A study of medical professionals' perspectives on medicines containing codeine in South Africa

Background: Misuse of codeine available on prescription and over-the-counter (OTC) has been highlighted as a potential problem in South Africa. Objective: To examine the perceptions of medical professionals regarding codeine use (prescribed and OTC), misuse, dependence and treatment options in South Africa. Method: Data for the study were obtained using a sample of medical professionals obtained through random and convenience sampling. A quantitative methodology was employed using a structured self-administered questionnaire with closed and open-ended items. Data analysis was conducted using SPSS version 21; 238 medical professionals involved in the prescribing of codeine completed the questionnaire. Results: Two-thirds of participants stated that they routinely reviewed patients prescribed codeine, and high levels of concern were expressed about the availability of OTC medicine containing codeine in pharmacies (84.9%) and on the internet (71.3%). There was agreement that medicines containing codeine should be regulated to a prescription-only medicine (85.3%). Only 22% of participants agreed that they had suitable screening methods to help with detection of codeine dependence. Eighty per cent indicated that they would welcome the opportunity for greater instruction on prescribing potentially addictive medicines. Conclusion: There appears to be a need to improve education on consumption and risks associated with codeine use. In addition, screening tools are needed to detect those with codeine dependence. Greater data sources are now needed to examine the sale of and consumption of codeine medicines in the interest of public health

The Impact of Alcohol on HIV Prevention and Treatment for South Africans in Primary Healthcare

Background: Antiretroviral treatment (ART) has substantially reduced morbidity and mortality for HIV patients. In South Africa; with the largest ART programme globally; attention is needed not only on the further expansion of ART coverage; but also on factors which undermine its effectiveness; such as alcohol use. Objective: South African primary health sector; it is important to document key aspects of alcohol use to be conveyed to HIV-positive individuals and those at risk for HIV. Method: This study comprised a narrative review of relevant literature. Results: Alcohol acts through both behavioural and physiological pathways to impact on the acquisition; further transmission and then progression of HIV disease. Besides links to risky sex; alcohol undermines the immune system; raising susceptibility to contracting and then countering HIV and other infections. There are important drug interactions between alcohol and ART; or therapies for opportunistic infections and other co-morbidities. Moreover; alcohol undermines adherence to the medication which is essential for effective ART. Conclusion: Primary healthcare clinic attendees need evidence-based information on the detrimental effects of alcohol consumption on HIV infection; which ensue throughout the clinical course of HIV. This spans the role of alcohol consumption as a risk factor for HIV infection; HIV replication in infected individuals; a person's response to HIV infection and HIV treatment. Primary healthcare workers; especially nurses and HIV counsellors; require training in order to screen for and provide appropriate interventions for HIV-positive patients; those on treatment and treatment-naive patients; who will benefit from reduced alcohol consumption or the cessation thereof

Methamphetamine abuse; psychosis and your patient

Recent findings from the MRC-led South African Community Epidemiology Network on Drug Use (SACENDU) Project (which collects data on treatment episodes from substance abuse treatment centres) point to a significant and unprecedented increase in the proportion of clients reporting methamphetamine (MA) as their primary and/or secondary drug of abuse at these specialist substance abuse treatment centres in the Western Cape. For example; the proportion of clients reporting methamphetamine-related problems has increased from 5