Misuse and Dependence on Non-Prescription Codeine Analgesics or Sedative H1 Antihistamines by Adults: A Cross-Sectional Investigation in France

Roussin, Anne; Bouyssi, Annabelle; Pouché, Lucie; Pourcel, Laure; Lapeyre‐Mestre, Maryse

doi:10.1371/journal.pone.0076499

Cited by 77 publications

(69 citation statements)

References 25 publications

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“…The phenomenon of codeine misuse appeared closely situated within the 'blurring' of therapeutic self-medication for legitimate medical reasons (chronic pain), and misuse for iatrogenic dependence Nielsen et al 2010;Hamer et al 2013;Roussin et al 2013;Nielsen et al 2014), alongside individual difficulties in self-identifying problematic use along their own trajectory of use (Pates et al 2002;Nielsen et al 2010). Of note were the invisible and covert characteristics of dependent use, combined with social isolation over time.…”

Section: Discussionmentioning

confidence: 99%

“…Prevalence of codeine misuse and dependence is difficult to monitor and quantify, and relies on indicators based on surveillance of treatment cases for codeine dependence (Pates et al 2002;Skurtveit et al 2011;Roussin et al 2013). 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).…”

Section: Introductionmentioning

confidence: 99%

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

Hout

Horan

Santlal³

et al. 2015

Ir. j. psychol. Med.

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Objectives. Global concern around over the counter availability of codeine containing products and risk of misuse, dependence and related harms are evident. A phenomenological study of lived experiences of codeine misuse and dependence was undertaken in Ireland, following the Pharmaceutical Society of Ireland's 2010 guidelines for restricted supply of non-prescription codeine containing products.Methods. In-depth interviews were conducted with a purposive sample of adult codeine misusers and dependents (n = 21), both actively using, in treatment and in recovery. The narratives were analysed using the Empirical Phenomenological Psychological five-step method (Karlsson, 1995). A total of 10 themes with 82 categories were identified. Two concepts at a higher level of abstraction above the theme-level emerged during the final stage of analysis. The concepts identified were 'emotional pain and user self-legitimization of use' and 'entrapment into habit-forming and invisible dependent use'. These concepts were reported in different ways by a majority of participants.Results. Findings are presented under the following themes: (1) profile and product preferences; (2) awareness of habit forming use and harm; (3) negotiating pharmacy sales; (4) alternative sourcing routes; (5) the codeine feeling; (6) the daily routine; (7) acute and chronic side effects; (8) social isolation; (9) withdrawal and dependence and (10) help-seeking and treatment experiences.Conclusions. There is a public health and regulatory imperative to develop proactive responses tackling public availability of codeine containing medicines, risk minimisation in consumer self-treatment for pain, enhanced patient awareness of potential for habit forming use and its consequences and continued health professional pharmacovigilence.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Hout

Horan

Santlal³

et al. 2015

Ir. j. psychol. Med.

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“…Reinforcers for problematic consumption include use relating to intoxicating purposes and when benefits of misuse outweigh adverse consequences (Casati, Sedefov et al 2012). The interplay between chronic non-cancer pain, self-medication of codeine and iatrogenic dependence has also been observed (Arora, Roxburgh et al 2013;Roussin, Bouyssi et al 2013;Hamer, Spark et al 2014). Reported health consequences from long term and/or excessive misuse of combination codeine analgesics include headaches, nephrotoxicity, gastro-intestinal conditions, hypokalaemia, acute haemorrhagic and necrotizing pancreatitis (Dyer, Martin et al 2004;Dutch 2008;Ernest, Chia et al 2010;Evans, Chalmers-Watson et al 2010;Frei, Nielsen et al 2010;McDonough 2011;Pilgrim, Dobbin et al 2013;Pilgrim and Drummer 2014).…”

Section: Introductionmentioning

confidence: 99%

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

Carney

Wells

Bergin

et al. 2016

Int J Ment Health Addiction

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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. AbstractMisuse of codeine containing preparations is a public health concern given the potential for associated harms and dependence. This study explores the perspectives of community pharmacists in three regulatory regimes on issues of customer misuse of over the counter (OTC) and prescribed codeine containing preparations. A qualitative design comprising six focus groups (n=45) was conducted in Ireland, United Kingdom, South Africa. Transcripts were analysed using the constant comparative method of content analysis. Pharmacists described popular codeine containing products; the need for improved medicine information and warning labels. Issues around legitimate availability of codeine and regulatory status; presence of therapeutic need; difficulties in customer-pharmacist communication; business environments and retail focus were raised. Participants also discussed how they identified customers potentially misusing codeine; customer pharmacy 'hopping' and difficulties in relationships between pharmacists and prescribers. Specialist training; reimbursement for customer consultation; screening and brief interventions; visible referral structures and assisted community pharmacy detoxification were discussed as ways to manage the issues. The study highlights the difficulties encountered by community pharmacists operating under various regulatory regimes when supplying codeine containing preparations in negotiating patient awareness and compliance and dealing with misuse and dependence. Key WordsCodeine containing preparations; Misuse; Community pharmacy; Pharmacists; RegulationWhat is known about this topic 2  Over-the-counter (OTC) and prescription codeine containing products, as dispensed in pharmacies, have the potential for misuse and dependence. Different countries have different regulations with regards to the provision and display of codeine and level of pharmacist intervention at point of sale. Strategies which prevent and address codeine misuse include screening, information provision and referral. What this paper adds Pharmacists in Ireland, South Africa, and the UK have multiple roles and face a number of challenges related to financial and time resources; perceptions of the pharmacist profession and advising on safe and appropriate use of medication, not only codeine. Pharmacists have their own ways to identify customers who may be misusing codeine, but customers' strategies such as 'pharmacy hopping' and some use of online pharmacies make this challenging. Support and referral interventions are provided by pharmacists, but these are not standard, and more information is needed on which services to refer customers to for codeine misuse.

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“…In common with other studies, denial of having a problem was listed as the biggest barrier preventing individuals misusing or dependent on codeine from coming to treatment, followed by not being ready for change and lack of awareness of where to go for treatment. [11][12][13] Research has shown that codeine users can feel ashamed when they realise they are dependent. Many perceive themselves as respectable, professional and highly functioning, and struggle to view themselves as an 'addict' .…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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Background. General practitioners are referring patients with codeine-related problems to specialist treatment facilities, but little is known about the addiction treatment providers, the kinds of treatment they provide, and whether training or other interventions are needed to strengthen this sector. Objectives. To investigate the perspectives of addiction treatment providers regarding treatment for codeine misuse or dependence. Method. Twenty addiction treatment providers linked to the South African Community Epidemiology Network on Drug Use and the South African Addiction Medicine Society were contacted telephonically and asked 20 questions. Results. While many participants had received training in pharmacological management of individuals with opioid dependence, only two had received specific training on codeine management. Between half and two-thirds of the treatment settings they worked in provided detoxification, pharmacotherapy, psychosocial treatment and aftercare. Very few treatment settings offered long-term treatment for codeine misuse and dependence. Participants indicated that over half of their codeine patients entered treatment for intentional misuse for intoxication, and dependence resulting from excessive or long-term use. The main barriers to patients entering treatment were seen as denial of having a problem, not being ready for change, mental health problems, stigma, and affordability of treatment. Participants identified a need for further training in how to manage withdrawal and detoxification, treatment modalities including motivational interviewing, and relapse prevention. Conclusions. Gaps in training among treatment providers need to centre on how to manage withdrawal from codeine use and detoxification, motivational interviewing and relapse prevention. Interventions are needed to address barriers to entering treatment, including user denial.

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Misuse and Dependence on Non-Prescription Codeine Analgesics or Sedative H1 Antihistamines by Adults: A Cross-Sectional Investigation in France

Cited by 77 publications

References 25 publications

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

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

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

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

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