals, with individuals living with chronic pain (n=10), to explore their experiences of self-medicating with codeine overtime. Phase 1 identified three themes: unintended consequences of codeine regulations, systemic failures, and social influences as issues at the interface between community pharmacies, and OTC codeine consumers in self-medicating. Phase 2 identified the through-line “just managing” as the driver of self-medicating with OTC codeine overtime across three emblematic themes; feeling disregarded, feelings of being misunderstood, and ‘OTC codeine is my enabler’. Overall, the emblematic themes highlighted how; 1. environmental factors (access to healthcare, quality of healthcare, classification of OTC analgesics and relationships with healthcare providers), 2. social factors (socio-economic status, psychosocial support, and social influences) and 3. individual factors (health status, knowledge and experience, psychological stability, and motivation and beliefs) pose as risk or protective factors to self-medicating on the continuum of OTC codeine use in pain management. The findings have significant implications for codeine provision, and healthcare policies going forward. The availability of codeine as an OTC analgesic has implications to its misuse and abuse in pain management. Upscheduling of OTC codeine to prescription only can minimise the misuse and abuse of codeine in pain management in Ireland. In addition, there is immediate need to provide adequate accessible care through primary and secondary care services informed by a national model of care in pain management services in Ireland. The current organisation and delivery of care has significant gaps that can influence elevated self-medicating with over-the counter codeine-based analgesics in pain management.