Codeine Abuse: what are you doing?

Should codeine containing products be regulated? How do we curb the rampant concerns of abuse we face in our daily settings as pharmacists? 

Well this short article raises a few suggestions but many more questions. 

We've all seen the typical codeine suspect coming in to get yet another box of "codein" with a friendly smile and a ready-to-use excuse. 

It's for family, I forgot mine at home, I travelled... etc etc. 

We indulge them more often then not and advise them to only buy for themselves and not for other family members but is it enough? 

It's especially worrying when they directly request (by name) specific codeine syrups and combination flu tablets without allowing the dispenser to suggest anything else or even slightly deviate from their request! There's no telling what goes in their private homes.. do they drink the whole bottle and take multiple pills at once? 

We often see notes or alerts left by previous dispenser warning the next dispenser of a possible addiction or misuse; But when do we say NO and refuse to sell?

Should there be a form that they fill much like that of the morning after/ emergency contraception? 

Should the law change yo limit the number of purchases of pack size and frequency per month? 

Should health care professionals make a bigger effort to educate populations against the misuse of codeine and its dangers? 

If we have sugar tax and other bizzar regulations surely the state can be more stringent concerning its beloved citizens' health? 

If you had a say and a national impact how would you address the issue of codeine abuse and misuse. 

Codeine:

You work too well for your own good. 

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What are Consultant Pharmacists?

Have you heard of consultant pharmacists?

Do you perhaps know one?

Consultant pharmacists are a new thing in Africa! This specialty is more common abroad, however it is still growing and patients are now getting to know what it's all about.

So what is consulting pharmacy?

 In summary, it's a one-on-one specialized consulting service provided by a pharmacist to a client. It goes deeper than what you typically experience at your retail pharmacy when you go in to fill a prescription or inquire to buy some over the counter medication. Consultant pharmacists provide information, dig much deeper, and perform complex investigations to provide well rounded, complete health care analysis and assessments.

They are therefore suitable for:

Private patients: who seek private one-on-one sessions. 

Those with Co-morbidities : patients who have multiple chronic diseases or illnesses and find themselves with many regimens to follow. Eg. A diabetic, hypertensive hyperlipidemic patient with heart failure.

The elderly: apart form falling in the first described category, the elderly have fragile sensitive systems. Excretion, metabolism and other functions usually decrease with age and therefore dose monitoring and drug adjustments are frequently necessary.

The miscellaneous: anyone with unusual, uncommon or rare conditions seeking additional support, resources or health care guidance.

Consultant Pharmacist also provide drug information to patients with uncomplicated prescriptions and those seeking daily medicinal advice.

MRs (medicines review) are individualized drug reviews done in certain pertinent instances.

CMRs (Complete Medicines Reviews)  or sometimes called comprehensive medication review are done on the entire patient profile. Whether annually or quarterly, Therese thorough reviews are done to monitor and track hidden issues unperceived by patients or their carers.

MTMs (medication therapy management) are a combination of reviews and action plans set to streamline, and simplify misunderstandings and complexities.

This specialty comes as a result of therapy gaps, mistakes, and non-adherence due to mis-coordination, multiple prescribers, and patient misunderstandings exacerbated by unbearable side effect profiles.

As pharmacists we always try to encourage patients to participate in their health care and thus become empowered to improve it.

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The Morning after Pill: Did You Know?

Here's a WHO, WHAT, WHEN, WHERE, & WHY breakdown about the mighty, infamous morning after pill. If you've ever wondered about it's uses, or have been too scared to ask; here is the 411.

Who: the pill is made to work on the female reproductive system to alter female hormones (for those who are of child bearing age and fertile) and it should therefore only be purchased and ingested by them, in an "emergency" situation.

What: these POP (progesterone only pills) /emergency contraceptives are high dose progesterone pills taken orally to prevent pregnancy. They should NOT therefore be taken if pregnancy is suspected or has been established.

When: the 'emergency pill' is preferably taken within 12h of unprotected intercourse. The sooner it is taken after intercourse, the  greater the percentage chance of preventing pregnancy. Its efficacy decreases with passing time. It should NOT be taken as a regular contraceptive pill and should not be repeated frequently as it may cause severe hormonal stress and disturbances.

Where: it acts to prevent ovulation and implantation of a fertilized egg (ovum) in the uterus. Depending on the stage of menstrual cycle at which it is taken.

Why: Pops are taken to prevent pregnancy when the female is in her fertile period of her menstrual cycle. Typically during ovulation time. It should be avoided otherwise.

Many times ladies rush into the pharmacy with a panic and request the morning after pill without considering some very important points.

It is not warranted if:

-She is pregnant

-She wishes to fall pregnant

-She takes daily contraceptives or other forms of contraception ( however some antibiotics and other drugs may decrease the efficacy of contraceptives in which case a second preventative measure is needed)

-She has had her period within a week  (5 days) or is expecting it within a week.

-She has a known allergy or hypersensitivity to any component in the pill.

-She' s at high risk of arterial disease or has undiagnosed vaginal bleeding.

NOTE:

The pill is neither a first line (condom, pessary, foam, etc) nor a second line (patch, daily pill, injection etc) pregnancy prevention mechanism. It should therefore be taken seriously and strictly in emergencies. They also do not prevent against sexually transmitted diseases. Ladies (and their partners) should be adequately informed before opting to take it.

Be in the know. Stay safe.

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www.pharmers.co.za

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