Comparing treatment‐seeking codeine users and strong opioid users: Findings from a novel case series

Nielsen, Suzanne; Murnion, Bridin; Dunlop, Adrian; Degenhardt, Louisa; Demirkol, Apo; Muhleisen, Peter; Lintzeris, Nicholas

doi:10.1111/dar.12224

Cited by 26 publications

(43 citation statements)

References 33 publications

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“…The phenomenon of codeine misuse appeared closely situated within the 'blurring' of therapeutic self-medication for legitimate medical reasons (chronic pain), and misuse for iatrogenic dependence Nielsen et al 2010;Hamer et al 2013;Roussin et al 2013;Nielsen et al 2014), alongside individual difficulties in self-identifying problematic use along their own trajectory of use (Pates et al 2002;Nielsen et al 2010). Of note were the invisible and covert characteristics of dependent use, combined with social isolation over time.…”

Section: Discussionmentioning

confidence: 99%

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

Hout

Horan

Santlal³

et al. 2015

Ir. j. psychol. Med.

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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.

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Section: Discussionmentioning

confidence: 99%

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

Hout

Horan

Santlal³

et al. 2015

Ir. j. psychol. Med.

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“…Codeine has an identified abuse potential due to its opiate effect and development of tolerance within a short timeframe (8), and by reported patient dependence (9). Neuro-adaptation occurs with repeated use (therapeutic and non-therapeutic) within a short period of time (10,11).…”

Section: Advisable For Intoxicating Purposes and When Risks And Advementioning

confidence: 99%

Best Practices and Innovations for Managing Codeine Misuse and Dependence

et al. 2016

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-Purpose. Promoting and ensuring safe use of codeine containing medicines remains a public health issue given the rise in reporting of misuse and dependence particularly in countries where available overthe-counter (OTC). The aim of this unique study was to identify best practices in management of opioid abuse and dependence, particularly codeine, and innovations to meet challenges surrounding safe and compliant use, patient awareness-raising, reducing health harms and enhancing successful treatment of dependence. Methods. A mixed methods approach using three data points was used that included : (1) analysis of data from existing scoping reviews to identify potential areas for innovation (2) interviews with key national stakeholders from public health, pharmaceutical, regulatory, primary care and addiction practice in three distinct regulatory regimes (Ireland, United Kingdom and South Africa); and (3) a circular email request for information on potential innovations to members of the European Medicine's Agency European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCEPP). Data from these three sources were analysed to identify best practices and opportunities for innovation. Results. Best practices and potential innovations were identified under the nine headings: (1) manufacture; (2) product information and public education; (3) responsible prescribing; (4) monitoring and surveillance; (5) dispensing, screening and brief interventions in community pharmacies; (6) safety in the workplace and on the road; (7) internet supply of codeine and online support; (8) treatment of codeine dependence; and (9) learning resources and training for health professionals. Conclusions. Challenges ensuring availability of codeine containing medicines for legitimate therapeutic use, while minimising misuse, dependence and related health harms warrant consideration of new innovations. Most promising innovative potential lies across the products' retail lifecycle from manufacture to prescriber and community pharmacy practitioner.

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“…3,10 People with substance use disorders are not always readily identified by stereotyped external features or behaviours, and such depictions can be detrimental in the context of substance use already being a highly stigmatised condition. They are often hesitant to disclose substance use, if indeed they acknowledge that their use is problematic.…”

mentioning

confidence: 99%

“…A study in Sydney reported that codeine was the sole substance used by 39% of patients with a pharmaceutical opioid dependence and 83% of these patients were using only over-the-counter codeine. 3 At a drug dependence unit in South Australia, the annual incidence of codeine dependence requiring intervention increased from 31 people in 2003 to 174 in 2014. The estimated cost of treating 30 patients with codeine-related admissions in one Adelaide hospital was over $1 million.…”

mentioning

confidence: 99%

“…An Australian case series found that buprenorphine/ naloxone is commonly prescribed for people who are codeine dependent. 3 This treatment may have advantages over methadone in terms of reduced risk of respiratory depression, greater experience with its use in the treatment of codeine dependence, and more flexibility with unsupervised (take-home) dispensing. Expanding buprenorphine treatment in primary care may be an ideal way to help patients with codeine dependence.…”

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confidence: 99%

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Editorial: Changes for codeine

Roberts¹,

Nielsen²

2018

Aust Prescr

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Comparing treatment‐seeking codeine users and strong opioid users: Findings from a novel case series

Abstract: There are important differences between codeine-dependent patients and strong prescription opioid-dependent patients. Further work should explore the outcomes of withdrawal versus maintenance treatment for codeine users.

Cited by 26 publications

References 33 publications

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

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

Best Practices and Innovations for Managing Codeine Misuse and Dependence

Editorial: Changes for codeine

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