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Over-The-Counter Codeine: Can Community Pharmacy Staff Nudge Customers into Its Safe and Appropriate Use?

Mody, Sapana; Kirkdale, Charlotte L.; Thornley, Tracey; Dickinson, Aimi; Avery, Anthony J.; Knaggs, Roger; Rann, Sarah; Bastable, Ruth


Sapana Mody

Charlotte L. Kirkdale

Tracey Thornley

Aimi Dickinson

Sarah Rann

Ruth Bastable


The misuse of opioids, including codeine which is sold over-the-counter (OTC) in United Kingdom (UK) community pharmacies, is a growing public health concern. An educational Patient Safety Card was developed and piloted to see if it nudged customers into the safe and appropriate use of OTC codeine. Exploratory analysis was conducted by (i) recording quantitative interactions for people requesting OTC codeine in community pharmacies; and (ii) a web-based pharmacy staff survey. Twenty-four pharmacies submitted data on 3993 interactions using the Patient Safety Card. Staff found the majority of interactions (91.3%) to be very or quite easy. Following an interaction using the card, customers known to pharmacy staff as frequent purchasers of OTC codeine were more likely not to purchase a pain relief medicine compared to customers not known to staff (5.5% of known customers did not purchase any pain relief product versus 1.1% for unknown customers (χ2 = 41.73, df = 1, p [less than] 0.001)). These results support both the use of a visual educational intervention to encourage appropriate use of OTC codeine in community pharmacy and the principles behind better self-care.


Mody, S., Kirkdale, C. L., Thornley, T., Dickinson, A., Avery, A. J., Knaggs, R., …Bastable, R. (2020). Over-The-Counter Codeine: Can Community Pharmacy Staff Nudge Customers into Its Safe and Appropriate Use?. Pharmacy, 8(4), Article 185.

Journal Article Type Article
Acceptance Date Oct 5, 2020
Online Publication Date Oct 8, 2020
Publication Date Oct 8, 2020
Deposit Date Nov 6, 2020
Publicly Available Date Nov 12, 2020
Journal Pharmacy
Electronic ISSN 2226-4787
Publisher MDPI
Peer Reviewed Peer Reviewed
Volume 8
Issue 4
Article Number 185
Public URL
Publisher URL


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