Is South Africa’s codeine abuse fuelled by private pharmacies? Investigation of over-the-counter codeine procurement patterns in Gauteng Province, South Africa

Abstract

Codeine is a natural opioid which is used as an analgesic and cough suppressant. The misuse and abuse of codeine are multi-factorial, which includes a quick development of tolerance. The objective of the study was to investigate the purchasing patterns of codeine-containing over-the-counter products of selected private healthcare pharmacies in Gauteng Province of South Africa. This quantitative, retrospective study was based on data extracted from a national private electronic procurement database for a period of six months. Sales data retrieved focused on the pattern of both codeine-containing medication and non-codeine-containing medication procured in Gauteng Province by 1162 community and private hospital pharmacies. The product name as per product composition, month of delivery, pack-size, quantity ordered and quantity delivered were analysed using SAS Enterprise 7.1. More than half (55.4%) of the analgesics procured during the data collection period contained codeine, and more than a quarter (29.9%) of the cough syrups procured also contained codeine. Products that contained paracetamol, doxylamine, codeine and caffeine accounted for more than half (59%) of all over-the-counter pain products procured. This study highlighted the high demand for codeine-containing analgesic medication in Gauteng Province, especially those in combination with sedating antihistamines. Policy makers must consider legislative changes to ensure stricter control of these medicines to curb rampant codeine misuse and abuse.