How do we combat the misuse codeine-based pain relief medicines

President of the Pharmaceutical Society of Australia, Grant Kardachi, explains the need for all healthcare professionals to be aware of the potential for addiction and growing misuse of codeine-containing products.
Codeine-containing products are often used to treat varying pain conditions – including headache, back pain, injury and trauma – and a recent study has added to calls for action to be taken to help address issues over the misuse of over-the-counter (OTC) pain relief medications containing codeine. We must all be aware of the potential for addiction to codeine-containing products.
The study, published in the International Journal of Pharmacy Practice, found that misusers “purchased OTC codeine with virtually no pharmacist interaction, or, the sale was refused with limited discussion”.
The report, Opportunities and challenges: over-the-counter codeine supply from pharmacists and codeine consumer perspectives by Suzanne Nielsen, Jacqui Cameron and Sanja Pahoki aimed to gain a better understanding on perspectives of over-the-counter codeine users and issues relating to codeine dependence in the community pharmacy setting in Australia.
I believe the key findings of the report are significant.
“Key themes identified included experience of participants acquiring OTC codeine and participants’ interactions with pharmacists,” the report said.
“The OTC codeine-dependent participants found it generally easy to access OTC codeine, describing ‘standard’ questioning, minimal intervention from pharmacists and only occasional refusal to supply. A better appearance and presentation was generally linked to easy codeine supply.”
The report concluded: “The experiences of participants suggest a number of barriers exist to effective intervention for OTC codeine dependence in the community pharmacy setting. Identification of these barriers will provide an opportunity to more effectively target interventions to reduce harm related to OTC codeine products. Increased involvement of pharmacists in OTC codeine sales was associated with help-seeking by codeine users.”
The study’s release was timely given recent media reports of concerns about significant adverse effects and even death over the misuse of over-the-counter medicines containing codeine.
The Pharmaceutical Society of Australia (PSA) has been concerned about this issue and is focussed on the possible roles pharmacists can play in helping to address potential problems. To this end, we are working towards finding possible solutions to try to improve the management of this issue.
The PSA is undertaking a pilot project on a health destination pharmacy model in which non-dispensing pharmacists would meet and counsel patients in the pharmacy and this could also be part of the solution to managing misuse of pain medications.
There have been calls to ban these products but I believe these are an over-reaction. Rather we must look to better solutions because these medications, when taken properly and according to instructions, are very effective in pain management. We must not take the easy option and deprive the majority of the community who seek pain relief through the use of these medicines because of the actions of a few is a knee-jerk overreaction.
The pharmacy profession as a whole needs to find ways of addressing the problem and one possible tool is better education for pharmacists and also campaigns to inform the public of the dangers of the misuse of OTC pain medications.
There is also a view among many people that simply because a medication is legal and freely available, then it must be safe. This misconception is dangerous and educating the community through public health campaigns could help to build quality use of medicines messages associated with the use of pain relief medications. Taking such an approach a step further could see such a campaign extend into schools as part of a broader QUM campaign incorporated into heath curriculums to educate young people before they are exposed to the risk of such abuse in the wider community.
We also need to better educate pharmacists about pain management, addiction problems and even mental health issues so that they are better equipped to manage the health issues of patients requesting OTC products containing codeine. Another tool in helping to address this issue is the introduction of reporting systems which give pharmacists the opportunity to meet users, discuss issues and identify patients that require further advice and treatment.
The Government’s proposed national real-time reporting system for controlled drugs could be extended to help in the fight against misuse of pain relief medications. There is, however, a danger in reporting systems in that pharmacists may believe they have done their job when they have reported and not follow up and address the issues of the patient and try to achieve better outcomes for that patient.
Regardless of any real-time reporting, there is great responsibility on individual pharmacists to help identify misusers and provide appropriate support and advice. The issue of the misuse of codeine-based pain relief medicines must be addressed in a whole-of-profession approach to achieve any real outcomes. I look forward to working with our colleagues at the Guild and other stakeholders to help make a very real impact on reducing this problem and achieving better outcomes for patients.
Grant Kardachi President
Pharmaceutical Society of Australia
Grant Kardachi was elected President of the PSA, after serving as Vice-President and a Board Member for three years. He is a community pharmacist who recently sold his business interests but is still accredited to undertake medication reviews and sits on the Australian Association of Consultant Pharmacy (AACP) Board