Codeine Misuse and Abuse:
Working Together to Create Awareness
The continuous misuse and abuse of codeine-containing medicines remains a cause of great concern for the profession as many of the perpetrators and victims of this misuse are the youth of this country. The normalisation of this misuse in popular culture and the subliminal endorsement by public figures has not helped in addressing this issue. As the custodians of ethical and legal practice, it is the duty of pharmacy professionals to avoid reckless dispensing and to be whistleblowers when they see criminal activity taking place in and around them.
The South African Pharmacy Council relies on pharmacists in the very critical role that they play in interacting with the public, to manage the responsible dispensing of codeine-containing medicines consequently reducing the misuse and abuse thereof. The Rules relating to Good Pharmacy Practice and the Rules relating to the Code of Conduct for Pharmacists and Other Persons Registered in terms of the Pharmacy Act are fundamental in guiding pharmacists on how they shall dispense medicines and monitor reactions and possible addiction.
The profession, its successes and failures are all dependent on the actions of each individual pharmacy professional. Hence it is the moral and professional obligation of pharmacy professionals to be the change they would like to see regarding the misuse and abuse of codeine-containing medicines and other addictive substances. In legislation, the Rules relating to acts or omissions for which the Council may take disciplinary action (“Ethical” Rules) and in particular Rules 5(2)(c) and 23 deem it unprofessional for pharmacists or other persons registered in terms of the Pharmacy Act (including pharmacy owners) to engage in any conduct that either negligently or intentionally, promotes misuse and/or abuse of any medicine by members of the public.
The Schedules to the Medicines and Related Substance Act, 101 of 1965 prescribe codeine as a Schedule 2 medicine which means that it can only be sold in a pharmacy in specified and restricted quantities. When dispensed by pharmacy support personnel, it must be dispensed under the direct supervision of a pharmacist. The dispenser (pharmacist, or pharmacy support personnel) is legislated to keep a record of the sale and the details of the person buying the medicine. This is a measure put in place to track repetitive sales to a specific patient. This is also in addition to other legal requirements to mitigate the risk of misuse or abuse such as the prohibition of sale to anyone under the age of 14, ensuring that codeine-containing medicines are not kept in an open shop like Schedule 0 medicines and that should a pack size of more than 100ml for liquids or more than a five-day treatment pack of tablets or capsules be sold, it is no longer a Schedule 2 medicine and the higher volume may not be sold without a prescription from an authorised prescriber.
Even with all these legislative provisions in place, customers who have succumbed to these habit-forming medicines and customers operating an illicit market for these and other habit-forming medicines, have found a way to circumvent these preventative measures. This is by doing what is called “pharmacy-hopping” which sees patients going to different pharmacies to get the maximum amount that they are allowed to get at one pharmacy and going to other pharmacies to get more and more codeine-containing medicines. Unsuspecting pharmacy professionals dispensing these medicines are none the wiser to this as they cannot cross-reference with every pharmacy in their area to check if this consumer has recently bought codeine-containing medicines or other scheduled medicines.
How can pharmacy professionals promote awareness and prevent misuse and abuse?
Pharmacy professionals can identify patients who frequent their pharmacy to buy codeine-containing medicines, monitor their intake and communicate with pharmacies in their surrounding areas to flag such patients. This should be supplemented by educating such patients on the effects of the misuse and abuse of codeine-containing medicines. This is especially important for young individuals who consume codeine-containing cough syrups for recreational use. It is imperative to redirect our efforts toward relieving the plight of habit-forming and recreational use of substances by educating the public about the lasting effects of the misuse of codeine medicines such as gastric ulcers, intestinal or internal bleeding, hepatotoxicity, hypokalaemia and/or inflammatory stomach conditions and long-term effects such as severe brain damage. Empowering patients with knowledge of the consequences of misuse and abuse of these medicines may help sound the alarm on the seriousness and urgency of the issue.
To report any misconduct you may witness, you may lodge a complaint on Council’s website. Should you or a loved one suffer from substance abuse issues, you may reach out to the South African National Council on Alcoholism and Drug Defence (SANCA) by clicking here to receive the help you need.