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

Abstract

In Saudi Arabia, there are concerning rates of non-compliance with pharmaceutical regulations prohibiting the pharmacy dispensing of prescription-only medications without a physician prescription. This is the first study in the Middle East which examines physicians’ perceptions regarding misuse of codeine, listed as a narcotic, controlled, and prescription-only drug. The CODEMISUSED survey was adapted to the Saudi Arabian context and pilot tested, prior to cross-sectional administration to physicians in Riyadh, Jeddah, Abha, and Jazan (n = 105). Descriptive statistics (frequencies and percentage) present physician level of agreement, neutrality, and disagreement with statements regarding codeine prescribing, patient awareness and use, online and community pharmacy availability, and dependence. The study indicates concern by physicians regarding patient intentional use of codeine to enhance mood, misuse patterns, lack of awareness around habit-forming use and iatrogenic dependence, and sourcing via illegal dispensing. It underscores the imperatives to address pharmacy compliance with pharmaceutical regulatory controls, implement enhanced pharmacovigilance, and improve awareness around safe use.

Patterns of Prescribing Postoperative Analgesic Medication After Thyroid Surgery: A Retrospective Cohort Study

“…Codeine is one of the most widely prescribed opioids in Saudi Arabia, and currently, four codeine-containing products are approved by the Saudi Food and Drug Authority. 20 Unfortunately, codeine can be purchased over-the-counter (OTC) from licensed pharmacies without a medical prescription. 21 , 22 Codeine is a “mild opioid”, but its long-term use can lead to serious medical problems, such as tolerance and addiction.…”

Suspected inappropriate use of prescription and non-prescription drugs among requesting customers: A Saudi community pharmacists’ perspective

“…In our study, the most requested product in this category was a combination of paracetamol and codeine. A recent Saudi study also highlighted the concerns of physicians regarding the easy availability of codeine-containing analgesics at community pharmacies ( Syed et al, 2021 ).…”

“…The problem of inappropriate medication use has globally affected developed and developing nations and continues to be a challenge due to increase in availability of prescription and OTC products ( Fuentes Albarrán and Villa Zapata, 2008 , McCabe et al, 2006 ). The Saudi Food and Drug Authority (SFDA) regulates the approval of drugs in Saudi Arabia and publicly provides a drug list with detailed information including the drug status (prescription, controlled or OTC) ( Syed et al, 2021 ). There have been strict restrictions by the Ministry of Health (MOH) to contain levels of inappropriate drug consumption and related drug dependence, evident by their recent policy reforms, for example there has been a reinforcement of regulations in 2018 regarding for dispensing of antibiotics without a valid prescription at community pharmacies ( Al-Tannir et al, 2020 ) and the shifting of controlled substances (e.g.…”

Knowledge and Attitude of First-Aid Treatments for Snakebites, and the Perception of Snakes among the Students of Health Sciences at Jazan University, Saudi Arabia

“…The Cronbach’s alpha values of 0.82, 0.87, and 0.84 for the knowledge, attitudes, and perception questions indicated excellent internal consistency. The pilot testing of the questionnaire was performed on a focus group of fifteen students, who were not included in the final analysis [ 26 ], and the suggestions received were discussed among all of the authors and incorporated into the final version of the questionnaire.…”

“…The respondents were also informed that all of their responses would remain confidential and anonymous and that the data generated from the study would only be used for scientific purposes. The inclusion criteria were also mentioned to ensure appropriate participation and they had to agree to the informed consent in order to proceed to the other sections of the questionnaire [ 26 , 28 , 29 ].…”