Medicine Misuse: Codeine

Codeine-containing medicines have, in recent years, become a real conundrum for Pharmacy – largely due to increased abuse and misuse, fuelled largely by popular culture and criminal elements operating an illicit market for these and other habit-forming medicines. This article reminds the profession of its responsibility to remain ethical custodians of medicines and the health of the population.

The role of the pharmacy professional in stopping codeine misuse

Pharmacies ensure medicine accessibility for members of the public and are an integral part of the healthcare system – with great power, comes great responsibility. The Rules relating to Good Pharmacy Practice and the Rules relating to the Code of Conduct for Pharmacists and Other Persons Registered in terms of the Pharmacy Act are the key instruments that guide how pharmacists may dispense medicines and monitor reactions and possible addiction. 

Ethical Rules 5(2)(c) and 23 expressly makes it unethical for pharmacy professionals or other persons registered in terms of the Pharmacy Act, including pharmacy owners, to engage in any conduct that, either negligently or intentionally, promotes misuse and/or abuse of any medicine, or results in the detrimental or injudicious or unsafe use of medicines by members of the public. 

The abuse of codeine-containing products is becoming a major general health challenge in countries around the world, and while ease of access to medicines such as cough syrups means addicts often have to jump through fewer hoops to access them, the proliferation of elicit markets for these medicines present a challenge. 

It goes without question that clinic, doctor, or pharmacy hopping cannot be ruled out as an access mechanism for addicts – in this practice, a person who appears to be a legitimate patient, seeks treatment and medicines from various healthcare facilities for the same ailment in order to access high volumes of the same medicines. However, this is a costly exercise, and as such most addicts simply access the medicines through elicit channels, as they would with elicit drugs. Pharmacists and pharmacy support personnel, as the first port of call for many in our communities, ought to go beyond what is required of them and provide advice and guidance to members of the community on the lethal dangers of misusing and abusing medicines, especially codeine-containing medicines.

All pharmacy professionals are expected to dispense all prescriptions in line with Rule 2.7 of the Rules relating to Good Pharmacy Practice (“Minimum standards for the dispensing of medicine or scheduled substances on the prescription of an authorised prescriber”). Hence, dispensing transactions of medicines scheduled 2 and higher are supposed to be recorded, with the names of persons purchasing the medicines together with their addresses and the dosage dispensed, amongst others, logged into a register or other permanent record so that pharmacists can track multiple purchases by the patient which could potentially suggest misuse. This record is also required during the South African Pharmacy Council’s inspection of pharmacy premises, any anomalies and lack of such record may result in disciplinary action being instituted by Council.

All medicines provided as part of pharmacist-initiated therapy, regardless of their schedule, should be dispensed in accordance with Rule 2.12 (“Minimum standards for pharmacist-initiated therapy”), and should comply with all other dispensing standards in line with Rule 2.7. In addition, Minimum Standard requires that a patient profile, comprising medicines supplied and conditions/symptoms treated, should be kept.

Promoting awareness to prevent abuse

Increasing awareness of the long-lasting effects of misuse of codeine-containing medicines, and other habit-forming medicines, may be one of the tools pharmacy professionals employ to help prevent misuse and abuse of medicines. Making members of the public aware of the effects of the misuse of codeine or codeine products such as gastric ulcers, intestinal or internal bleeding, hepatotoxicity, hypokalaemia and/or inflammatory stomach conditions and long-term effects such as severe brain damage, may be key to empowering patients and preventing misuse. 

Council encourages pharmacy professionals who become aware of a patient potentially abusing a substance to refer the patient to the relevant and appropriate practitioner or institution. 

To report any misconduct you may witness, you may lodge a complaint on Council’s website. Should you or a loved one suffer from substance abuse issues, you may reach out to the South African National Council on Alcoholism and Drug Defence (SANCA) by clicking here to receive the help you need.

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