Codeine: metabolism and primary care use in Australia

Abstract

The overall aim of this thesis is to explore codeine’s mechanism of action and metabolism, its supply by Australian community pharmacists, and considerations for optimising its utilisation in the future. This thesis is divided into three main sections. The first (Chapter 2) reviews and discusses the scientific literature in respect of the metabolites and their contributions to the mechanism of action of codeine. The second (Chapter 3) explores the management of codeine by Australian pharmacists in primary care management of acute pain, and how this management changed after the announcement that codeine would be restricted to supply by prescription from a physician. The third (Chapter 4) provides a brief outline of some pros and cons of codeine as an option for primary care management of acute pain by pharmacists, published as an editorial. It should be noted that while JH is attributed authorship of the against, JH also composed much of the for, but due to the format of the article ceded authorship to academic supervisors (who also contributed) to avoid confusion upon publication. Finally (Chapter 5), the findings are discussed at the conclusion of this thesis, including some considerations for future research. Appended to this thesis are two conference presentations on research included in this thesis, and a brief discussion of recent legal developments affecting pharmaceutical manufacturers of opioids.