Best Practices and Innovations for Managing Codeine Misuse and Dependence

Abstract

-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.

Counting the cost of over‐the‐counter codeine containing analgesic misuse: A retrospective review of hospital admissions over a 5 year period

“…Aside from rescheduling OTC‐CACC to require a prescription, real‐time monitoring in community pharmacies has been suggested to more closely monitor the supply of OTC‐CACC products . Such a program is designed to record the details of the person presenting for OTC‐CACC and, as such, provides alerts when patients frequently present requesting CACC, sometimes, from multiple pharmacies .…”

Codeine misuse and dependence in South Africa: Perspectives of addiction treatment providers

“…[23] Many of these interventions were also identified as being important in interviews conducted with key national stakeholders from a variety of sectors beyond addiction practice in the UK, Ireland and SA in another component of the CODEMISUSED project. [24] …”

“…[26] The training needs of treatment providers should be addressed as a matter of urgency to cover best practices for managing codeine misuse and dependence, including detoxification modalities, pharmacotherapy maintenance treatment, psychosocial support and ensuring proper aftercare. [24] Given the relatively low numbers of individuals in treatment for codeine-related problems [5] and the possible barriers that may make it harder for them to access treatment, active steps are needed, in particular to address denial of the problem and fear of being stigmatised. This first needs to be verified by research conducted among codeine-dependent patients themselves.…”

“…Among other things, appropriate responses might include increasing media coverage of the problem of codeine misuse and dependence, and public health campaigns highlighting that anyone can become addicted to codeine products when used in the long term or excessively. [13,24] Awareness campaigns should also educate the public on where they can go to seek help.…”

The Misuse and Abuse of Ophthalmic Preparations: a Scoping Review of Clinical Case Presentations and Extant Literature

“…The use of over-the-counter (OTC) and prescription medication for non-clinical use and self-medication is a global public health challenge (Casati et al 2012;Norman et al 2016;Wazaify et al 2017). OTC medications are those that do not need a prescription while prescription medications are those that cannot be dispensed unless a prescription is written by a physician (Lessenger and Feinberg 2008;Van Hout and Norman 2015;Foley et al 2015).…”