Over-the-Counter Medications and Their Misuse: A Focus on Codeine

Abstract

Codeine is a low-strength opioid that accounts for the majority of global consumption of narcotics for medical reasons. Codeine is generally used to treat mild to moderate pain conditions. The International Narcotics Board does not require low-dose codeine to be monitored and reported, so estimating the rate of its use and misuse globally is difficult. Types of codeine misuse can vary, and include therapeutic dependence, nonmedical or recreational use, and high dose dependence. Misuse can often develop when people self-manage an acute injury and increase their dosage over time. Codeine misuse has been found to occur as a way of self-treating mental health conditions such as depression, anxiety, psychosis, and obsessive-compulsive behaviors. The physical impacts of codeine misuse range from immediate side effects such as constipation and drowsiness to longer-term side effects such as gastrointestinal ulcers and hemorrhage. Prevention of codeine misuse should focus on multiple targets: improved chronic pain treatment and prescribing practices, identifying risk factors for misuse, addressing psychosocial responses to prevention, and increased research that specifically addresses codeine misuse prevention efforts.