“Doctor shopping and pharmacy hopping”: practice innovations relating to codeine

Abstract

Purpose – The misuse of pharmaceutical opioid analgesics is identified as a global public health concern. Codeine represents an interesting quandary in terms of its regulated status, with individuals varying in their metabolism of codeine, estimation of safe dosages, risk of adverse health consequences and abuse potential. Efforts to quantify and address hidden non-compliant medical codeine use, overuse and intentional misuse is compromised by availability to the public in prescribed and over the counter forms. The paper aims to discuss these issues. Design/methodology/approach – A review of literature on codeine use, misuse and dependence, and associated innovative medical and pharmacy interventions is presented, and was conducted as part of a larger scoping review on codeine. Findings – The review highlights the complexities associated with monitoring public health awareness of codeine's abuse potential, and customer/patients trends in non-compliant codeine use for therapeutic and recreational purposes. Aberrant codeine behaviours centre on visiting multiple doctors for prescriptions, repeated lost or stolen prescriptions, forging prescriptions and use of multiple pharmacies. Innovations to monitor misuse of codeine include national prescription databases and recent developments in real-time monitoring of dispensing activity. Practical implications – Further development of real-time monitoring processes with process evaluation is advised. Originality/value – This viewpoint is intended to demonstrate how efforts to quantify and address codeine use are compromised by its availability. It intends to encourage further policy and practitioner dialogue on how to monitor, support and intervene with consumers misusing codeine.

Extent of misuse and dependence of codeine-containing products among medical and pharmacy students in a Nigerian University

“…It includes self-medicating with drugs for a longer period, usually at larger doses and for recreational reasons. Medicine misuse is also considered as a problematic consumption where risks and adverse consequences outweigh the benefits [13–15]. The epidemic of opioid abuse has led to significant increase in concern by the global public health authorities and medicines regulatory bodies due to its overall consequences on the youths and society at large [16, 17].…”

“…Codeine (3-methylmorphine), a weak opiate is one of the most widely accessible and commonly used opiates worldwide, particularly because of its analgesic, antitussive and anti-diarrhoeal properties [21]. Although, codeine is considered a weak opiate, drug dependence and side effects such as sedation, euphoria and constipation among others are inherent [15, 22]. In Nigeria and some other developing countries, studies that evaluate extent of use and misuse of opioid-containing substance among youths is scarce.…”

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

“…Several participants stressed that increased pharmacovigilance was also needed, together with increased aftercare services following treatment of individuals misusing or dependent on codeine, better sharing of information within and across sectors, and more community-based addiction services in general. [23] Many of these interventions were also identified as being important in interviews conducted with key national stakeholders from a variety of sectors beyond addiction practice in the UK, Ireland and SA in another component of the CODEMISUSED project. [24] …”

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

“…Fig. 4 Level of agreement on codeine dependence 2016; Van Hout, 2014). Further medical education is warranted both at university level, during internships, and during continuing professional development to raise awareness around patient safe use of codeine; the risk factors for misuse and dependence; how best to support pain patients with iatrogenic dependence; and how best to intervene at dispensing point of care.…”

“…There is a growing literature base in many countries on consumer access routes and trajectories to codeine misuse and dependence via community pharmacy dispensing and diversion (Carney et al, 2016(Carney et al, , 2018Nielsen et al, 2012;Van Hout et al, 2017b;Wells et al, 2018;). 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;, 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(Foley et al, , 2017(Foley et al, , 2018.…”