A scoping review of interventions employed by community pharmacists to reduce or prevent misuse-related harm to consumers of over-the-counter codeine-containing products

Objectives:
The misuse of over-the-counter codeine-containing products is a worldwide public health issue. Community pharmacists have a key role in preventing or reducing harm. The objective of this scoping review is to identify, map, and summarise pharmacist interventions to reduce or prevent potential harm to consumers of over-the-counter codeine-containing analgesic products.
Methods:
Four databases (CINAHL, EMBASE, PsycINFO, and Medline) were searched from January 2014 to January 2025, following the Joanna Briggs Institute guidance for articles describing pharmacist interventions regarding the misuse of over-the-counter codeine-containing-products. Google Scholar and Scopus were searched for grey literature. Forward and backward citation searching was undertaken.
Key findings:
After applying inclusion and exclusion criteria, 36 articles were included. Pharmacist interventions include: screening and assessment of over-the-counter codeine-containing product misuse, employment of regulatory actions, patient-directed interventions, information sharing and collaboration, upskilling pharmacy staff, and challenges to providing interventions. Lack of formal screening and brief intervention tools, inconsistency in the employment of regulatory actions, and a lack of meaningful collaboration or formal referral pathways limit community pharmacists in their ability to identify and reduce harm to consumers.
Conclusions:
While codeine remains available to purchase, pharmacists hold responsibility for managing the risks posed by these products. Tools should be developed to support pharmacists with screening and assessment of codeine misuse and to aid their discussions with affected individuals. Inter-agency working between pharmacies, primary care, and specialist addictions services should be improved. Pharmacists require more access to addiction-specific training. Real-time monitoring systems to track and quantify codeine misuse within pharmacies should be developed, which would also aid research into the demographics of this population. Further research is required into the efficacy of up-scheduling codeine to a prescription-only medication in reducing codeine misuse