Take a non-judgmental stance when assessing the patient’s condition and reasons for taking codeine – the patient’s behaviour is neither good nor bad.
Information that can support next steps may include:
- How has codeine been used, at what dose or frequency and over what period of time?
- Has the dose increased over time?
- Has codeine been used for conditions for which there is no indication?
- Are there symptoms if a dose is missed?
Dependency is a possible adverse effect of opioids (including codeine). Other possible adverse effects include sedation and constipation. Frame the conversation around balancing the potential benefits of codeine therapy (pain relief) with the harms (dependency, sedation, constipation, etc).1
Start with a broad scope and let the patient speak. Use open questions to find out attitudes toward medicines in general and codeine more specifically. Avoid “yes/no” style questions and give them the chance to explain their perception of their medicine use. Some examples are:
- What do your medicines mean to you?
- How do you feel these medicines help you?
- Are you worried about your codeine use?
- When you made the appointment, what were you hoping for?
Explore warning signs of codeine dependence – listen for conversation cues suggestive of dependence and expand on these further. Some examples are:
- Have you ever taken your pain medicines for other reasons?
- Have you ever taken them to help you sleep? When under stress? After a fight with a partner or loved one?
Drug misuse behaviours can include persistently complaining about the need for a drug, asking for specific drugs by name, requesting to have the dose increased, hoarding drugs, pharmacy shopping, unwillingness to consider other drugs and treatments.2,3
Patients with codeine dependence may not self-identify as ‘people who use drugs’. They may be socially advantaged with high achievements in education, adequate social supports and good incomes.3