{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:29:43Z","timestamp":1785421783337,"version":"3.56.0"},"reference-count":22,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T00:00:00Z","timestamp":1715299200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0Pharmacy professionals working in community pharmacies frequently provide pharmacist-initiated therapy, including codeine-containing medicines. Codeine is an opioid with great potential for misuse, adding to the global opioid epidemic burden. Professional pharmacy personnel are the first intervention point in relation to management of codeine use. This study highlights the importance of pharmacy professionals\u2019 perceptions and behaviours in combatting the opioid epidemic.\n\nMethods:\u00a0A descriptive cross-sectional study was conducted. Simple random sampling included pharmacy professionals in the metropolitan city of Johannesburg. An electronic questionnaire was distributed via e-mail and data analysed descriptively.\n\nResults:\u00a0Findings indicate that pharmacy personnel routinely ask patients about codeine use (n\u00a0= 48; 53.9%), avoid dispensing over-the-counter (OTC) codeine as an initial treatment (n\u00a0= 61; 69%) and express confidence to identify and manage codeine misuse (n\u00a0= 69; 77.5%). Despite this, increased patient demands for OTC codeine (n\u00a0= 69; 77.5%) were concerning, highlighting the ease of availability from internet sources (n\u00a0= 76; 85.4%) and multiple pharmacies (n\u00a0= 84; 94.4%). Apprehension about the lack of patient awareness on adverse health consequences (n\u00a0= 66; 74.2%) and the risk of codeine dependence (n\u00a0= 79; 88.8%) was expressed.\n\nConclusion:\u00a0Growing concern regarding availability and accessibility of codeine-containing medicines within the community pharmacy sector is highlighted. Adverse health consequences of codeine misuse and dependence are not understood by customers and the ineffective information provided by pharmacy personnel was highlighted as a concern.\n\nContribution:\u00a0The results of this study give insight to the influence of dispensing personnel\u2019s attitude towards the growing challenges with respect to codeine containing medication abuse.<\/jats:p>","DOI":"10.4102\/safp.v66i1.5862","type":"journal-article","created":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T21:38:31Z","timestamp":1715377111000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["The misuse of codeine containing medicines: Perceptions and behaviours of qualified pharmacy professionals"],"prefix":"10.4102","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6872-5417","authenticated-orcid":false,"given":"Elmien","family":"Bronkhorst","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/003hsr719","id-type":"ROR","asserted-by":"publisher"}],"name":"Sefako Makgatho Health Sciences University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5750-9720","authenticated-orcid":false,"given":"Munira","family":"Adamjee","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/003hsr719","id-type":"ROR","asserted-by":"publisher"}],"name":"Sefako Makgatho Health Sciences University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7289-3408","authenticated-orcid":false,"given":"Madan","family":"Poka","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/003hsr719","id-type":"ROR","asserted-by":"publisher"}],"name":"Sefako Makgatho Health Sciences University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2024,5,10]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Gray A, Riddin J, Jugathpal J. International perspectives on pharmacy practice health care and pharmacy practice in South Africa. Can J Hosp Pharm. 2016;69(1):36\u201341. https:\/\/doi.org\/10.4212\/cjhp.v69i1.1521","DOI":"10.4212\/cjhp.v69i1.1521"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Tay EMY, Roberts DM. A spotlight on the role, use, and availability of codeine and the implications faced. Expert Rev Clin Pharmacol [Internet]. 2018;11(11): 1057\u20131059. https:\/\/doi.org\/10.1080\/17512433.2018.1537122","DOI":"10.1080\/17512433.2018.1537122"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Carney T, Wells J, Parry CDH, McGuinness P, Harris R, Van Hout MC. A comparative analysis of pharmacists\u2019 perspectives on codeine use and misuse \u2013 A three country survey. Subst Abus Treat Prev Policy. 2018;13(1):6\u201313. https:\/\/doi.org\/10.1186\/s13011-018-0149-2","DOI":"10.1186\/s13011-018-0149-2"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"\u0106eli\u0107 I, Bach-Rojecky L, Mer\u0107ep I, Soldo A, Petrak AK, Bu\u010dan A. Resolving issues about efficacy and safety of low-dose codeine in combination analgesic drugs: A systematic review. Pain Ther. 2020;9(1):171\u2013194. https:\/\/doi.org\/10.1007\/s40122-020-00162-8","DOI":"10.1007\/s40122-020-00162-8"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Cooper RJ. Over-the-counter medicine abuse \u2013 A review of the literature. J Subst Use. 2013;18(2):82\u2013107. https:\/\/doi.org\/10.3109\/14659891.2011.615002","DOI":"10.3109\/14659891.2011.615002"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Padayachee N, Rothberg AD, Truter I, Butkow N. Utilization of over-the-counter analgesics in two private medical insurance schemes in South Africa. Drug Healthc Patient Saf. 2019;11:37\u201345. https:\/\/doi.org\/10.2147\/DHPS.S194347","DOI":"10.2147\/DHPS.S194347"},{"key":"ref6","unstructured":"Anekar AA, Hendrix JM, Cascella M. Who analgesic ladder [homepage on the Internet]. StatPearls. StatPearls Publishing; 2023. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK554435\/"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Richards GC, Aronson JK, MacKenna B, Goldacre B, Hobbs FDR, Heneghan C. Sales of over-the-counter products containing codeine in 31 countries, 2013\u20132019: A retrospective observational study. Drug Saf. 2022;45(3):237\u2013247. https:\/\/doi.org\/10.1007\/s40264-021-01143-2","DOI":"10.1007\/s40264-021-01143-2"},{"key":"ref8","unstructured":"South African Health Products Regulatory Authority. South Africa Medical device regulation [homepage on the Internet]. Sahpra. 2017, p. 101. Available from: https:\/\/www.gov.za\/sites\/default\/files\/gcis_document\/201606\/40041gon620.pdf"},{"key":"ref9","unstructured":"Sourial M, Les\u00e9 MD. The pharmacist\u2019s role in pain management during transitions of care. US Pharm [serial online]. 2017;42(8):17\u201328. Available from: https:\/\/www.uspharmacist.com\/article\/the-pharmacists-role-in-pain-management-during-transitions-of-care"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Wells JSG, Bergin M, Van Hout MC, et al. Purchasing over the counter (OTC) medicinal products containing codeine \u2013 Easy access, advertising, misuse and perceptions of medicinal risk. J Pharm Pharm Sci. 2019;21(1):286\u2013295. https:\/\/doi.org\/10.18433\/jpps30049","DOI":"10.18433\/jpps30049"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Hoppe D, Ristevski E, Khalil H. The attitudes and practice strategies of community pharmacists towards drug misuse management: A scoping review. J Clin Pharm Ther. 2020;45(3):430\u2013452. https:\/\/doi.org\/10.1111\/jcpt.13100","DOI":"10.1111\/jcpt.13100"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Nyamuzihwa T, Tembo A, Martyn N, et al. The South African community pharmacy sector \u2013 An untapped reservoir for delivering HIV services. Front Reprod Health. 2023;5:1\u20135. https:\/\/doi.org\/10.3389\/frph.2023.1173576","DOI":"10.3389\/frph.2023.1173576"},{"key":"ref13","unstructured":"City Johannesburg. City of Johannesburg Metropolitan GAU [homepage on the Internet]. Vol. 1, Profile: City Of Johannesburg Metro; 2018. Available from: https:\/\/www.cogta.gov.za\/ddm\/wp-content\/uploads\/2020\/08\/Take2_DistrictProfile_JHB1606-2-2.pdf"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Foley M, Carney T, Rich E, Parry C, Van Hout MC, Deluca P. Medical professionals\u2019 perspectives on prescribed and over-the-counter medicines containing codeine: A cross-sectional study. BMJ Open. 2016;6(7):1\u201310. https:\/\/doi.org\/10.1136\/bmjopen-2016-011725","DOI":"10.1136\/bmjopen-2016-011725"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Aziz Z. Continuing professional development: Views and barriers toward participation among Malaysian. Eur J Soc Behav Sci. 2013;4(1):713\u2013726. https:\/\/doi.org\/10.15405\/FutureAcademy\/ejsbs(2301-2218).2012.4.6","DOI":"10.15405\/FutureAcademy\/ejsbs(2301-2218).2012.4.6"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Guo Y, Kopec JA, Cibere J, Li LC, Goldsmith CH. Population survey features and response rates: A randomized experiment. Am J Public Health. 2016;106(8): 1422\u20131426. https:\/\/doi.org\/10.2105\/AJPH.2016.303198","DOI":"10.2105\/AJPH.2016.303198"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Gumede LC, Helberg E, Bezuidenhout S. Pharmacists\u2019 practices and challenges regarding Continuing Professional Development in Mpumalanga province, South Africa. Pharm Educ. 2021;21:247\u2013254. https:\/\/doi.org\/10.46542\/pe.2021.211.247254","DOI":"10.46542\/pe.2021.211.247254"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Dada S, Burnhams NH, Van Hout MC, Parry CDH. Codeine misuse and dependence in South Africa \u2013 Learning from substance abuse treatment admissions. S Afr Med J. 2015;105(9):776\u2013779. https:\/\/doi.org\/10.7196\/SAMJnew.8172","DOI":"10.7196\/SAMJnew.8172"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Carney T, Wells J, Bergin M, Dada S, Foley M, McGuiness P, et al. A comparative exploration of community pharmacists\u2019 views on the nature and management of over-the-counter (OTC) and prescription codeine misuse in three regulatory regimes: Ireland, South Africa and the United Kingdom. Int J Ment Health Addict. 2016;14(4):351\u2013369. https:\/\/doi.org\/10.1007\/s11469-016-9640-z","DOI":"10.1007\/s11469-016-9640-z"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Foley M, Carney T, Rich E, Dada S, Mburu C, Parry C. A study of medical professionals\u2019 perspectives on medicines containing codeine in South Africa. S Afr J Psychiatry. 2018;24:1\u20137. https:\/\/doi.org\/10.4102\/sajpsychiatry.v24.i0.1162","DOI":"10.4102\/sajpsychiatry.v24.i0.1162"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Hamer AM, Spark MJ, Wood PJ, Roberts E. The upscheduling of combination analgesics containing codeine: The impact on the practice of pharmacists. Res Soc Adm Pharm. 2014;10(4):669\u2013678. https:\/\/doi.org\/10.1016\/j.sapharm.2013.08.004","DOI":"10.1016\/j.sapharm.2013.08.004"}],"container-title":["South African Family Practice"],"original-title":[],"link":[{"URL":"https:\/\/safpj.co.za\/index.php\/safpj\/article\/viewFile\/5862\/8782","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/safpj.co.za\/index.php\/safpj\/article\/viewFile\/5862\/8783","content-type":"application\/epub+zip","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/safpj.co.za\/index.php\/safpj\/article\/viewFile\/5862\/8784","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/safpj.co.za\/index.php\/safpj\/article\/viewFile\/5862\/8785","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/safpj.co.za\/index.php\/safpj\/article\/view\/5862\/8785","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T09:08:14Z","timestamp":1774948094000},"score":1,"resource":{"primary":{"URL":"https:\/\/safpj.co.za\/index.php\/safpj\/article\/view\/5862"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,10]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1,29]]}},"URL":"https:\/\/doi.org\/10.4102\/safp.v66i1.5862","relation":{},"ISSN":["2078-6190","2078-6204"],"issn-type":[{"value":"2078-6190","type":"print"},{"value":"2078-6204","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,10]]},"article-number":"a5862"}}