Misuse and dependence on non-prescription codeine analgesics or sedative H1 antihistamines by adults: a cross-sectional investigation in France

PLoS One. 2013 Oct 3;8(10):e76499. doi: 10.1371/journal.pone.0076499. eCollection 2013.

Abstract

Background: Given the growing worldwide market of non-prescription drugs, monitoring their misuse in the context of self-medication represents a particular challenge in Public Health. The aim of this study was to investigate the prevalence of misuse, abuse, and dependence on non-prescription psychoactive drugs.

Method: During one month, in randomly solicited community pharmacies, an anonymous questionnaire was offered to adults requesting paracetamol (control group), codeine combined with paracetamol in analgesics, or sedative H1 antihistamines. Responses about misuse (drug use not in agreement with the Patient Information Leaflet) abuse (excessive drug use having detrimental consequences), and dependence (established according to questions adapted from the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria) on psychoactive drugs were compared to those of the paracetamol control group.

Results: 295 patients (mean age 48.5 years, 68.5% of women) having used one of the studied drugs during the previous month were included. Misuse and dependence to codeine analgesics concerned 6.8% and 17.8% of the patients exposed to these drugs, respectively, (n = 118), which was significantly higher than for paracetamol. 19.5% had used codeine analgesics daily for more than six months. Headache was the most frequent reason for persistent daily use. A high prevalence of persistent daily users of sedative H1 antihistamines was also observed. Whereas these drugs are recommended only for short treatment courses of occasional insomnia, 72.2% of the participants having taken doxylamine (n = 36) were daily users, predominantly for more than six months.

Conclusions: Results on misuse and dependence on non-prescription codeine analgesics suggest that chronic pain, in particular chronic cephalalgia, requires better medical care. In addition, as for hypnotics on prescription, persistent use of doxylamine for self-medication is not justified until an acceptable benefit-risk ratio for chronic sleep disturbance is shown by clinical data.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetaminophen / administration & dosage
  • Adult
  • Aged
  • Analgesics, Opioid / administration & dosage*
  • Codeine / administration & dosage*
  • Cross-Sectional Studies
  • Female
  • France / epidemiology
  • Histamine H1 Antagonists / administration & dosage*
  • Humans
  • Male
  • Middle Aged
  • Nonprescription Drugs / administration & dosage*
  • Prevalence
  • Self Medication
  • Substance-Related Disorders / epidemiology*
  • Surveys and Questionnaires

Substances

  • Analgesics, Opioid
  • Histamine H1 Antagonists
  • Nonprescription Drugs
  • Acetaminophen
  • Codeine

Grants and funding

This work was supported by the Mission Interministérielle de la Lutte contre les Drogues et Toxicomanies (MILDT) (http://www.drogues.gouv.fr/) in relationship with the French Health Products Safety Agency (Afssaps)which has been renamed the Agence Nationale de Sécurité des Médicaments et Produits de Santé (ANSM) (http://www.ansm.sante.fr/Activites/Appels-a-projets-de-recherche). The reference grant number was: 0802707. The Scientific Commission of Afssaps has had a role in the study design by recommending to randomly select community pharmacies instead to use national sentinel network of pharmacies. Afssaps gave its agreement to publish results. However the funders did not have any role in data collection and analysis as well as preparation of the manuscript.