Study highlights codeine dependence – a problem for pharmacy?

Pharmacies are a common source of codeine for dependent people, according to a new study, but only one in 50 dependent users seeks a pharmacist’s support.

Researchers advertised an online survey on Facebook, Twitter, websites and via e-mails to staff and students at two universities. They recruited 316 adults aged, on average, 35.3 years from the UK (90.5 per cent of responders) and Eire. Sixty-seven per cent were female. Based on scores on the Severity of Dependence Scale, 17.1 per cent of respondents were dependent on codeine.

During the last three months, 13.3 per cent reported tolerance to codeine weekly and 8.5 per cent indicated withdrawal. A further 5.7 per cent experienced both tolerance and withdrawal. A third (36.7 per cent) used codeine daily, while 9.8 per cent took more than 240mg codeine a day.

OTC products purchased in a pharmacy (43.7 per cent) and prescription codeine (43.4 per cent) were the commonest sources of codeine, but 7.9 per cent said they mainly obtained it from a family member, friend or acquaintance. An internet shop was the main source for 3.2 per cent of respondents.

Most codeine-dependent and non-dependent patients used codeine to alleviate pain (78 and 91 per cent respectively), but dependent users were significantly more likely than non-dependent users to have used codeine to:
• Help them relax (48 and 19 per cent respectively)
• Feel better when down or depressed (44 and 12 per cent)
• Help sleep (38 and 20 per cent)
• Stop worrying about a problem (33 and 7 per cent)
• Feel elated and euphoric (28 and 10 per cent)
• Ease withdrawal symptoms of other opiates (13 and 2 per cent).

Thirty per cent of dependent users faked and exaggerated symptoms to get a codeine prescription, while 20 per cent received prescriptions from at least three prescribers in six months. Five per cent of non-dependent users admitted these behaviours.

Sixty-one per cent of dependent people and 31 per cent of non-dependent users bought OTC codeine from at least three pharmacies in six months, with 24 and 6 per cent saying they had been refused codeine from a pharmacy so went to a different pharmacy.

“Restrictive dispensing policies and engagement between pharmacy customers and staff could potentially reduce excessive codeine use,” the authors comment.

Forty-one per cent of dependent people and 6 per cent of non-dependent users sought help from the internet. Just 19 and 3 per cent had sought help from GPs and 2 per cent and less than 1 per cent from pharmacists. Nevertheless, the authors suggest that “screening and brief interventions delivered by community pharmacies could offer immediate support to individuals with codeine misuse experience and help local areas address problematic opioid use”.

QJM DOI:10.1093/qjmed/hcx076

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