Determining the prevalence of use of over-thecounter (OTC) codeine-containing products in the central Johannesburg area: a mixed methods study.

Abstract

The abuse and misuse of codeine medication is a growing concern, in South Africa (SA) codeine combination products and cough syrups are available without a prescription, thereby making it easy to access these products from various pharmacies (Foley et al., 2018). The South African National Council on Alcoholism and Drugs claimed that codeine is the most abused OTC codeine drug in South Africa (Hodes, 2019). There is little known about the prevalence of opioid and codeine use in African countries (Harker et al., 2020). Aim: The aim of the study is to analyse patterns of over the counter (OTC) codeine-containing products in central Johannesburg pharmacy sector and to explore the pharmacist perceptions on the effectiveness of current regulations. Method: A mixed method research design was done by quantitatively analyzing the sales/usage patterns of OTC codeine medications in retail pharmacies in central Johannesburg for the retrospective period of January 2019 to December 2020 and by qualitatively interviewing twelve practicing retail pharmacists on their views regarding OTC codeine abuse/misuse in SA. Results: The results obtained from the retrospective analysis of codeine sales demonstrated that Adco-dol and Gen-payne were the most frequently sold OTC codeine products in central Johannesburg. When the sales were described between the different income areas the high income areas highest sold product was Benylin with codeine. Both the middle and low income areas most sold product was Adco-dol. In the qualitative phase, practicing pharmacists were interviewed where it was found that OTC codeine is believed to be abused/misused in SA. Participants expressed concerns over factors which contribute to the abuse thereof, the ineffectiveness of the schedule 2 register and the possibility of the installation of a national database to control/monitor codeine use. Conclusion: In this study it became apparent that OTC codeine is being misused/abused in SA with current regulations not adequately controlling or preventing this issue. There is an urgent need to re-evaluate the current regulations. This study highlighted the views of the ineffectiveness of the current schedule 2 register in SA along with the suggestion of a more monitored intervention strategy to curb this issue of codeine abuse/misuse. Most participants 13 agreed that the best way to prevent OTC codeine abuse/misuse was to up-schedule it to a prescription only drug or to implement a national database that is automated and integrated into the current pharmacy software