What do codeine shoppers really need?

codeine shoppers: sad woman examines a white tablet

There has been a lot of discussion by pharmacists in recent times about surveillance of codeine shoppers, writes 2010 PSA Pharmacist of the Year Karalyn Huxhagen.

Codeine seeking behaviour is different to pseudoephedrine (PSE) seeking behaviour.

With PSE there is the issue of diverting the medication to manufacture methyl amphetamines and the impact this has on society.

With codeine seeking behaviour, the majority of the product is for personal use to feed the addiction that the person has developed in the management of their pain.

The need to identify patients who are “pharmacy” shopping is realistic but the final outcome is the same, whether they are regular consumers at your pharmacy or whether they visit multiple pharmacies. They need education and support to improve the management of their pain condition.

We have been taught that effective management of disease states is based on a firm diagnosis, selection of appropriate medication, effective communication and monitoring of outcomes.

Pain may be a symptom for a myriad of disease states and medical conditions but the management of pain is complex and relies on a whole-of-patient regime to improve the patient outcomes.

The pharmacist is a key part of the pain management team. Our role is to support, monitor, intervene and give acceptable, evidence based advice.

We are not police or drug surveillance officers.

Patients with complex pain needs who I see as a consultant pharmacist often require more than a home medicine review every two years. They need regular support, a person to discuss their medications questions with and a person that they can trust.

The pharmacist needs to open up the discussion on effective management of medical conditions that cause pain.

While you may feel that you are a rote machine in asking the questions as per the WHAT STOP GO or CARER protocol the fact that you ask the questions gives you the opportunity to open the communication to a level where you can demonstrate that you are able to provide informed care to these patients.

These same principles apply to all requests for pain relief medicine, such as basic analgesics, analgesic rubs and spray and even requests for tape and bracing.

I am an advocate of developing and formulating a pain management pathway with patients. This can be as simple as a plan written on the back of a repeat folder or a formalised medication review with a personalised patient management plan.

A pharmacist has the skills and tools to do be the interventionist and communicator and support person who works collaboratively with the patient and medical practitioners to effectively manage the patient’s pain.

How do you manage requests for pain relief in your workplace?

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