A study of medical professionals’ perspectives on medicines containing codeine in South Africa

Abstract

BackgroundMisuse of codeine available on prescription and over-the-counter (OTC) has been highlighted as a potential problem in South Africa.ObjectiveTo examine the perceptions of medical professionals regarding codeine use (prescribed and OTC), misuse, dependence and treatment options in South Africa.MethodData for the study were obtained using a sample of medical professionals obtained through random and convenience sampling. A quantitative methodology was employed using a structured self-administered questionnaire with closed and open-ended items. Data analysis was conducted using SPSS version 21; 238 medical professionals involved in the prescribing of codeine completed the questionnaire.ResultsTwo-thirds of participants stated that they routinely reviewed patients prescribed codeine, and high levels of concern were expressed about the availability of OTC medicine containing codeine in pharmacies (84.9%) and on the internet (71.3%). There was agreement that medicines containing codeine should be regulated to a prescription-only medicine (85.3%). Only 22% of participants agreed that they had suitable screening methods to help with detection of codeine dependence. Eighty per cent indicated that they would welcome the opportunity for greater instruction on prescribing potentially addictive medicines.ConclusionThere appears to be a need to improve education on consumption and risks associated with codeine use. In addition, screening tools are needed to detect those with codeine dependence. Greater data sources are now needed to examine the sale of and consumption of codeine medicines in the interest of public health.

Effects of prescription drug diversion, misuse and abuse on the health system in eThekwini District, KwaZulu-Natal, South Africa: Key stakeholders’ perceptions

“…This study has also shown that consumer's attitude and behaviour as an additional challenge faced by health care providers. This translate into poor protocol implementation for most health care providers who shun away from conflicts with patients or costumers at pharmacy and weak enforcement of regulations and policies has being reported (16). On other hand, consumers' denial and dishonesty adds to the burdened health system gaps such as lack of screening tools (16), lack of monitoring systems (18), poor supervision (16) therefore perpetuating drug diversion problem.…”

“…In South Africa there is limited data on drug diversion, misuse and abuse. The misuse of opioids in the form of codeine containing products has recently being documented as most commonly accessed in local pharmacies (5,(16)(17)(18)(19)(20)(21)(22). Tolerance, dependence and addiction of codeine can develop very rapidly (11).…”

“…Tolerance, dependence and addiction of codeine can develop very rapidly (11). Whilst, about 80% of medical professionals lack appropriate knowledge or guidance on prescribing potentially addictive medicines (16). In addition to the stigma and discrimination experienced by people living with HIV (PLWH), some data suggest that they are also affected with chronic pain (23)(24)(25)(26), thus, predisposing them to frequent use prescription drugs such as opioids (27,28).…”

“…In addition to the HIV burden South Africa is faced with, it is imperative to understand the context of drug diversion, misuse and abuse. To date, research investigating the diversion, misuse and abuse of medicines either obtained over-the-counter or by prescription has been neglected to a large extent (5,16,(18)(19)(20). As a result, there is little available literature on the prevalence of drug diversion, misuse and abuse to support anecdotal reports in South Africa (22).…”

“…Prevailing gaps in the health care system also drives drug diversion and misuse. Public health care facilities are perceived to be mostly challenged with insufficient consultation time, negligence and lack of proper guidelines meanwhile private health care facilities are money driven.Although evidence reports that the availability(5,16) and accessibility(44)(45)(46)(47) of medicines contributes to drug diversion, misuse and abuse, different manifestation of drug diversion are still prevalent. A study byWells et al (2018), agrees to our findings that drug misuse is not impacted by being aware and knowledgeable of the potential drug risks…”