The upscheduling of combination analgesics containing codeine: The impact on the practice of pharmacists

BackgroundPrior to the 1st May 2010 some combination analgesics containing codeine (CACC) were available for sale over the counter (OTC) in Australia with no requirement for input from a pharmacist. Since then the upscheduling of these medications requires the involvement of a pharmacist in all OTC CACC sales.ObjectiveTo explore how the upscheduling of OTC CACC has impacted the practice of community pharmacists.MethodsA descriptive qualitative design was used, with data collected via face-to-face semi-structured interviews that were recorded and transcribed verbatim. The data were analyzed thematically via open, axial and selective coding.ResultsPharmacists were found to monitor the supply of OTC CACC by recording sales and to intervene when they felt that the medication was being used too frequently. They perceived a number of challenges surrounding the provision of OTC CACC including; supply from other pharmacies, establishing therapeutic need, managing codeine dependent people, lacking confidence in discussing misuse with people, being unsure where to refer dependent people for help and purchaser resentment towards pharmacist involvement in all sales. People who request OTC CACC tended to be stereotyped by participants as either ‘genuine’ or ‘misusers.’ConclusionA number of challenges faced by community pharmacists to ensure the safe provision of OTC CACC and to assist codeine dependent people were identified, highlighting the need for more effective ways of monitoring the use of OTC CACC and intervening in OTC codeine dependence.