Advertising of Over-the-Counter Codeine-Containing Medicines in the EU: Differences in the Regulation of Advertising Between Member States

Foley, Michelle; Kelly, Peter; Deluca, Paolo; Kimergård, Andreas

doi:10.1007/s40290-018-0245-7

Cited by 4 publications

(2 citation statements)

References 19 publications

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“…For this reason, the online survey was open to respondents from all countries. However, in these re-analyses of the data in the present study, it was decided to only include respondents living the UK for several reasons: (i) There is great disparity between levels of codeine consumption, availability of codeine as “over-the-counter” medicines or POM, the amount of codeine included in codeine containing medicines and regulation of advertising of codeine containing medicines across countries around the world ( 11 , 28 – 30 ) which may affect aberrant codeine behavior differently. By limiting the sample to the UK, respondents completing the SDS were sourcing and using codeine under similar conditions and regulation; (ii) conducting analysis of the SDS according to nationality was not feasible as some nations were represented by very few respondents; and (iii) the survey was only available in English.…”

Section: Methodsmentioning

confidence: 99%

The Severity of Dependence Scale (SDS) for Codeine: Preliminary Investigation of the Psychometric Properties of the SDS in an Online Sample of Codeine Users From the UK

et al. 2021

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Objective: Investigate the psychometric properties of the Severity of Dependence Scale (SDS) for codeine and its association with aberrant codeine related behaviors.Design: A voluntary and uncompensated cross-sectional online survey.Setting: Online population (≥18 years).Respondents: Two hundred and eighty-six respondents (66% women) who had used codeine containing medicines in the last 3 months and were living in the UK.Results: Of the respondents (mean age = 35.4 years, SD = 12.5), more than half were employed. Only 3.5% respondents reported no income. The majority of respondents (45.1%) primarily obtained prescription-only codeine from a consultation with a health professional, whilst 40.9% mainly purchased “over-the-counter” codeine containing medicines in a pharmacy without a medical prescription. Principal component analysis indicated a single factor solution accounting for 75% of the variance. Factor loadings ranged from 0.83 to 0.89. Cronbach's Alpha was high (α = 0.92). Several behaviors relating to codeine use were found to significantly predict probable codeine dependence. These included: daily codeine use in the last 3 months (OR = 66.89, 95% CI = 15.8–283.18); tolerance to codeine (OR = 32.14, 95% CI = 13.82–74.75); problems with role responsibility due to intoxication (OR = 9.89, 95% CI = 4.95–19.78); having sought advice on the internet to manage codeine use (OR = 9.56, 95% CI = 4.5–20.31); history of alcohol or drug treatment (OR = 3.73, 95% CI = 1.88–7.43).Conclusions: The SDS was acceptable and feasible to use to assess probable psychological codeine dependence in an online sample of people using codeine containing medicines. SDS scores were associated with behaviors known to be indicators of codeine dependence. Studies are needed in well-defined populations of people who use codeine to test the different aspects of psychometry of the scale compared against “gold standard” criterion [a diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)].

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Section: Methodsmentioning

confidence: 99%

The Severity of Dependence Scale (SDS) for Codeine: Preliminary Investigation of the Psychometric Properties of the SDS in an Online Sample of Codeine Users From the UK

et al. 2021

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“…In England (and in many other countries) [ 8 ], codeine combined with a non-opioid analgesic (such as paracetamol or ibuprofen) are used to treat mild to moderate types of pain [ 9 ]. Codeine-containing medicines (CCM) containing small amounts of codeine present at the low end of the spectrum of analgesics that begins with non-opioids (such as paracetamol and ibuprofen), progressing to codeine combined with non-opioid analgesics sold over the counter (OTC) from licensed pharmacies, then to prescribed codeine of 15 mg and more (either alone or combined with paracetamol), and onto stronger psychoactive medicines such as tramadol, oxycodone and fentanyl for more severe kinds of pain.…”

Section: Introductionmentioning

confidence: 99%

Identification of factors influencing tampering of codeine-containing medicines in England: a qualitative study

Kimergård¹,

Parkin²,

Jennings³

et al. 2020

Harm Reduct J

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Background Tampering of psychoactive medicines presents challenges to regulation and public health. However, little is currently known about what influences the decisions to treat codeine-containing medicines (CCM) with cold water extraction (CWE) from the perspective of individuals employing these techniques. The article identifies factors influencing utilisation of CWE to separate codeine from compounded analgesics, such as paracetamol and ibuprofen, found in CCM. Methods Purposive sampling of 27 participants residing in England who took part in a qualitative interview. Of these, 14 individuals (11 males and 3 females) reported tampering of psychoactive medicines, and the relevant transcripts were included in the analyses for the study. Participants were recruited from one addiction treatment service and from an online survey. The mean age of the participants was 31.5 years (range = 18–42 years). Qualitative data analysis followed the processes of iterative categorization (IC). The codes ‘harm reduction’, ‘information sources’ and ‘changes on the drug markets’ were grouped and summarised. The coding of the data was done in a Microsoft® Word document. Results Two groups of participants were identified in the data analysis: (i) individuals who used CCM (n = 5), and (ii) individuals who used CCM and heroin (n = 9). Participants in both groups used CWE due to concerns of paracetamol overdose from the use of excessive dosages of CCM. For both of them, information obtained from the internet encouraged the use of CWE. Participants using CCM described how the many steps involved in conducting CWE, including sourcing codeine boxes from pharmacies (over the counter), presented a barrier against using CWE. Participants using CCM and heroin explained how reduced availability in the local heroin supply influenced utilisation of CWE techniques to maintain their use of opioids and avoid withdrawal. Withdrawal symptoms and cravings outweighed the concerns about the quality of the extracted codeine mixtures in this participant group, especially the ability of CWE to remove paracetamol and tablet fillers. Conclusions Utilisation of CWE of codeine was influenced by several factors including drug market supply, the availability of detailed information on the internet about CWE and restrictions on codeine sourcing in pharmacies. Risks identified with CWE include consumption of unknown doses of paracetamol if the CWE techniques are not used correctly. Attempts at extracting codeine from CCM should be considered in risk assessments of opioid medicines.

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A Review of Labeling Based on Patient-Reported Outcome Endpoints for New Oncology Drugs Approved by the European Medicines Agency (2017-2021)

Gnanasakthy¹,

Levy²,

Norcross³

et al. 2023

Value in Health

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Advertising of Over-the-Counter Codeine-Containing Medicines in the EU: Differences in the Regulation of Advertising Between Member States

Cited by 4 publications

References 19 publications

The Severity of Dependence Scale (SDS) for Codeine: Preliminary Investigation of the Psychometric Properties of the SDS in an Online Sample of Codeine Users From the UK

The Severity of Dependence Scale (SDS) for Codeine: Preliminary Investigation of the Psychometric Properties of the SDS in an Online Sample of Codeine Users From the UK

Identification of factors influencing tampering of codeine-containing medicines in England: a qualitative study

A Review of Labeling Based on Patient-Reported Outcome Endpoints for New Oncology Drugs Approved by the European Medicines Agency (2017-2021)

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