Over-The-Counter Codeine: Can Community Pharmacy Staff Nudge Customers into Its Safe and Appropriate Use?

Abstract

The misuse of opioids, including codeine which is sold over-the-counter (OTC) in United Kingdom (UK) community pharmacies, is a growing public health concern. An educational Patient Safety Card was developed and piloted to see if it nudged customers into the safe and appropriate use of OTC codeine. Exploratory analysis was conducted by (i) recording quantitative interactions for people requesting OTC codeine in community pharmacies; and (ii) a web-based pharmacy staff survey. Twenty-four pharmacies submitted data on 3993 interactions using the Patient Safety Card. Staff found the majority of interactions (91.3%) to be very or quite easy. Following an interaction using the card, customers known to pharmacy staff as frequent purchasers of OTC codeine were more likely not to purchase a pain relief medicine compared to customers not known to staff (5.5% of known customers did not purchase any pain relief product versus 1.1% for unknown customers (χ2 = 41.73, df = 1, p < 0.001)). These results support both the use of a visual educational intervention to encourage appropriate use of OTC codeine in community pharmacy and the principles behind better self-care.

Opioids in the United Kingdom: safety and surveillance during COVID-19

“…Useful feedback on the design of these information leaflets was also obtained. Nonprescription codeine safety was also explored by Mody et al [ 38 ▪▪ ] within the context of developing a new educational safety card to be handed out at pharmacies. Twenty four pharmacies were involved in distributing this card between June and July 2020, during the COVID-19 pandemic, and recorded data on the impact of interactions with customers using the card [ 38 ▪▪ ].…”

“…Nonprescription codeine safety was also explored by Mody et al [ 38 ▪▪ ] within the context of developing a new educational safety card to be handed out at pharmacies. Twenty four pharmacies were involved in distributing this card between June and July 2020, during the COVID-19 pandemic, and recorded data on the impact of interactions with customers using the card [ 38 ▪▪ ]. Specific to the COVID-19 pandemic, the authors noted that customer numbers in pharmacies may have been reduced during the study period and that pharmacies were selected taking into account the operational impact of COVID-19.…”

“…Specific to the COVID-19 pandemic, the authors noted that customer numbers in pharmacies may have been reduced during the study period and that pharmacies were selected taking into account the operational impact of COVID-19. Of 3993 interactions recorded, 5.5% of customers who were known to staff and frequently bought codeine products chose not to purchase any pain relief products, compared with 1.1% of unknown customers ( P < 0.0001) [ 38 ▪▪ ]. The card was found to be easy to use by staff and the majority of patients accepted the card when offered.…”

“…The card was found to be easy to use by staff and the majority of patients accepted the card when offered. The results of the study suggest that community pharmacists can be involved in behavioural change regarding purchasing codeine, which could assist in decreasing misuse [ 38 ▪▪ ]. These studies highlight the potential risks of codeine containing products which are available to purchase without a prescription.…”