Pharmacists' experience with patients suspected to be addicted to over-the-counter codeine and their attitudes towards potential remediation strategies: a cross-sectional study.

Background: Croatia is one of the European Union (EU) countries where low-dose codeine products (LDCP) can be purchased over the counter (OTC) directly from community pharmacists without a prescription. The misuse and dependence potential of OTC LDCP have raised growing public health concerns. As the first point of contact for patients seeking these medications, pharmacists play a critical role in identifying misuse and implementing harm-reduction strategies. However, little is known about the experiences and perspectives of pharmacists in Croatia regarding codeine addiction. This study aimed to examine the experience of pharmacists in Croatia with patients addicted to over-the-counter codeine and their attitudes toward potential remediation strategies.

Methods: A cross-sectional study was conducted between October 18, 2021, and December 23, 2021. Eligible participants were pharmacists, members of the Croatian Chamber of Pharmacists, employed in community pharmacies in Croatia. The data were collected via an online questionnaire that examined the attitudes and experiences of pharmacists in Croatia regarding OTC medicines containing codeine and the demographic characteristics of pharmacists.

Results: Out of 2800 active pharmacists in Croatia, 594 participated in the study (21% response rate). The majority (92%) saw patients who regularly purchased high quantities of OTC products containing codeine and for whom pharmacists suspected they could be addicted to this medicine. Most participants occasionally talked to patients about possible codeine abuse and addiction. Two-thirds of participants did not report suspected adverse reactions associated with OTC codeine use to the national pharmacovigilance system, despite patients indicating a potential link. More than half of the participants noted that codeine-containing medicines should be switched from OTC to prescription-only status.

Conclusions: This study showed that 92% of pharmacists in Croatia encountered patients who may be misusing or are dependent on OTC codeine products. However, they indicated limited engagement in formal reporting or intervention. The findings highlight the need for more precise guidelines, enhanced pharmacist education, and consideration of regulatory changes, such as reclassifying codeine-containing medicines to prescription-only status, to support pharmacists in mitigating risks associated with codeine misuse.