Opportunities and challenges: Over-the-counter codeine supply from the codeine consumer's perspective

Objectives: This study aimed to gain a better understanding on perspectives of over-the-counter (OTC) codeine users and issues relating to codeine dependence in the community pharmacy setting. Examining OTC codeine users' experiences aimed to promote better understanding of OTC codeine dependence, and inform pharmacy practices. Methods: Utilising a qualitative research methodology we conducted interviews with 20 participants who were OTC codeine users and met DSM IV criteria for codeine dependence. Key findings: Key themes identified included experience of participants acquiring OTC codeine and participants' interactions with pharmacists. The OTC codeine-dependent participants found it generally easy to access OTC codeine, describing 'standard' questioning, minimal intervention from pharmacists and only occasional refusal to supply. A better appearance and presentation was generally linked to easy codeine supply. Conclusions: The experiences of participants suggest a number of barriers exist to effective intervention for OTC codeine dependence in the community pharmacy setting. Identification of these barriers will provide an opportunity to more effectively target interventions to reduce harm related to OTC codeine products. Increased involvement of pharmacists in OTC codeine sales was associated with help-seeking by codeine users.