Kinnaird Emma, Kimergård Andreas, Jennings Stacey, Drummond Colin, Deluca Paolo
Department of Eating Disorders, Psychological Medicine, King's College London, London, UK.
Addictions Department, King's College London, London, UK.
BMJ Open. 2019 Apr 3;9(4):e025331. doi: 10.1136/bmjopen-2018-025331.
To investigate the views and experiences of people who use codeine in order to describe the 'risk environment' capable of producing and reducing harm.
This was a qualitative interview study. Psychological dependence on codeine was measured using the Severity of Dependence Scale. A cut-off score of 5 or higher indicates probable codeine dependence.
Participants were recruited from an online survey and one residential rehabilitation service.
16 adults (13 women and 3 men) from the UK who had used codeine in the last 12 months other than as directed or as indicated. All participants began using codeine to treat physical pain. Mean age was 32.7 years (SD=10.1) and mean period of codeine use was 9.1 years (SD=7.6).
Participants' experiences indicated that they became dependent on codeine as a result of various environmental factors present in a risk environment. Supporting environments to reduce risk included: medicine review of repeat prescribing of codeine, well-managed dose tapering to reduce codeine consumption, support from social structures in form of friends and online and access to addiction treatment. Environments capable of producing harm included: unsupervised and long-term codeine prescribing, poor access to non-pharmacological pain treatments, barriers to provision of risk education of codeine related harm and breakdown in structures to reduce the use of over the counter codeine other than as indicated.
The study identified microenvironments and macroenvironments capable of producing dependence on codeine, including repeat prescribing and unsupervised use over a longer time period. The economic environment was important in its influence on the available resources for holistic pain therapy in primary care in order to offer alternative treatments to codeine. Overall, the goal is to create an environment that reduces risk of harm by promoting safe use of codeine for treatment of pain, while providing effective care for those developing withdrawal and dependence.
调查使用可待因者的观点和经历，以描述能够产生伤害和降低伤害的“风险环境”。
这是一项定性访谈研究。使用依赖严重程度量表来衡量对可待因的心理依赖。临界值为5或更高表明可能存在可待因依赖。
参与者从一项在线调查和一家住院康复服务机构招募。
16名来自英国的成年人（13名女性和3名男性），他们在过去12个月内曾非按指示或说明使用过可待因。所有参与者开始使用可待因是为了治疗身体疼痛。平均年龄为32.7岁（标准差=10.1），可待因使用的平均时长为9.1年（标准差=7.6）。
参与者的经历表明，他们因风险环境中存在的各种环境因素而对可待因产生了依赖。降低风险的支持性环境包括：对可待因重复开药进行药物审查、妥善管理剂量递减以减少可待因消费、朋友和网络等社会结构的支持以及获得成瘾治疗。能够产生伤害的环境包括：无监督和长期的可待因开药、难以获得非药物性疼痛治疗、提供可待因相关伤害风险教育的障碍以及减少非按指示使用非处方可待因的结构崩溃。
该研究确定了能够导致对可待因产生依赖的微观环境和宏观环境，包括重复开药和较长时间的无监督使用。经济环境对初级保健中整体疼痛治疗的可用资源有重要影响，以便提供可待因的替代治疗方法。总体而言，目标是营造一个通过促进安全使用可待因治疗疼痛来降低伤害风险的环境，同时为出现戒断和依赖的人提供有效护理。
