ArticleBMJ open2019
From pain treatment to opioid dependence: a qualitative study of the environmental influence on codeine use in UK adults.
Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 20 citations in OpenAlex.
- preSCRIPT: Large-scale prescription search and annotation engine for pharmacogenomic studies.Pharmacological reports : PR · 2026Article
- Temporal trends and patterns in initial opioid prescriptions after hospital discharge following colectomy in England over 10 years.BJS open · 2023Article
- Logic model for opioid safety in chronic non-malignant pain management, an in-depth qualitative study.International journal of clinical pharmacy · 2023Article
- Over-the-Counter Drug Misuse and Dependence: Public Health Ethics' Foray into Fight against the Codeine Crisis.Pharmacy (Basel, Switzerland) · 2022Article
- Sales of Over-the-Counter Products Containing Codeine in 31 Countries, 2013-2019: A Retrospective Observational Study.Drug safety · 2022Observational
- Over-The-Counter Codeine: Can Community Pharmacy Staff Nudge Customers into Its Safe and Appropriate Use?Pharmacy (Basel, Switzerland) · 2020Article
- Identification of factors influencing tampering of codeine-containing medicines in England: a qualitative study.Harm reduction journal · 2020Article
- Designing Effective Warnings about Addiction on the Patient Information Leaflet of Over-the-Counter Codeine Sold in England to University Students.International journal of environmental research and public health · 2020Article
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
Abstract
objectivesTo investigate the views and experiences of people who use codeine in order to describe the 'risk environment' capable of producing and reducing harm.
designThis was a qualitative interview study. Psychological dependence on codeine was measured using the Severity of Dependence Scale. A cut-off score of 5 or higher indicates probable codeine dependence.
settingParticipants were recruited from an online survey and one residential rehabilitation service.
participants16 adults (13 women and 3 men) from the UK who had used codeine in the last 12 months other than as directed or as indicated. All participants began using codeine to treat physical pain. Mean age was 32.7 years (SD=10.1) and mean period of codeine use was 9.1 years (SD=7.6).
resultsParticipants' experiences indicated that they became dependent on codeine as a result of various environmental factors present in a risk environment. Supporting environments to reduce risk included: medicine review of repeat prescribing of codeine, well-managed dose tapering to reduce codeine consumption, support from social structures in form of friends and online and access to addiction treatment. Environments capable of producing harm included: unsupervised and long-term codeine prescribing, poor access to non-pharmacological pain treatments, barriers to provision of risk education of codeine related harm and breakdown in structures to reduce the use of over the counter codeine other than as indicated.
conclusionThe study identified microenvironments and macroenvironments capable of producing dependence on codeine, including repeat prescribing and unsupervised use over a longer time period. The economic environment was important in its influence on the available resources for holistic pain therapy in primary care in order to offer alternative treatments to codeine. Overall, the goal is to create an environment that reduces risk of harm by promoting safe use of codeine for treatment of pain, while providing effective care for those developing withdrawal and dependence.
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Registered trials
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