Medical prescription forms of opioid cough suppressants falsified by the patients before and after they switched from over‐the‐counter to prescription‐only in France

Abstract

The French Ministry of Health scheduled opioid cough suppressants as prescription-only drugs on 12 July 2017. The present study assessed the impact of this regulation on the diversion modalities of the concerned drugs and the related drug pholcodine by analysing the national OSIAP (Ordonnances Suspectes Indicateur d'Abus Possible) database. Methods: Medical prescriptions with at least 1 mention of codeine, dextromethorphan, ethylmorphine, noscapine or pholcodine for cough suppression recorded in 2013-2019 were extracted from OSIAP. Annual mentioning rates were estimated by dividing numbers of mentions over those of prescriptions recorded the year considered. A descriptive analysis compared the characteristics of prescriptions before and after 12 July 2017.Results: Overall, 832 mentions of the requested drugs were retrieved on 827 prescription forms. Codeine was the most frequent (n = 809, 8.7%) with 6 additional mentions of codeine/ethylmorphine combination, followed by dextromethorphan (n = 11, 0.1%) and pholcodine (n = 6, 0.1%). There was no mention of noscapine.Annual mentioning rates varied between 0 and 0.3% for all drugs except codeine.Codeine mentioning rates ranged between 0.3% (n = 2) and 0.7% (n = 9) before 12 July 2017 and increased to 10.1% (n = 61) thereafter in 2017, 16.1% (n = 314) in 2018, and 19.8% (n = 414) in 2019. The profile of subjects evolved accordingly with an increased male/female ratio (10.0 vs. 1.5 before) and decreased age (23 vs. 40 y before, P < .001).Discussion: The sharp increase of recourse to falsified prescription forms indicates that codeine diversion continues despite restricted access, whereas the other drugs studied do not seem to have been impacted.

Sales of over the counter (OTC) codeine-containing products in the United Kingdom: a retrospective observational study

“…One dosage unit of codeine costs an average of £0. 13 In this present study it was not possible to determine the specific indications for the billions of dosage units of codeine sold OTC; however, use was probably driven by several factors. Codeine is most often used to manage physical pain, including migraine, dental, back, menstrual, joint, postoperative, and childbirth pain [10,30,31].…”

“…Most (56%; 15 of 27) of the member states in the European Union do not allow OTC sale of codeine [12]. In 2017, France reclassified codeine from OTC to prescription-only [13,14], whereafter, more falsified codeine prescriptions for cough were presented to pharmacies [15]. A questionnaire sent to 33 pharmacies in Normandy, France, showed that sales of OTC codeine products, such as sirop Euphon®, more than doubled between May and June 2017, the month before the restrictions were implemented [16].…”