Pharmaciae (SAPC) | Codeine abuse

Codeine abuse – Pharmacist’s responsibilities in terms of the legislation

As highlighted by the eNCA programme Checkpoint as well as MNet’s Carte Blanche recently, there is a growing trend amongst the youth whereby Schedule 2 codeine containing cough mixtures are mixed with cold drinks and consumed for recreational purposes. This disturbing habit is wreaking havoc in communities, schools and families where young people find themselves addicted to codeine containing medicines.

“I’ve been waiting in the que for twenty minutes! I don’t have time for this!” We’ve all heard these sorts of complaints and excuses from patients, but there is no valid excuse for NOT recording a patient’s details when selling Schedule 1 and 2 medicines. That’s right, we said Schedule 1 and 2 medicines. In terms of Regulation 35 of the General Regulations published under the Medicines and Related Substances Act, 101 of 1965, it is the pharmacist’s responsibility to record the sale of ALL scheduled medicines.

“35.

A prescription book or other permanent record in respect of Schedules 1, 2, 3, 4, 5 and 6 substances shall be kept in hard copy or electronically on all premises where such substances or medicines are sold or dispensed.
In the case of Schedule 1 medicines and substances sold by any person other than a manufacturer or wholesaler, a prescription book or other permanent record contemplated in subregulation (1) shall contain the following particulars:
1. The name of the person to whom it was sold;
2. the name and quantity of the substance or medicine; and
3. the name of the pharmacist, pharmacist intern or pharmacist’s assistant who sold it.
In the case of Schedule 2, 3, 4 and 5 medicines and substances sold by any person other than a manufacturer or wholesaler, the prescription book or other permanent record contemplated in subregulation (1) shall contain the following particulars:
1. The name of the medicine or scheduled substance;
2. the date on which the prescription was dispensed;
3. the dosage form and quantity of the medicine or scheduled substance;
4. the name, identification number and address of –
  1. the patient;
  2. in the case of a prescription for a neonate, the name, identification number and address of a parent or guardian; or
  3. in the case of a prescription issued by a veterinarian, the person to whom the medicine or scheduled substance was sold;
5. where applicable, the name of the medical practitioner, dentist, veterinarian or any other authorised person who issued the prescription; and
6. prescription reference number, which is the reference number or unique identifier assigned at the point of dispensing.”

It is the responsibility of the Responsible Pharmacist to ensure that there are systems in place to abide by the abovementioned regulations, and to ensure that all pharmacy staff are aware of and familiar with these systems. It may seem like a small, time-consuming administrative task with no real benefit, but the benefits of complying with these regulations are numerous. For starters, if an addict enters your pharmacy and is asked for details such as his/her ID number and address they may be deterred from their mission of purchasing codeine containing medicines for recreational use. Secondly, if a South African Pharmacy Council inspector performs an inspection at your pharmacy and finds that you have not complied with the regulations, disciplinary action may be taken against you. This disciplinary action may result in a caution and warning, but it may also result in a fine or even suspension from the register.

Above all, a pharmacist should always put the health of the patient first, and this applies to all sectors of pharmacy. Remember, if you suspect that a patient is misusing or abusing medicines, or that a pharmacy or dispensing doctor is ordering excessive amounts of habit forming medicines, it is within your right as a professional pharmacist to refuse to dispense or dispatch such prescription or order for medication to them. Rule 23 of the Ethical Rules applies to all pharmacists and it is important to note that selling or dispensing medicines in a manner that does or appears to promote the misuse or abuse of medicine will result in a professional conduct inquiry in terms of Chapter V of the Pharmacy Act.