Codeine dependence, cannabinoids, acute dental pain and deprescribing… Debbie Rigby covers the latest research relevant to pharmacists
Codeine dependence is a significant public health problem, motivating the recent rescheduling of codeine in Australia. A systematic review of 41 studies shows strategies for identifying problematic codeine use are needed. Careful questioning about recent patterns of use, the reasons for taking codeine, and withdrawal symptoms upon cessation may help identify when a patient should be comprehensively assessed for an opioid use disorder. Commonly described approaches for managing codeine dependence include opioid taper, opioid agonist treatment, and psychological therapies.
Med J Aust. Published online: 12 February 2018.
A systematic review of 18 trials shows a significant analgesic effect of cannabinoids as compared to placebo in patients with malignant diseases. The main side effects were drowsiness, nausea, vomiting and dry mouth. There is evidence that cannabinoids are safe and modestly effective in neuropathic pain and also for relieving pain in patients with malignant diseases. The target dose for relieving pain in patients with malignant diseases is most likely about 10 actuations per day, which is about 27 mg tetrahydrocannabinol (THC) and 25 mg cannabidiol (CBD).
Journal of Pain Research 2018:11 837–842.
An overview of systematic reviews on orally administered medication or medication combinations for relief of acute dental pain shows NSAIDS, with or without paracetamol, offers the most favorable balance between benefits and harms, optimizing efficacy while minimizing acute adverse events. A combination of 400 milligrams of ibuprofen and 1,000 milligrams of paracetamol was superior to any opioid-containing medications studied.
A description of the role of pharmacists in general practice includes medicines optimisation, enhancing interprofessional communication and development of collaborative working relationships. Enhancing the relationship between the general practice environment and community pharmacy, assist with ongoing monitoring of medicines management and enhance outcomes associated with medicines use are other benefits of the role.
J Pharm Pract Res 2018;48:183-5.