A comparative analysis of pharmacists\u2019 perspectives on codeine use and misuse \u2013 a three country survey

Tara Carney,Padraig Mcguinness,Marie Claire Van Hout,John Wells,Richard Harris,Charles D H Parry

doi:10.1186/s13011-018-0149-2

Abstract

BackgroundThe misuse of codeine is of increasing concern in a number of countries, particularly as this relates to over -the-counter pain and cough relief medication, and is also supplied as a prescription medicine. The study aimed to obtain and analyse the opinions and experience of pharmacy staff with regard to codeine misuse.MethodsA cross-sectional web-based survey of pharmacy staff’s perspectives on this issue was administered through professional or regulatory bodies and completed by samples drawn in South Africa (n = 124), Ireland (n = 464) and the United Kingdom (n = 129).ResultsThe majority of participants reported combination codeine-containing products as most popular, but significantly more pharmacy staff in South Africa reported codeine-containing cough syrups as most commonly popular (X2 = 122.7(2), p < 0.001). Codeine use was also seen significantly more of a public health problem in South Africa than in the other two countries (X2 = 7.6(2), p = 0.02). There was no difference across countries in the level of codeine misuse reported by pharmacy staff. Further findings indicate that professional training and education is desired, with unequivocal findings for the need for greater codeine control (X2 = 12.0(2), p = 0.002).ConclusionIn conclusion, there were some inter-country differences, but overall the findings seem to suggest that pharmacists across all three countries view codeine misuse as a problem among their customers. Recommendations centre on risk management, surveillance and staff training.

Highlights

The misuse of codeine is of increasing concern in a number of countries, as this relates to over -the-counter pain and cough relief medication, and is supplied as a prescription medicine
It was undertaken as part of a large scale multi-country effort (CODEMISUSED Project) to investigate codeine use, Table 1 Codeine Regulations in Ireland, South Africa and the United Kingdom (UK)
Most pharmacy studies investigating the misuse of pharmaceutical opioids have focused on stronger opioids as opposed to weaker opioids like codeine which are frequently sold over the counter as combination pharmaceuticals

Summary

Introduction

The misuse of codeine is of increasing concern in a number of countries, as this relates to over -the-counter pain and cough relief medication, and is supplied as a prescription medicine. Viewed as a weak opiate, it still has the potential for misuse and abuse or dependence and has a number of associated side effects, such as sedation, euphoria and constipation [6]. Long term or high dose use of combination products containing codeine with ibuprofen or paracetamol can lead to a number of side effects [6] such as inflammatory bowel conditions, nephrotoxicity, hypokalemia, pancreatitis, gastric ulcers, gastrointestinal haemorrhage, medication over-use, headache, depression and paracetamol hepatotoxicity [7]. Physical tolerance develops over time and unpleasant withdrawal type physical effects can occur when usage stops [6, 8]

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