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“Doctor shopping and pharmacy hopping”: practice innovations relating to codeine

Marie Claire Van Hout (Coordinator, based at School of Health Sciences, Waterford Institute of Technology, Waterford, Ireland)

Drugs and Alcohol Today

ISSN: 1745-9265

Article publication date: 25 November 2014




The misuse of pharmaceutical opioid analgesics is identified as a global public health concern. Codeine represents an interesting quandary in terms of its regulated status, with individuals varying in their metabolism of codeine, estimation of safe dosages, risk of adverse health consequences and abuse potential. Efforts to quantify and address hidden non-compliant medical codeine use, overuse and intentional misuse is compromised by availability to the public in prescribed and over the counter forms. The paper aims to discuss these issues.


A review of literature on codeine use, misuse and dependence, and associated innovative medical and pharmacy interventions is presented, and was conducted as part of a larger scoping review on codeine.


The review highlights the complexities associated with monitoring public health awareness of codeine's abuse potential, and customer/patients trends in non-compliant codeine use for therapeutic and recreational purposes. Aberrant codeine behaviours centre on visiting multiple doctors for prescriptions, repeated lost or stolen prescriptions, forging prescriptions and use of multiple pharmacies. Innovations to monitor misuse of codeine include national prescription databases and recent developments in real-time monitoring of dispensing activity.

Practical implications

Further development of real-time monitoring processes with process evaluation is advised.


This viewpoint is intended to demonstrate how efforts to quantify and address codeine use are compromised by its availability. It intends to encourage further policy and practitioner dialogue on how to monitor, support and intervene with consumers misusing codeine.



The research leading to these results has received funding from the European Community's Seventh Framework Programme FP7/2007-2013 under grant agreement no. 611736.


Claire Van Hout, M. (2014), "“Doctor shopping and pharmacy hopping”: practice innovations relating to codeine", Drugs and Alcohol Today, Vol. 14 No. 4, pp. 219-234.



Emerald Group Publishing Limited

Copyright © 2014, Emerald Group Publishing Limited

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