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 make 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.

All pharmacy professionals are expected to dispense all prescriptions in line with Rule 2.7 of the Rules relating to Good Pharmacy Practice. 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 logged into a register or other permanent record so that pharmacists can track multiple purchases by the patient which could potentially suggest misuse.

Promoting Awareness to Prevent Abuse

Increasing awareness of the long-lasting effects of misuse of codeine-containing 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 misuse, 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. 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) to receive the help you need.