Codeine Addiction

[Jeff]

Really ? I thought it had gone out of favour in place of safer alternatives (Imodium, ORT)

Gelatin in loperamide capsules - ORT doesn't treat the symptoms - just avoids problems until natural recovery occurs.

Jeff

[Sir_Dispensalot]

here's what an american pharmacist suggested for a do-it-yourself detox:

The *Angriest* Pharmacist ? Blog Archive Did I do something wrong?


admittedly this is for heroin but the principles would be the same if an individual was determined to come off codeine without the help of GP or SMS.

I'm a bit dubious about the alcohol advice but it does help mask some of the symptoms associated with withdrawal.

[SolomonQ]

alot of the meds recommended above are outside their licenses i.e. (un-licensed), would that really be suitable, what if the patient ends up in hospital or kicking the bucket, because of what was recomended by the pharmacist???

[Sir_Dispensalot]

i've seen all the doses suggested on there on script before so little danger of serious problems - the main concern is the diphenhydramine and overuse for the drowsy effects. Fortunately it's hard to OD on it as it has a short half life, and it can be safely taken every 4-6 hours if you can stay awake to take it! The calcold kids med has it in if i recall correctly - quite safe to give QDS.
An alternative might be phenergan instead.
Paracetamol (tylenol) and ibuprofen alternating every 2 hours - therefore paracetamol every four hours (up to qds) and ibuprofen 400mg qds cc (although OTC only recommends tds you can safely have up to 1600mg daily) - all safe to take and good clinical doses.

However, 'as detox from opiate' is hardly within the licence terms of any OTC medicine it should all be done under caution. It should be noted that the technique outlined by our american cousins should only be used as a last resort for someone who is truly committed to detoxing AND cannot go via the SMS / gp detox route for any good reason.

As long as you make all this extremely clear to the patient - including the downsides - then you are effectively giving them informed consent. It may not be legal in the strictest terms of the law but you are exercising your clinical, chemical and professional knowledge.

Tony's the man to talk to about SMS referral from codiene addicts though. He may have encountered the odd one amongst his service users.

After all, how many otc lines are used completely outside the licensing indications? (family guy's ipecac vomit competition springs to mind)

[Nik]

she hasn't gone somewhere else, we've got the sneaky suspicion that she's getting somebody else to come in and buy them for her

how is anybody supposed to stop someone like that from buying codeine without blurting out your suspicions ??

With regards to this woman (who came in again last sat + bough co-cod + nytol) we are most likely going to refuse her request to buy said items again this saturday (if she comes in). Pharm't will probably deal with her similarly to the lady who we originally stopped from buying the drugs.

Too many people get hooked on OTC opiate meds and I reckon they should be moved back from P to POM

[Jeff]

With regards to this woman (who came in again last sat + bough co-cod + nytol) we are most likely going to refuse her request to buy said items again this saturday (if she comes in). Pharm't will probably deal with her similarly to the lady who we originally stopped from buying the drugs.

Too many people get hooked on OTC opiate meds and I reckon they should be moved back from P to POM

Please - along with refusal refer the lady to her GP or failing that suggest that she has a read of the codeinefree.me.uk forums.

Jeff

[Nik]

Please - along with refusal refer the lady to her GP or failing that suggest that she has a read of the codeinefree.me.uk forums.

Jeff

Well I'll try to let the pharmacist know, but it's not as simple as referring the person to a GP, when the person says she is buying for someone else. I suppose the best that could happen is to advise that that "someone else" should see a doctor if s/he needs that much co-cod or nytol, but solutions to the problem seem very limited unless said person openly admits to being the one taking the drugs mentioned.

[dizzyb23]

We have many customers who regularly come in and buy the OTC codeine preps. We are running on locums again and we do mention it to them to deal with in anyway they see fit. I suspect this dependency on OTC's has become a much bigger problem. We also do a very high number of scripts for POM codeine meds. Some days that's all we do.....
Someone also mentioned Phenergan. We have many Mums who regularly come in to buy it. We don't keep it in stock and only order it when it's actually on a script. Are there any pharmacies that still sell this item to customers??
And thank goodness there are supportive web sites like Codeinefree. They do an amazing job....

[Nik]

There was an article in the PJ recently about a pharmacist who was struck off for regularly supplying large quantities of codeine linctus OTC to people he knew who were addicts. Apparently an inspector went into the shop and was able to buy 10 bottles of codeine linctus without the pharmacist being involved in the supply. They were ordering something like 5000 bottles over a year period at one point.

[hibernia]

In the Republic of Ireland we have new guidelines on the supply of codeine containing productshttp://www.pharmaceuticalsociety.ie/...lines_2010.pdf


Main points are that
1) the products aren't on display
2) pharmacist must interview EACH customer before EACH supply and deem it appropriate to supply under the terms of the product licence
3) with EVERY sale appropriate advice on usage, side-effects and dangers of addiction must be given.

It was a lot of work at first but staff and patients quickly got used to it. Sales have dropped considerably.
Addicts will still get supplies, they always do somehow - that is the nature of addiction, and it is too early to say what the long-term impact will be but we should have a lot less problems in the future.
It is also making a lot of regular users, who aren't addicted, re-consider their options and question their need for these products.

One issue we have is the over-spill of advertising from UK TV networks in Ireland. It has always been illegal to advertise them here but there is no doubt that the UK advertising, which was particularly noticable during the World Cup, is driving demand, and much of that demand is for inappropriate use where problems start.
If you are serious about tackling codeine addiction the first thing has to be a ban on advertising, especially on TV, but the companies will resist, just as tobacco companies have done, and for the same reasons.