SA to control misuse of codeine

 The use of codeine, a popular over-the-counter drug that is commonly misused and abused, faces clamp down by the South African pharmacy industry from the beginning of next year (2014).

While this move has been on the cards since its announcement in June 2013, it is now known that as of 2 January 2014, patients will be required to supply key personal details including ID numbers, when they purchase a range of popular over-the-counter medications containing codeine in South Africa. By this date the Misused Substance Database, a central database of all purchases of medication containing the active ingredient, will be operational, and codeine is the first substance to be captured and controlled in this project. In time, other commonly misused ingredients, such as those used in sleeping tablets, will be included in this process.

The announcement was made at the Clicks 7th Annual Healthcare Conference at Emperors Place, which brought together 600 healthcare professionals, including Clicks pharmacists, members of the medical scheme industry, the pharmaceutical industry and the South African Pharmacy Council (SAPC) to engage on issues affecting pharmacy today.

The dangers of codeine

Rachel Wrigglesworth, new Head of Healthcare at Clicks welcomed the initiative.  “We offer our full cooperation to the industry bodies rolling out the project.”

Codeine is an active ingredient found in a range of popular flu and pain medications. These include Myprodol and Mybulen, which are obtainable through a doctor’s prescription. But it also includes the cough mixture, Benylin C; as well as Syndol, AdcoDol, Tensodol, Sinutab C, and Sinumax Co amongst other products. These can all be purchased over the counter, making South Africa one of the few countries in the world where this is the case.

While codeine has proven a highly successful ingredient, it is also addictive when not used correctly and is prone to misuse and abuse through ignorance, multiple stockpiling purchases, or frequent unmonitored purchases. Last year 32 million units of codeine were sold in South Africa.

In most countries all medication containing codeine are now obtainable through a prescription only.

The Codeine Care initiative launched by the Community Pharmacy Sector (CPS) and The Pharmacy Society of South Africa (PSSA) aims to prevent the need for the prescription only route, but at the same time to offer a responsible alternative.

“The aim of the initiative is to introduce an innovative solution to assist pharmacists to make an informed decision around the recommendation and sale of these products. We also want to protect patients from misuse and abuse of codeine-containing substances,” Nicola Brink, a consultant to the Self-Medication Manufacturers Association of South Africa (SMASA), told the conference.

”As many products containing codeine are currently available in South Africa in pharmacies as over-the-counter medicines, it is difficult to regulate as no national database exists. Codeine Care will  help to regulate the distribution and sale of medicines that contain codeine and at the same time will help to address, curb and ultimately prevent codeine medication misuse through providing information as a key to better responsible self-care and self-medication,” says Brink.

Added burden to healthcare system

CPS and PSSA through Codeine Care will create a centralised real time database to track all purchases by individuals.

While the major pharmaceutical groups have all signed up, the next phase will be the roll out to dispensing doctors, clinics and mine hospitals.  

Brink says Codeine Care is receiving interest from numerous other countries. Brink cautioned that while there may be resistance to the initiative, the only alternative is to move all medicine containing codeine to a higher schedule which would require a doctor’s prescription. Such moves have previously had an adverse effect on the sale of certain brands of medication and will place a further burden on an already overburdened healthcare system if a patient must go to their doctor for pain, fever and cold and flu symptoms requiring a medication a little stronger than paracetamol and the like.

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