Use of codeine-containing medicines by Irish psychiatric inpatients before and after regulatory limitations on their supply

Abstract

BackgroundIn recent years, concerns have been highlighted in several jurisdictions, including Ireland, regarding abuse of over-the-counter codeine-containing medicines. On the 1st of August 2010, national regulatory guidelines aimed at limiting the supply of these medicines in Ireland came into force.AimsTo study the effects of the new regulations on the use of non-prescribed codeine-containing medicines by psychiatric patients admitted to an Irish university teaching hospital before (n = 117) the regulations came into effect and 6 months afterwards (n = 126).MethodsParticipants completed a brief self-administered survey questionnaire about their use of over-the-counter codeine-containing medicines in the preceding 3 months.ResultsCompared with before the introduction of the new regulations, there was a large decline in the reported ‘often’ or ‘regular’ use of codeine-containing medicines in the 3 months before admission (33.3% v. 17.4%, χ2 = 6.354, p = 0.01) and there was a reduction in the proportion of patients for whom others had expressed concerns about their frequency of use of such medications (15.5% v. 4.8%, χ2 = 7.29, p = 0.03). There was also a decline in the proportion of patients who stated that they would use codeine-containing medicines for either a ‘feel-good’ effect or to curb cravings (15.9% v. 1.9%, p < 0.01, two-tailed Fisher's exact test).ConclusionWe conclude that tight regulations on the supply of non-prescription codeine-containing medicines have the potential to reduce the use and abuse of such medicines in patient populations availing of admission to psychiatry hospitals.

Misuse of non-prescription codeine containing products: Recommendations for detection and reduction of risk in community pharmacies

“…Misuse and dependence occurs in a wide range of groups, with studies reporting on parental medication of children (Allotey, Reidpath, & Elisha, 2004), recreational users (Agnich, Stogner, Miller, & Marcum, 2013;Ford & Good, 2007;Lam & Shek, 2006;Peters et al, 2003;, Peters, Williams, Ross, Atkinson, & Yacoubian, 2007, Peters, Amos, et al, 2007Van Hout, 2014a, 2014b, university students (Acocella, 2005), pharmacy customers (Albsoul-Younes, Wazaify, Yousef, & Tahaineh, 2010;Sweileh, Arafat, Al-Khyat, Al-Masri, & Jaradat, 2004), older people (Agaba, Agaba, & Wigwe, 2004;Roumie & Griffin, 2004), psychiatric patients (Agyapong et al, 2013), injecting drug users (Arora et al, 2013), non-treatment seeking individuals (Nielsen, Cameron, & Lee, 2011) and drug treatment patients (Akram and Roberts, 2003;Cohen, Unoh, Barry, & O'Connor, 2009;Cooper, 2013c;Myers, Siegfried, & Parry, 2003;Nielsen et al, 2008;Nielson et al, 2010;Thekiso & Farren, 2010;Yang & Yuan, 2008). Nielson et al (2010Nielson et al ( , 2011 highlight the unique and distinct nature of codeine dependence, as distinct from other forms of opioids, and identified a 'blurring' between use of codeine containing products for therapeutic, recreational and high dose purposes (Nielson et al, 2010(Nielson et al, , 2011.…”

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

“…Pharmacists' roles include record keeping and direct pharmacist intervention at point of sale (Cooper 2011;Cooper 2013c;Hamer, Spark et al 2014). Whilst such regulatory measures may contribute to positive outcomes relating to public deterrence of codeine misuse (Agyapong, Singh et al 2013), the empirical support for such interventions specific to codeine is not well developed.…”

‘Codeine is my companion’: misuse and dependence on codeine containing medicines in Ireland

“…Within trajectories of codeine misuse and dependence, a wide ranging profile of codeine user exists; for example, the elderly (Roumie & Griffin, 2004;Agaba et al 2004); youth (Elwood, 2001;Peters et al 2003Peters et al , 2007aPeters et al , 2007bPeters et al , 2007cFord, 2009;Lao et al 2010;Wilson et al 2010;Tang et al 2012;Agnich et al 2013); parents (Allotey et al 2004); students (Acocella, 2005); pharmacy customers (Sweileh et al 2004;Albsoul-Younes et al 2010); drug and psychiatric treatment patients (Agyapong et al 2013); addiction treatment patients (Akram & Roberts, 2003;Myers et al 2003;Yang & Yuan, 2008;Cohen et al 2009;Thekiso & Farren, 2010;Cooper, 2013b) and internet drug forum users (Van Hout, 2015) each with their own motives, patterns and outcomes for use. However, there is a lack of consensus around a definition of misuse of pharmaceutical opioid narcotics (Barrett et al 2008;Casati et al 2012;Cooper, 2013a) with broad misuse of pharmaceutical definitions including incorrect but legitimate use for medical purposes; use outside of acceptable medical guidelines when self-medicating at higher doses and for longer than advised; use for reasons other than for the instructions on the label or the intended purpose; recreational use for intoxication purposes; and where risks and adverse consequences outweigh the benefits (Nielsen et al 2008;Casati et al 2012).…”

“…Codeine dependence is generally treated in residential detoxification programmes, with opiate substitution therapy (methadone or buprenorphine) or lofexidine in community detoxification (Frei et al 2010;Mattick et al 2008;Kelly & Madadi, 2012). Clinical profiles vary, with majority representation of those in middle to late age, females, poly substance users, alcohol users and those with underlying psychiatric conditions (Myers et al 2003;Johansson et al 2003;Thekiso & Farren, 2010;Robinson et al 2010;Agyapong et al 2013). Other studies report on characteristics of individuals dependent on codeine as young, with lower levels of education and employment, reporting chronic pain, family history of problematic substance use and with greater proportions female when compared with other cohorts of opiate dependent individuals .…”

“…This is timely given the changes employed by the Irish pharmacy regulator (Pharmaceutical Society of Ireland) in 2010 to regulate safe supply of non-prescription combination products containing codeine and paracetamol, aspirin or ibuprofen for supply only as 'second line' products for the treatment of pain relief; with comprehensive patient advice provided around correct use for short-term use (no longer than 3 days and with products in-accessible to the public for self-selection). Arguably, more stringent regulations for safe supply could potentially reduce misuse of codeine medicines among psychiatric patients (Agyapong et al 2013).…”