Health

Over the Counter Codeine Use Misuse and Dependence (CODEMISUSED)

The CODEMISUSED project was selected for funding under the FP7 Marie Curie Industry Academia Partnership and Pathways strand and valued at €2.04 million. It ranked 2nd place in Life Sciences Division with a score of 96/100.

Contemporary research has underscored the need for ‘increased pharmaco-vigilance’ around codeine dispensing as the most commonly consumed opiate worldwide. Codeine represents an interesting quandary in terms of its regulated status, with individuals varying in their metabolism of codeine, estimation of safe dosages, and abuse potential. Although effects are milder than heroin, abuse potential remains of concern, with physical dependence occurring with regular use over a short period of time.

Within user trajectories of codeine use, a variety of subgroups exist in the form of pain patients, elderly, youth, parents, recreational, problematic and opiate dependent drug users, and each with their own motives, patterns and outcomes for use. Increases in treatment uptakes relating to codeine dependency and concerns for appropriate design of treatment protocols have been recorded globally.

There is a clear need for the unique CODEMISUSED collaboration (Waterford Institute of Technology, Ireland, Kings College London, UK, Medical Research Council, South Africa, Cara Pharmacy Group, Ireland, Weldricks Pharmacy, UK and Leading Pharmacy Group, South Africa) to present data on codeine user (prescribed, over the counter, web retailed) profiles so as to inform the design of protective mechanisms in the pharmacy profession to track, monitor, support and refer codeine misusers.

Data will be used to inform the design of innovative outputs in the form of pharmacy based brief interventions and customer monitoring systems, continuing staff training and management of appropriate treatment interventions. Industry (pharmacy chains) and academia exchanges in the form of secondments of staff, workshops, seminars and conferences will occur throughout the duration of the project so as to collaborate, exchange knowledge and expertise, inform and guide the work.

This project is supported by an Expert Advisory Panel with representatives of the EMA, EMCDDA, South African Central Drug Authority and Royal Pharmaceutical Society UK.

Publications arising from the CODEMISUSED Project:

Kimergård, A., Foley, M., Davey, Z., Wadsworth, E., Drummond, C., & Deluca, P. (2017). The challenge of complex drug use: Associated use of codeine‐containing medicines and new psychoactive substances in a European cross‐sectional online population. Human Psychopharmacology: Clinical and Experimental, in press. http://doi.org/10.1002/hup.2611

Kimergård, A., Foley, M., Davey, Z., Dunne, J., Drummond, C., & Deluca, P. (2017). Codeine use, dependence and help-seeking behaviour in the UK and Ireland: an online cross-sectional survey. QJM: An International Journal of Medicine, 1–6. http://doi.org/10.1093/qjmed/hcx076

Parry, C., Rich, E., Van Hout, M. C., & Deluca, P. (2017). Codeine misuse and dependence in South Africa: Perspectives of addiction treatment providers. South African Medical Journal, 107, 451–456. http://doi.org/10.7196/SAMJ.2017.v107i5.12242

Kimergård, A., Deluca, P., Hindersson, P., & Breindahl, T. (2017). How Resistant to Tampering are Codeine Containing Analgesics on the Market? Assessing the Potential for Opioid Extraction. Pain and Therapy, 5, 187–201. http://doi.org/10.1007/s40122-016-0053-2

Foley, M., Breindahl, T., Hindersson, P., Deluca, P., & Kimergård, A. (2016). Misuse of “over- the-counter” codeine analgesics: does formulation play a role? Public Health, 130, 95–96. http://doi.org/10.1016/j.puhe.2015.10.006

Foley, M., Carney, T., Rich, E., Parry, C., Van Hout, M. C., & Deluca, P. Medical professionals' perspectives on prescribed and over-the-counter medicines containing codeine: a cross-sectional study. BMJ Open, 6, e011725. http://dx.doi.org/10.1136/bmjopen-2016-011725

Kimergård, A., Breindahl, T., Hindersson, P., & Deluca, P. (2016). Tampering of opioid analgesics: a serious challenge for public health? Addiction, 111, 1701–1702. http://doi.org/10.1111/add.13436

Parry, C., Deluca, P., Cooper, R., & Van Hout, M. C. (2015). Do we have sufficient information to optimally inform regulatory or other policy decisions about medications containing codeine? Addiction, 110, 1690–1692. http://doi.org/10.1111/add.13047

Aims

The research aims to quantify the extent of codeine use, misuse and dependence in three countries (Ireland, United Kingdom and South Africa), with focus on therapeutic and non-therapeutic use, so as to create user profiles of use and abuse and capture individual user, pharmacy, medic and treatment provider perspectives across the three regulatory regimes. A mixed-method approach will commence with a meta-analysis and systematic review of literature, existing national data sources and sales trends, which along with national pharmacist and policy maker surveying, will inform the design and implementation of sweep surveys of individuals purchasing OTC and prescribed codeine in pharmacies, internet-based codeine user focus groups targeting web-based sales and use, and in-depth face-to-face interviews with codeine users, misusers and dependents in each country.