Codeine handling ‘suboptimal,’ says study

white capsules, that resemble OMG Slim capsules

Newly published research has shown that in roughly a quarter of direct product requests for non-prescription combination analgesics containing codeine, pharmacists weren’t involved

Researchers from LaTrobe University conducted 145 covert pharmacy visits in which one of two scenarios took place, each of which involved a direct product request for Nurofen Plus.

The scenarios involved identical reasons for use, symptoms and medical history but varied previous product use: one involved a first-time user while the other had used the products regularly for the past month.

The research was undertaken between July and August 2015, well before the Pharmacy Guild’s MedsASSIST program began to roll out in March 2016. The product category is to be upscheduled to prescription-only on 1 February 2018.

Treatment was provided in the majority of visits, but refused in 24% due to lack of photo ID.

“A pharmacist was involved (directly or indirectly) in 77% of visits,” the authors wrote. “Adequate questioning to establish therapeutic need occurred in 50% of pharmacy visits, safety was established in 17% of visits, and adequate counselling provided in 17% of visits. The SP scenario did not significantly affect the NP-CACC supply outcomes.”

Only one pharmacy visit achieved the maximum score relating to supply of the product.

The authors described the management of requests as “suboptimal”.

“Both scenarios involved a direct product request (DPR) which has previously been shown to be related to reduced patient assessment and counselling compared to symptom-based requests,” they wrote.

“DPRs have been reported to be more intimidating for pharmacy staff with fewer opportunities to engage with the patient and therefore exchange of clinical information may be less likely.”

The authors also observed a variation in the degree of pharmacist involvement during pharmacy visits.

“Due to legal requirements, it was expected that there would be either direct or indirect (supervised) pharmacist involvement in all sales. Encouragingly, the majority of sales involved a pharmacist.

“The 23% of interactions that did not involve a pharmacist did not meet the Pharmacist Only Medicine provision requirements.”

They said that more frequent questioning from pharmacists when a customer purchases codeine-containing OTCs has been identified as an important factor and may decrease the frequency of problematic use, as well as increasing the number of users seeking support.

The authors also pointed out that when approached with an OTC codeine request by a customer who did not have photo ID, in very few interactions was an alternative analgesic or solution offered.

The researchers said MedsASSIST may have limited usefulness because its use was and remains voluntary.

“MedsASSIST will potentially reduce inappropriate sales of NP-CACC but if these patients are not offered support or help for their dependency or pain problem will they then turn to sourcing the opioids they need from alternative, possibly illegal sources?”

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