A study of medical professionals’ perspectives on medicines containing codeine in South Africa

Background Misuse of codeine available on prescription and over-the-counter (OTC) has been highlighted as a potential problem in South Africa. Objective To examine the perceptions of medical professionals regarding codeine use (prescribed and OTC), misuse, dependence and treatment options in South Africa. Method Data for the study were obtained using a sample of medical professionals obtained through random and convenience sampling. A quantitative methodology was employed using a structured self-administered questionnaire with closed and open-ended items. Data analysis was conducted using SPSS version 21; 238 medical professionals involved in the prescribing of codeine completed the questionnaire. Results Two-thirds of participants stated that they routinely reviewed patients prescribed codeine, and high levels of concern were expressed about the availability of OTC medicine containing codeine in pharmacies (84.9%) and on the internet (71.3%). There was agreement that medicines containing codeine should be regulated to a prescription-only medicine (85.3%). Only 22% of participants agreed that they had suitable screening methods to help with detection of codeine dependence. Eighty per cent indicated that they would welcome the opportunity for greater instruction on prescribing potentially addictive medicines. Conclusion There appears to be a need to improve education on consumption and risks associated with codeine use. In addition, screening tools are needed to detect those with codeine dependence. Greater data sources are now needed to examine the sale of and consumption of codeine medicines in the interest of public health.

[1]  C. Parry,et al.  Medical professionals' perspectives on prescribed and over-the-counter medicines containing codeine: a cross-sectional study , 2016, BMJ Open.

[2]  I. Norman,et al.  Practice implications and recommendations for managing codeine misuse and dependence , 2015, Acta pharmaceutica.

[3]  P. Wiffen,et al.  Non-prescription (OTC) oral analgesics for acute pain - an overview of Cochrane reviews. , 2015, The Cochrane database of systematic reviews.

[4]  M. Van Hout,et al.  The availability of over-the-counter codeine medicines across the European Union. , 2015, Public health.

[5]  M. Van Hout,et al.  Do we have sufficient information to optimally inform regulatory or other policy decisions about medications containing codeine? , 2015, Addiction.

[6]  C. Parry,et al.  Codeine misuse and dependence in South Africa--learning from substance abuse treatment admissions. , 2015, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[7]  C. Tobin,et al.  Regulatory responses to over‐the‐counter codeine analgesic misuse in Australia, New Zealand and the United Kingdom , 2013, Australian and New Zealand Journal of Public Health.

[8]  M. Salter.  Ibuprofen-Induced Hypokalemia and Distal Renal Tubular Acidosis: A Patient's Perceptions of Over-the-Counter Medications and Their Adverse Effects , 2013, Case reports in critical care.

[9]  R. Sedefov,et al.  Misuse of Medicines in the European Union: A Systematic Review of the Literature , 2012, European Addiction Research.

[10]  S. Nielsen,et al.  OTC codeine: Examining the evidence for and against , 2012 .

[11]  S. Nielsen,et al.  Serious morbidity associated with misuse of over‐the‐counter codeine–ibuprofen analgesics: a series of 27 cases , 2010, The Medical journal of Australia.

[12]  C. Parry,et al.  Over-the-counter and prescription medicine misuse in Cape Town--findings from specialist treatment centres. , 2003, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[13]  B. Sproule,et al.  Long-term codeine use is associated with depressive symptoms. , 1999, Journal of clinical psychopharmacology.

[14]  T. Warholak,et al.  Patient knowledge and use of acetaminophen in over-the-counter medications. , 2014, Journal of the American Pharmacists Association : JAPhA.