Misuse of non-prescription codeine containing products: Recommendations for detection and reduction of risk in community pharmacies

Best Practices and Innovations for Managing Codeine Misuse and Dependence

“…There are mixed views with regards the merits or otherwise of retaining codeine in OTC available preparations (6). Jurisdictions with OTC availability of codeine containing products should consider all best practices and innovations prior to up-scheduling.…”

“…To date, attempts to address codeine misuse and dependence have primarily centred on practices that relate to manufacturing, responsible prescribing, dispensing, monitoring and surveillance, education and psychosocial interventions (3,6,7). While such practices, for example, 'real time monitoring' (The Codeine Care Project) are an important deterrent for misuse and dependence (7,(42)(43), they are not solely sufficient.…”

“…Challenges for policy makers and practitioners centre on how to ensure availability of codeine containing medicines for legitimate therapeutic use, while minimising consumer risk of misuse, dependence and related health harms (6)(7)(14)(15). This is complicated by the complexity of inter-relations between pharmacological, social, economic, legal and individual factors which shape consumption patterns; the heterogeneous nature of misuse; blurring between therapeutic use and misuse; focus of drug agencies on surveillance of opiate users and dependents; difficulties in estimating prevalence of misuse given the broad definition of misuse and the covert nature of medicinal misuse itself; and the presence of displacement between public sourcing of prescribed, OTC and internet sourced products (3,6,14).…”

Commentary on Liang et al. (2018): The potential impact of medical cannabis on public health with respect to reducing prescription opioid use and associated harm

“…Secondly, however, codeine has an abuse potential. Although this abuse potential was evaluated to be lower compared to Schedule II opioids, abuse has been documented with both prescribed and over‐the‐counter codeine . Furthermore, codeine use may contribute as a gateway to other opioids, both prescription and illicit opioids, with high overdose potential .…”

Commentary on Cairnset al.(2016): Over-the-counter codeine in Australia-questioning the efficacy of current restrictions or re-scheduling

“…Following the recognition of increasing rates of harm associated with misuse of over‐the‐counter/combination analgesics containing codeine (OTC‐CACC) formulations , the Australian Therapeutic Goods Administration (TGA) are currently considering re‐scheduling such products from S3 (pharmacist only) to S4 (prescription only) . This move has been followed by much controversy about the availability of OTC‐CACCs, with industry and some consumer groups advocating against such a move while many in Addiction Medicine and Public Health are calling for re‐scheduling .…”