‘Codeine is my companion’: misuse and dependence on codeine containing medicines in Ireland

Abstract

Objectives. Global concern around over the counter availability of codeine containing products and risk of misuse, dependence and related harms are evident. A phenomenological study of lived experiences of codeine misuse and dependence was undertaken in Ireland, following the Pharmaceutical Society of Ireland's 2010 guidelines for restricted supply of non-prescription codeine containing products.Methods. In-depth interviews were conducted with a purposive sample of adult codeine misusers and dependents (n = 21), both actively using, in treatment and in recovery. The narratives were analysed using the Empirical Phenomenological Psychological five-step method (Karlsson, 1995). A total of 10 themes with 82 categories were identified. Two concepts at a higher level of abstraction above the theme-level emerged during the final stage of analysis. The concepts identified were 'emotional pain and user self-legitimization of use' and 'entrapment into habit-forming and invisible dependent use'. These concepts were reported in different ways by a majority of participants.Results. Findings are presented under the following themes: (1) profile and product preferences; (2) awareness of habit forming use and harm; (3) negotiating pharmacy sales; (4) alternative sourcing routes; (5) the codeine feeling; (6) the daily routine; (7) acute and chronic side effects; (8) social isolation; (9) withdrawal and dependence and (10) help-seeking and treatment experiences.Conclusions. There is a public health and regulatory imperative to develop proactive responses tackling public availability of codeine containing medicines, risk minimisation in consumer self-treatment for pain, enhanced patient awareness of potential for habit forming use and its consequences and continued health professional pharmacovigilence.

Codeine use, dependence and help-seeking behaviour in the UK and Ireland: an online cross-sectional survey

“…Previous research suggests that codeine administration for emotional distress may be a good indicator for dependence or risk of developing dependence. 29 GPs and pharmacists need to be vigilant of reasons for use when deciding to prescribe or sell codeine.…”

Codeine misuse and dependence in South Africa: Perspectives of addiction treatment providers

“…[18] Most people were reluctant to spend time travelling on costly public transport, and people were also reluctant to pay for treatment, as they were often aware that there were government-funded centres available -albeit with a lengthy waiting list. [14] Surprisingly, only 10% of our SA participants indicated that the geographical location of treatment settings would be a problem, compared with 22% for Ireland, and none mentioned transport-related costs as being a barrier for codeine patients in SA, compared with 30% for Ireland. [16] Practitioners were optimistic about preventing relapse by the use of alternative non-opioid pain relief in patients with coexisting pain and addiction to codeine medicines.…”

“…[13] Qualitative research recently conducted in SA and Ireland furthermore underscores the lack of awareness of risk around habitforming use of medicines containing codeine and pathways towards dependence in patients who attended treatment. [14,15] Stigma was listed as less of a problem in SA compared with data obtained from the UK and Ireland as part of the CODEMISUSED project, [16] but in SA and Ireland child-care issues were raised more frequently than in the UK. Six out of 10 addiction treatment providers surveyed in SA indicated that affordability of services would be a barrier to codeine patients accessing treatment, compared with only 22% in Ireland and none in the UK, where there is a National Health Insurance system.…”

“…In view of this, specific best-practice guidelines for managing codeine misuse and dependence should be developed and/or updated to incorporate innovations to ensure that individuals misusing or dependent on codeine receive a uniform and proven treatment option. [14,15,25] Availability of opioid agonists should probably be expanded to low-threshold services in the treatment of codeine dependence. [26] The training needs of treatment providers should be addressed as a matter of urgency to cover best practices for managing codeine misuse and dependence, including detoxification modalities, pharmacotherapy maintenance treatment, psychosocial support and ensuring proper aftercare.…”

Best Practices and Innovations for Managing Codeine Misuse and Dependence

“…Recent data suggests that individuals who continue to misuse or are dependent on codeine containing medicines intentionally bypass 'real time monitoring' practices and engage communication strategies centred on manipulation and deceitfulness either when negotiating scripts from their doctor or purchasing their medicines. Managing such behaviours require further advanced communications training for medical and pharmacy practitioners, particularly in the area of interpersonal communication strategies with a specific focus on motivational interviewing and brief interventions (44,45).…”