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Substance Abuse Treatment, Prevention, and Policy
Published in: Substance Abuse Treatment, Prevention, and Policy 1/2018

Open Access 01-12-2018 | Research

A comparative analysis of pharmacists’ perspectives on codeine use and misuse – a three country survey

Authors: Tara Carney, John Wells, Charles D. H. Parry, Padraig McGuinness, Richard Harris, Marie Claire Van Hout

Published in: Substance Abuse Treatment, Prevention, and Policy | Issue 1/2018

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Abstract

Background

The 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.

Methods

A 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).

Results

The 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).

Conclusion

In 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.
Literature
1.
Casati A, Sedefov R, Pfeiffer-Gerschel T. Misuse of medicines in the European Union: a systematic review of the literature. Eur Addict Res. 2012;18(5):228–45.CrossRefPubMed
2.
UNODC. The non medicinal use of prescription drugs. Vienna: United Nations; 2011.
3.
Van Hout M, Norman I. Over the counter codeine misuse: recommendations for detection and reduction of risk in community pharmacies. Int J Drug Policy. 2016;27:17–22.CrossRefPubMed
4.
INCB. Narcotic drugs - yellow list. International Narcotics Control Board: Austria; 2011.
5.
Derry S, Karlin SM, Moore R. Single dose oral ibuprofen plus codeine for acute postoperative pain in adults. Cochrane Database Sys Rev. 2015;2:CD010107.
6.
Nielsen S, Van Hout MC. Over-the-counter codeine –from therapeutic use to dependence, and the grey areas in between. Curr Top Behav Neurosci. 2016;34:59–75.CrossRef
7.
Van Hout MC. Doctor shopping and pharmacy hopping: practice innovations relating to codeine. Drug Alcohol Today. 2014;14(4):219–34.CrossRef
8.
Nielsen S, Cameron J, Pahoki S. Over the counter codeine dependence. Turning Point Alcohol and Drug Centre: Victoria, Australia; 2010.
9.
Cooper R. ‘Respectable addiction’ - a qualitative study of over the counter medicine abuse in the UK. London: Pharmacy Practice Research Trust; 2011.
10.
Cooper RJ. Over-the-counter medicine abuse: a review of the literature. J Subs Use. 2013;18:82–107.CrossRef
11.
12.
Wazaify M, Shields E, Hughes CM, McElnay JC. Societal perspectives on over-the-counter (OTC) medicines. Fam Pract. 2005;22(2):170–6.CrossRefPubMed
13.
Fleming GF, McElnay JC, Hughes CM. Development of a community pharmacy-based model to identify and treat over the counter drug abuse/misuse: a pilot study. Pharm World Sci. 2004;26:282–8.CrossRefPubMed
14.
Carney T, Wells J, Bergin M, Dada S, Foley M, McGuiness P, et al. A comparative community pharmacists’ views on the nature and management of over-the-counter (OTC) and prescription codeine misuse in three regulatory regimes: Ireland, South Africa and the United Kingdom. Int J Ment Health Addict. 2016;14:351–9.
15.
16.
Dobbin M, Tobin CL. Over-the-counter ibuprofen/codeine analgesics: misuse and harm. Drugs Policy and Services Branch Department of Human Services: Melbourne; 2008.
17.
Pates R, McBride A, Li S, Ramadan R. Misuse of over-the-counter medicines: a survey of community pharmacies in a South Wales health authority. Pharm J. 2002;268:179–82.
18.
Nielsen S, Cameron J, Lee N. Characteristics of a non-treatment seeking sample of over-the-counter codeine users: implications for intervention and prevention. J Opioid Manag. 2011;7(5):363–70.CrossRefPubMed
19.
Foley M, Harris R, Rich E, Rapca A, Bergin M, Norman I, et al. The availability of over-the-counter codeine medicines across the European Union. Public Health. 2015;129:1465–70.CrossRefPubMed
20.
McAvoy BR, Dobbin MD, Tobin CL. Over-the-counter codeine analgesic misuse and harm: characteristics of cases in Australia and New Zealand. N Z Med J. 2011;124(1346):29–33.PubMed
21.
Hamer AM, Spark MJ, Wood PJ, Roberts E. The upscheduling of combination analgesics containing codeine: the impact on the practice of pharmacists. RSAP. 2014;10(4):669–78.PubMed
22.
Dada S, Harker Burnhams N, Van Hout MC, Parry CDH. Codeine misuse and dependence in South Africa-learning from substance use treatment admissions. SAMJ. 2015;105(9):776–9.CrossRefPubMed
23.
Parry C, Deluca P, Cooper R, Van Hout MC. Do we have sufficient information to optimally inform regulatory or other policy decisions about medications containing codeine? Addiction. 2015;110(10):1690–2.CrossRefPubMed
24.
Cooper R. Surveillance and uncertainty: community pharmacy responses to over the counter medicine abuse. Health Soc Care Community. 2013;21(3):254–62.CrossRefPubMed
25.
MacFayden L, Eadie D, McGowan T. Community pharmacists’ experience of over-the-counter medicine misuse in Scotland. J R Soc Promo Health. 2001;121(3):185–92.CrossRef
26.
Matheson C, Bond C, Pitcairn J. Misuse of over-the-counter medicines from community pharmacies: a population survey of Scottish pharmacists. Pharm J. 2002;269:66–8.
27.
Reed K, Bond A, Witton J, Cornish R, Hickman M, Strang J. The changing use of prescribed benzodiazepines and z-drugs and of over-the-counter codeine-containing products in England: a structured review of published English and international evidence and available data to inform consideration of the extent of dependence and harm. In: National Addiction Centre KCL, and School of Social and Community Medicine, University of Bristol, editor. London: Kings College London; 2011.
28.
Wright J, Bond CM, Robertson HD, Matheson C. Changes in over-the-counter drug misuse over 20 years: perceptions from Scottish pharmacists. J. Public Health. 2016;38(4):793–9.
29.
Van Hout MC, Rich E, Dada S, Bergin M. Codeine is my Helper: A qualitative study of pharmacy access and codeine misuse in South Africa. Qual Health Res. 2015; ahead of print
30.
Shand F, Campbell G, Hall W, Lintzeris N, Cohen M, Degenhardt L. Real-time monitoring of schedule 8 medicines in Australia: evaluation is essential. Med J Aus. 2013;198(2):80–1.CrossRef
31.
Bergin M, Norman I, Foley M, Harris R, Rapca A, Rich E, et al. Practice implications and recommendations for managing codeine misuse and dependence. Acta Pharma. 2015;65:351–64.CrossRef
32.
Van Hout M, Bergin M, Foley M, Rich E, Rapca A, Harris R, et al. A scoping review of codeine use, misuse and dependence, final report. 2014.
33.
Le Roux K. Marketing of CPS. SAPJ. 2013;80(5):43–7.
34.
Haggan M. Year in review: Codeine: An unscheduled dilemma. AJP. 2017;98(1168):18.
35.
Sheridan J, Butler R. “They’re legal so they’re safe, right?” what did the legal status of BZP-party pills mean to young people in New Zealand? Int J Drug Policy. 2010;21(1):77–81.CrossRefPubMed
36.
Phokeo V, Sproule B, Raman-Wilms L. Community Pharmacists’ attitudes toward and professional interactions with users of psychiatric medication. Psychiatr Serv. 2004;55(12):1434–6.CrossRefPubMed
37.
Berger K, Eickhoff C, Schulz M. Counselling quality in community pharmacies: implementation of the pseudo customer methodology in Germany. J Clin Pharm Ther. 2005;30:45–57.CrossRefPubMed
38.
Benrimoj SI, Gilbert A, Quintrell N, Neto AC. Non-prescription medicines: a process for standards development and testing in community pharmacy. Pharm World Sci. 2007;29(4):386–94.CrossRefPubMed
39.
Benrimoj SI, Gilbert AL, de Almeida Neto AC, Kelly F. National implementation of standards of practice for non-prescription medicines in Australia. Pharm World Sci. 2009;31(2):230–7.CrossRefPubMed
40.
Agnich LE, Stogner JM, Miller BL, Marcum CD. Purple drank prevalence and characteristics of misusers of codeine cough syrup mixtures. Addict Behav. 2013;38(9):2445–9.CrossRefPubMed
Metadata
Title
A comparative analysis of pharmacists’ perspectives on codeine use and misuse – a three country survey
Authors
Tara Carney
John Wells
Charles D. H. Parry
Padraig McGuinness
Richard Harris
Marie Claire Van Hout
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Substance Abuse Treatment, Prevention, and Policy / Issue 1/2018
Electronic ISSN: 1747-597X
DOI
https://doi.org/10.1186/s13011-018-0149-2

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