The upscheduling of combination analgesics containing codeine: The impact on the practice of pharmacists

Hamer, Ainslie M.; Spark, M. Joy; Wood, Pene; Roberts, Emily

doi:10.1016/j.sapharm.2013.08.004

Cited by 34 publications

(54 citation statements)

References 22 publications

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“…Two way displacements between prescribed codeine for physical pain management and over the counter sourcing were observed and similar to that illustrated in Cooper's study in the United Kingdom (2013a). Similar to extant research (Inciardi et al 2009(Inciardi et al , 2010Wilsey et al 2010;Hamer et al 2013) online sourcing of codeine rarely occurred in preference for pharmacies, and prescribers.…”

Section: Discussionsupporting

confidence: 69%

“…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%

See 1 more Smart Citation

‘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: Discussionsupporting

confidence: 69%

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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“…Reinforcers for problematic consumption include use relating to intoxicating purposes and when benefits of misuse outweigh adverse consequences (Casati, Sedefov et al 2012). The interplay between chronic non-cancer pain, self-medication of codeine and iatrogenic dependence has also been observed (Arora, Roxburgh et al 2013;Roussin, Bouyssi et al 2013;Hamer, Spark et al 2014). Reported health consequences from long term and/or excessive misuse of combination codeine analgesics include headaches, nephrotoxicity, gastro-intestinal conditions, hypokalaemia, acute haemorrhagic and necrotizing pancreatitis (Dyer, Martin et al 2004;Dutch 2008;Ernest, Chia et al 2010;Evans, Chalmers-Watson et al 2010;Frei, Nielsen et al 2010;McDonough 2011;Pilgrim, Dobbin et al 2013;Pilgrim and Drummer 2014).…”

Section: Introductionmentioning

confidence: 99%

A Comparative Exploration of Community Pharmacists’ Views on the Nature and Management of Over-the-Counter (OTC) and Prescription Codeine Misuse in Three Regulatory Regimes: Ireland, South Africa and the United Kingdom

Carney

Wells

Bergin

et al. 2016

Int J Ment Health Addiction

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A comparative exploration of community pharmacists' views on the nature and management of Over-the-Counter (OTC) and Prescription codeine misuse in three regulatory regimes; Ireland, South Africa and the United Kingdom. AbstractMisuse of codeine containing preparations is a public health concern given the potential for associated harms and dependence. This study explores the perspectives of community pharmacists in three regulatory regimes on issues of customer misuse of over the counter (OTC) and prescribed codeine containing preparations. A qualitative design comprising six focus groups (n=45) was conducted in Ireland, United Kingdom, South Africa. Transcripts were analysed using the constant comparative method of content analysis. Pharmacists described popular codeine containing products; the need for improved medicine information and warning labels. Issues around legitimate availability of codeine and regulatory status; presence of therapeutic need; difficulties in customer-pharmacist communication; business environments and retail focus were raised. Participants also discussed how they identified customers potentially misusing codeine; customer pharmacy 'hopping' and difficulties in relationships between pharmacists and prescribers. Specialist training; reimbursement for customer consultation; screening and brief interventions; visible referral structures and assisted community pharmacy detoxification were discussed as ways to manage the issues. The study highlights the difficulties encountered by community pharmacists operating under various regulatory regimes when supplying codeine containing preparations in negotiating patient awareness and compliance and dealing with misuse and dependence. Key WordsCodeine containing preparations; Misuse; Community pharmacy; Pharmacists; RegulationWhat is known about this topic 2  Over-the-counter (OTC) and prescription codeine containing products, as dispensed in pharmacies, have the potential for misuse and dependence. Different countries have different regulations with regards to the provision and display of codeine and level of pharmacist intervention at point of sale. Strategies which prevent and address codeine misuse include screening, information provision and referral. What this paper adds Pharmacists in Ireland, South Africa, and the UK have multiple roles and face a number of challenges related to financial and time resources; perceptions of the pharmacist profession and advising on safe and appropriate use of medication, not only codeine. Pharmacists have their own ways to identify customers who may be misusing codeine, but customers' strategies such as 'pharmacy hopping' and some use of online pharmacies make this challenging. Support and referral interventions are provided by pharmacists, but these are not standard, and more information is needed on which services to refer customers to for codeine misuse.

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“…While such practices, for example, 'real time monitoring' (The Codeine Care Project) are an important deterrent for misuse and dependence (7,(42)(43), they are not solely sufficient. Recent data suggests that individuals who continue to misuse or are dependent on codeine containing medicines intentionally bypass 'real time monitoring' practices and engage communication strategies centred on manipulation and deceitfulness either when negotiating scripts from their doctor or purchasing their medicines.…”

Section: Discussionmentioning

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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The upscheduling of combination analgesics containing codeine: The impact on the practice of pharmacists

Cited by 34 publications

References 22 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

A Comparative Exploration of Community Pharmacists’ Views on the Nature and Management of Over-the-Counter (OTC) and Prescription Codeine Misuse in Three Regulatory Regimes: Ireland, South Africa and the United Kingdom

Best Practices and Innovations for Managing Codeine Misuse and Dependence

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