A comparative analysis of pharmacists' perspectives on codeine use and misuse - A three country survey

Background: The misuse of codeine is of increasing concern in a number of countries, particularly as this relates to over -the-counter pain and cough relief medication, and is also supplied as a prescription medicine. The study aimed to obtain and analyse the opinions and experience of pharmacy staff with regard to codeine misuse. Methods: A cross-sectional web-based survey of pharmacy staff's perspectives on this issue was administered through professional or regulatory bodies and completed by samples drawn in South Africa (n=124), Ireland (n=464) and the United Kingdom (n=129). Results: The majority of participants reported combination codeine-containing products as most popular, but significantly more pharmacy staff in South Africa reported codeine-containing cough syrups as most commonly popular (X²=122.7(2), p<0.001). Codeine use was also seen significantly more of a public health problem in South Africa than in the other two countries (X²=7.6(2), p=0.02). There was no difference across countries in the level of codeine misuse reported by pharmacy staff. Further findings indicate that professional training and education is desired, with unequivocal findings for the need for greater codeine control (X²=12.0(2), p=0.002). Conclusion: In conclusion, there were some inter-country differences, but overall the findings seem to suggest that pharmacists across all three countries view codeine misuse as a problem among their customers. Recommendations centre on risk management, surveillance and staff training.