Over-The-Counter Codeine: Can Community Pharmacy Staff Nudge Customers into Its Safe and Appropriate Use?

The misuse of opioids, including codeine which is sold over-the-counter (OTC) in United Kingdom (UK) community pharmacies, is a growing public health concern. An educational Patient Safety Card was developed and piloted to see if it nudged customers into the safe and appropriate use of OTC codeine. Exploratory analysis was conducted by (i) recording quantitative interactions for people requesting OTC codeine in community pharmacies; and (ii) a web-based pharmacy staff survey. Twenty-four pharmacies submitted data on 3993 interactions using the Patient Safety Card. Staff found the majority of interactions (91.3%) to be very or quite easy. Following an interaction using the card, customers known to pharmacy staff as frequent purchasers of OTC codeine were more likely not to purchase a pain relief medicine compared to customers not known to staff (5.5% of known customers did not purchase any pain relief product versus 1.1% for unknown customers (χ2 = 41.73, df = 1, p [less than] 0.001)). These results support both the use of a visual educational intervention to encourage appropriate use of OTC codeine in community pharmacy and the principles behind better self-care

Surgery and opioids: evidence-based expert consensus guidelines on the perioperative use of opioids in the United Kingdom

There are significant concerns regarding prescription and misuse of prescription opioids in the perioperative period. TheFaculty of Pain Medicine at the Royal College of Anaesthetists have produced this evidence-based expert consensusguideline on surgery and opioids along with the Royal College of Surgery, Royal College of Psychiatry, Royal College ofNursing, and the British Pain Society. This expert consensus practice advisory reproduces the Faculty of Pain Medicineguidance. Perioperative stewardship of opioids starts with judicious opioid prescribing in primary and secondary care.Before surgery, it is important to assess risk factors for continued opioid use after surgery and identify those with chronicpain before surgery, some of whom may be taking opioids. A multidisciplinary perioperative care plan that includes aprehabilitation strategy and intraoperative and postoperative care needs to be formulated. This may need the input of apain specialist. Emphasis is placed on optimum management of pain pre-, intra-, and postoperatively. The use ofimmediate-release opioids is preferred in the immediate postoperative period. Attention to ensuring a smooth caretransition and communication from secondary to primary care for those taking opioids is highlighted. For opioid-naivepatients (patients not taking opioids before surgery), no more than 7 days of opioid prescription is recommended.Persistent use of opioid needs a medical evaluation and exclusion of chronic post-surgical pain. The lack of grading of theevidence of each individual recommendation remains a major weakness of this guidance; however, evidence supportingeach recommendation has been rigorously reviewed by experts in perioperative pain management.</div