Medical professionals' perspectives on prescribed and over-the-counter medicines containing codeine: a cross-sectional study

Abstract

ObjectivesTo explore prescribing practitioners' perspectives on prescribed codeine use, their ability to identify dependence and their options for treatment in the UK.DesignCross-sectional design using a questionnaire containing closed-ended and open-ended items.SettingA nationally representative sample of prescribing professionals working in the UK.Participants300 prescribing professionals working in primary care and pain settings.ResultsParticipants stated that they regularly reviewed patients prescribed codeine, understood the risks of dependence and recognised the potential for codeine to be used recreationally. Over half the participants felt patients were unaware of the adverse health consequences of high doses of combination codeine medicines. One-quarter of participants experienced patient resentment when asking about medicines containing codeine. Just under 40% of participants agreed that it was difficult to identify problematic use of codeine without being informed by the patient and did not feel confident in identification of codeine dependence. Less than 45% of all participants agreed that codeine dependence could be managed effectively in general practice. Slow or gradual withdrawal was the most popular suggested treatment in managing dependence. Education and counselling was also emphasised in managing codeine-dependent patients in primary care.ConclusionsCommunication with patients should involve assessment of patient understanding of their medication, including the risk of dependence. There is a need to develop extra supports for professionals including patient screening tools for identifying codeine dependence. The support structure for managing codeine-dependent patients in primary care requires further examination.

Medicines containing codeine: perspectives of medical professionals in the Republic of Ireland

“…Patients were thought to be unaware of risk of dependence and safe use of codeine-containing medicines. This was similar to findings reported by practitioners in the UK (25). The indication by prescribing professionals regarding patients' lack of knowledge surrounding their use of codeine medicines is worrying and requires greater exploration.…”

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

“…In both countries, codeine is available as Prescription-only medicines (POM) and as Pharmacy medicines (P) sold 'over-the-counter' in licensed pharmacies without a medical prescription. 12 Prescribed codeine may contain a high dose of codeine (15,30 or 60 mg per unit dose), either alone or in combination with a non-opioid analgesic, such as paracetamol or ibuprofen. The codeine dose in 'over-the-counter' preparations is restricted to lower amounts (maximum 12.8 mg per unit dose).…”

“…However, a UK survey of general medical practitioners (GPs) underlined problems relating to both categories: more than half reported that patients lack awareness of the potential harms of prescribed codeine and more than 80% reported that the availability of 'over-the-counter' codeine adds to the potential for misuse. 15 An investigation of codeine use and dependence in the UK and Ireland is timely because of the recent indicators of problems of mortality and dependence.…”

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

“…Previous research has indicated that such training is needed for a broad range of health professionals, including psychiatrists, pharmacists, and in particular GPs. [4] Best-practice guidelines for the management of opioid use disorders have been developed by SAAMS, [19] but few of the non-medical treatment providers surveyed were aware of them. Furthermore, these guidelines and those from countries such as Australia and New Zealand are not specific to individuals dependent on codeine and tend to focus on stronger opioids such as heroin.…”

“…[4] The corresponding percentages for Ireland and South Africa (SA) were 43% and 35%, respectively. [5] As a result, individuals who are misusing or dependent on codeine are increasingly being seen in specialist substance abuse treatment centres.…”