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We Need to Talk About Codeine: an Implementation Study to reduce the number of Emergency Department patients discharged on high-strength co-codamol using the Behaviour Change Wheel
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  • Published on:
    Maybe codeine's pharmacokinetics are an issue too
    • Paul Tanto, Adult EM & PEM consultant London North West University Healthcare NHS Trust

    A well timed project with the contemporary interest in the subject of drug misuse in Scottish politics, and also with the recent airing of Dopesick on streaming services about the US experience.

    I wonder whether the known CYP2D6 polymorphism leading to poor metabolism of codeine has a role in the increase of opioid prescriptions? Mikus and Weiss (2005) state that 5-10% of Caucasian have severely impaired metabolism of codeine and that a further 10-15% show some impairment. This means up to 1 in 4 Caucasians don't get a full analgesic effect from codeine.

    Maybe we are seeing a lessening of patients putting up with their lot of suboptimal pain control? And in turn an increase in prescriptions to accommodate that demand.

    Dihydrocodeine by contrast doesn't have the same issues with metabolism and ineffective analgesia. While acknowledging the past issues when DF118s were misused, perhaps prescribing dihydrocodeine instead of codeine we'll see better analgesia in our patients and perhaps a reduction in demand for prescriptions?

    Mikus G and Weiss J. (2005) 'Influence of CYP2D6 Genetics on Opioid Kinetics, Metabolism and Response', Current Pharmacogenomics, 3, pp43-52

    Conflict of Interest:
    None declared.