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Codeine, a weak opiate, requires increased pharmacovigilance relating to availability, heterogeneous nature of misuse, dependence and associated harm. A scoping review of literature on codeine was conducted using Arksey & O’Malley’s framework (1). Databases searched included PubMed, EBSCO Host, Science Direct, EMBASE, PsycINFO, Cochrane library and Medline from 1994 to 2014. Follow-up search strategies involved hand searching and searching of pharmaceutical, health, medical and drug related websites. Initial zscreening identified 3,105 articles with 475 meeting the inclusion criteria. Eight broad categories organised the literature, data charting and qualitative synthesis. This paper presents implications for practice and makes recommendations to address these issues. Themes identified relate to raising public and practitioner awareness, risk management, dispensing practices and monitoring and surveillance of codeine. Evidence to inform law enforcement, drug surveillance, public health initiatives, harm reduction approaches, pharmacy, clinical and treatment practices is warranted.

Aims: There is limited literature on the challenges encountered during household surveys on alcohol consumption in low- and middle-income countries. This paper aims to describe the problems encountered during data collection for the IAC study in South Africa and put forward recommendations for addressing identified challenges.Methods: Data on methodological and other challenges emerged from feedback sessions held with fieldworkers, supervisors, observations made of and follow up meetings with project investigators, based on the pilot and main study of 2844 adults and adolescents in Tshwane (South Africa).Results: Challenges identified included the following: delays in software development which resulted in postponement of data collection with subsequent budgetary implications; difficulties in identifying the full range of alcohol beverages during the adaptation of the questionnaire as manufacturers sometimes changed quantities and packaging to enhance sales; a resultant lengthy questionnaire which negatively impacted on participation; potential participants sometime being afraid to allow fieldworkers onto premises due to high crime rates in many participating areas and religious beliefs concerning alcohol consumption that prevented some parents from consenting to their adolescent children’s participation.Conclusion: When planning community surveys on alcohol use, it is important to anticipate and prepare for these and other challenging conditions that arise in the preparation for, and execution of fieldwork. [ABSTRACT FROM PUBLISHER]

Background: Misuse of codeine-containing medicines is an emerging public health issue. Aims: We present the application of Liese and Franz's (1996) cognitive developmental model of substance abuse to the trajectory from legitimate codeine use for pain, towards that of therapeutic and other forms of misuse, and physical and psychological dependence. It illustrates a cognitive behavioural analysis of the experiences of codeine misusers - which 'surfaces' the specific beliefs, thoughts, emotions and behaviours of this group of hidden codeine dependent individuals, who are distinct and unique from other opioid-dependent cohorts. Method: In-depth one-to-one interviews with codeine misusers and dependent individuals in Ireland (n = 21) and South Africa (n = 25) are analysed and applied to Liese and Franz's (1996) cognitive developmental model of substance abuse. Results: Misuse and dependence pathways are maintained by the interplay between physiological determinants relating to pain, withdrawal and tolerance, and psychological influences such as therapeutic need, pre-empting of anticipated physical pain, pleasure from the dreamy sedative opiate effect of codeine and relief of emotional distress. Progression towards habitual use and misuse for therapeutic and intoxication purposes appears to be mediated by external environmental triggers pertaining to availability, internal meta-cognitions around physical pain and emotional distress, and increasing importance of codeine in the life of the user. Conclusion: The concept mapping of codeine misuse and dependence presented here could provide psychological therapists working with individuals experiencing problems with codeine, misusing codeine and those with iatrogenic dependence, with an enhanced understanding of the key concepts involved in misuse and recovery pathways. [ABSTRACT FROM AUTHOR]

Misuse of codeine-containing medicines is an emerging global public health concern. The majority of research has been conducted in developed countries (European Members States, Australia, the United States). This study aimed to gain an understanding of unique individual and collective experiences of trajectories of codeine misuse and dependence in South Africa. In-depth interviews were conducted with a purposive sample of adult codeine misusers and dependents (n = 25). Narratives were analyzed using the empirical phenomenological psychological five-step method. Nine themes with 63 categories emerged, with two additional high levels of abstraction. Findings are illustrated: participant profile and product preferences, motives for use, transitioning to misuse and dependence, pharmacy purchasing and alternative sourcing routes, effects and withdrawal experiences, help-seeking and treatment experiences, and strategies for prevention. The study underscores the need for continued support for enhanced patient awareness of risk of habit forming use and related health consequences and professional pharmacovigilance. [ABSTRACT FROM AUTHOR]

Hazardous alcohol consumption may compromise optimal antiretroviral therapy (ART) adherence among patients. Adoption of hegemonic notions of masculinity may encourage health-risk behaviours, such as alcohol consumption, and discourage health-enhancing behaviours, such as ART adherence among men. This study aimed to explore linkages between masculinity, alcohol consumption, and taking ART medication among male ART recipients in South Africa. Male facilitators conducted five focus group discussions with 27 black male ART recipients aged between 28 and 65 years at five ART clinics. Eligibility criteria were: 18 years or older, at least three months on ART, and alcohol consumption in the past three months. Data were analysed inductively using thematic content analysis. The men demonstrated a masculinity that fostered commitment to taking ART. However, normative notions of masculinity in the men’s social circles often compromised their timeous taking of medication. Fears of alcohol-ART interactions often led to intentional non-adherence to ART when drinking. Finally, healthcare provider-patient power dynamics seemed to prevent the men from discussing their challenges regarding alcohol use and ART adherence with their healthcare providers. Interventions that focus on addressing harmful hegemonic notions of masculinity among men are needed in community settings such as drinking establishments where men tend to socialise. Patient-centred approaches which enhance men’s sense of involvement in their treatment are needed in healthcare settings. [ABSTRACT FROM PUBLISHER]

Group psychotherapy remains an under-utilised treatment modality in South Africa. Similarly, there is paucity of local research on sexual orientation and psychological well-being. This article attempts to make sense of the potential contribution of therapy groups not only to the lesbian, gay, bisexual, and transgender (LGBT) sector, but also to South African society more generally. Informed by a longitudinal study conducted between 1995 and 2003, this article evaluates whether a Gauteng-based therapy group that has been in existence since 1995 indeed meets the needs of its predominantly gay male members, has an impact on their well-being, and can be considered effective in empowering members to deal with various issues in their lives. The study employed a triangulation approach and combined both quantitative and qualitative methodologies. Results indicate that the therapy group, hosted under the auspices of the non-profit organisation, OUT LGBT Well-being, received high positive ratings from a purposive sample of 40 members who previously participated in the group. This study confirmed earlier findings that indicated that, due to marginalisation and the threat of discrimination, many gay individuals are prone to experiencing perceived rejection by society, self-devaluation, identity confusion, hiddenness and isolation, excessive self-reliance, lack of trust, control issues, and difficulties in familial interactions. Positive changes reported by participants as a result of their therapy group experience include increased self-acceptance and self-confidence, a heightened sense of identity, increased tolerance in relation to others, increased honesty including disclosure of sexual orientation, and social integration. [ABSTRACT FROM AUTHOR]

Background: Misuse of codeine available on prescription and over-the-counter (OTC) has been highlighted as a potential problem in South Africa., Objective: To examine the perceptions of medical professionals regarding codeine use (prescribed and OTC), misuse, dependence and treatment options in South Africa., Method: Data for the study were obtained using a sample of medical professionals obtained through random and convenience sampling. A quantitative methodology was employed using a structured self-administered questionnaire with closed and open-ended items. Data analysis was conducted using SPSS version 21; 238 medical professionals involved in the prescribing of codeine completed the questionnaire., Results: Two-thirds of participants stated that they routinely reviewed patients prescribed codeine, and high levels of concern were expressed about the availability of OTC medicine containing codeine in pharmacies (84.9%) and on the internet (71.3%). There was agreement that medicines containing codeine should be regulated to a prescription-only medicine (85.3%). Only 22% of participants agreed that they had suitable screening methods to help with detection of codeine dependence. Eighty per cent indicated that they would welcome the opportunity for greater instruction on prescribing potentially addictive medicines., Conclusion: There appears to be a need to improve education on consumption and risks associated with codeine use. In addition, screening tools are needed to detect those with codeine dependence. Greater data sources are now needed to examine the sale of and consumption of codeine medicines in the interest of public health., Competing Interests: The authors declare that they have no financial or personal relationships which may have inappropriately influenced them in writing this article.

Background: General practitioners are referring patients with codeine-related problems to specialist treatment facilities, but little is known about the addiction treatment providers, the kinds of treatment they provide, and whether training or other interventions are needed to strengthen this sector., Objectives: To investigate the perspectives of addiction treatment providers regarding treatment for codeine misuse or dependence., Method: Twenty addiction treatment providers linked to the South African Community Epidemiology Network on Drug Use and the South African Addiction Medicine Society were contacted telephonically and asked 20 questions., Results: While many participants had received training in pharmacological management of individuals with opioid dependence, only two had received specific training on codeine management. Between half and two-thirds of the treatment settings they worked in provided detoxification, pharmacotherapy, psychosocial treatment and aftercare. Very few treatment settings offered long-term treatment for codeine misuse and dependence. Participants indicated that over half of their codeine patients entered treatment for intentional misuse for intoxication, and dependence resulting from excessive or long-term use. The main barriers to patients entering treatment were seen as denial of having a problem, not being ready for change, mental health problems, stigma, and affordability of treatment. Participants identified a need for further training in how to manage withdrawal and detoxification, treatment modalities including motivational interviewing, and relapse prevention., Conclusions: Gaps in training among treatment providers need to centre on how to manage withdrawal from codeine use and detoxification, motivational interviewing and relapse prevention. Interventions are needed to address barriers to entering treatment, including user denial.

Objectives: To explore prescribing practitioners' perspectives on prescribed codeine use, their ability to identify dependence and their options for treatment in the UK., Design: Cross-sectional design using a questionnaire containing closed-ended and open-ended items., Setting: A nationally representative sample of prescribing professionals working in the UK., Participants: 300 prescribing professionals working in primary care and pain settings., Results: Participants stated that they regularly reviewed patients prescribed codeine, understood the risks of dependence and recognised the potential for codeine to be used recreationally. Over half the participants felt patients were unaware of the adverse health consequences of high doses of combination codeine medicines. One-quarter of participants experienced patient resentment when asking about medicines containing codeine. Just under 40% of participants agreed that it was difficult to identify problematic use of codeine without being informed by the patient and did not feel confident in identification of codeine dependence. Less than 45% of all participants agreed that codeine dependence could be managed effectively in general practice. Slow or gradual withdrawal was the most popular suggested treatment in managing dependence. Education and counselling was also emphasised in managing codeine-dependent patients in primary care., Conclusions: Communication with patients should involve assessment of patient understanding of their medication, including the risk of dependence. There is a need to develop extra supports for professionals including patient screening tools for identifying codeine dependence. The support structure for managing codeine-dependent patients in primary care requires further examination., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)