Abstract
The misuse of opioids, including codeine which is sold over-the-counter (OTC) in United Kingdom (UK) community pharmacies, is a growing public health concern. An educational Patient Safety Card was developed and piloted to see if it nudged customers into the safe and appropriate use of OTC codeine. Exploratory analysis was conducted by (i) recording quantitative interactions for people requesting OTC codeine in community pharmacies; and (ii) a web-based pharmacy staff survey. Twenty-four pharmacies submitted data on 3993 interactions using the Patient Safety Card. Staff found the majority of interactions (91.3%) to be very or quite easy. Following an interaction using the card, customers known to pharmacy staff as frequent purchasers of OTC codeine were more likely not to purchase a pain relief medicine compared to customers not known to staff (5.5% of known customers did not purchase any pain relief product versus 1.1% for unknown customers (χ2 = 41.73, df = 1, p < 0.001)). These results support both the use of a visual educational intervention to encourage appropriate use of OTC codeine in community pharmacy and the principles behind better self-care.
Highlights
Opioid analgesics are used for pain relief where medicines such as paracetamol or ibuprofen alone have not provided relief [1]
While codeine is licensed for use in those aged over 12 years in the United Kingdom (UK), it is contraindicated in those under 18 years who have breathing problems [5]
With the majority of interactions using the card classed as easy and with receptive customers, this work indicates that pharmacy teams can influence an individual’s knowledge and comprehension about the safe and appropriate use of OTC codeine
Summary
Opioid analgesics are used for pain relief where medicines such as paracetamol or ibuprofen alone have not provided relief [1]. In addition to being available on prescription in the UK, codeine-containing medicines are available to purchase from a pharmacy (usually behind the counter or in locked cabinets), sold by or under the supervision of a pharmacist, and are known by the metonymic term of over-the-counter (OTC). Regular or excessive use of codeine, even for short periods, can lead to tolerance [6], and psychological and physical dependence [5]. Those that become dependent may experience negative personal, professional or social impacts, and obtain illicit supplies; this could lead to criminality and has been linked into several preventable deaths [7,8,9]. One report on pharmacist perceptions indicated a perceived increase in misuse [11], and another cross-sectional survey of the general population reported that the products most commonly misused were codeine-containing analgesics [12]
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