Physician Perspectives on Codeine Accessibility, Patterns of Use, Misuse, and Dependence in Saudi Arabia

Mamoon H Syed,Ayesha Yasmeen,Marie-Claire Van Hout

doi:10.1007/s11469-021-00670-4

Mamoon H Syed, Ayesha Yasmeen + Show 1 more

Open Access

https://doi.org/10.1007/s11469-021-00670-4

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Abstract

In Saudi Arabia, there are concerning rates of non-compliance with pharmaceutical regulations prohibiting the pharmacy dispensing of prescription-only medications without a physician prescription. This is the first study in the Middle East which examines physicians’ perceptions regarding misuse of codeine, listed as a narcotic, controlled, and prescription-only drug. The CODEMISUSED survey was adapted to the Saudi Arabian context and pilot tested, prior to cross-sectional administration to physicians in Riyadh, Jeddah, Abha, and Jazan (n = 105). Descriptive statistics (frequencies and percentage) present physician level of agreement, neutrality, and disagreement with statements regarding codeine prescribing, patient awareness and use, online and community pharmacy availability, and dependence. The study indicates concern by physicians regarding patient intentional use of codeine to enhance mood, misuse patterns, lack of awareness around habit-forming use and iatrogenic dependence, and sourcing via illegal dispensing. It underscores the imperatives to address pharmacy compliance with pharmaceutical regulatory controls, implement enhanced pharmacovigilance, and improve awareness around safe use.

Highlights

The misuse and abuse of codeine-containing medications both prescribed and over the counter continues to represent a global public health and policy challenge (Bergin et al, 2015; Dada et al, 2015; Myers et al, 2003; Parry et al, 2015; Wells et al, 2018)
A meager percentage of respondents (2.9%) strongly agreed to the statement that patients were cognizant of the adverse effects of taking codeine in higher doses
To the authors’ knowledge, this is the first study of its kind in the Middle East and presents a unique illustration of physician perspectives on the prescribing of codeine, patient consumption patterns, and levels of awareness of risks and related harms of long-term/high-dose use and dependence in Saudi Arabia

Summary

Introduction

The misuse and abuse of codeine-containing medications both prescribed and over the counter continues to represent a global public health and policy challenge (Bergin et al, 2015; Dada et al, 2015; Myers et al, 2003; Parry et al, 2015; Wells et al, 2018). Despite it being a weak opiate and used to treat mild to moderate pain in adults, misuse is broadly defined as “the use of a medicine, with or without a doctor’s prescription, clearly outside of accepted medical practice or guidelines, for recreational purposes or in the framework of self-medication, in greater dosages or for longer periods than were prescribed, in which the risks and problems associated with use outweigh the benefits” There are increased efforts to develop medical and community practice-based innovations to detect, intervene, and support those affected(Norman et al 2014; Van Hout, 2014; Van Hout & Norman, 2016), supported by assessments of medical and pharmacy practitioner perspectives on codeine use, pathways toward misuse and dependence, the detection of patient aberrance, and support interventions (Foley et al, 2016, 2017, 2018)

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