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'For pain, no shame' and 'My secret solace': Accounts of over-the-counter codeine dependence using Q methodology


Kirschbaum, M and Barnett, T and Cross, M, 'For pain, no shame' and 'My secret solace': Accounts of over-the-counter codeine dependence using Q methodology, International Journal of Drug Policy, 73 pp. 121-128. ISSN 0955-3959 (2019) [Refereed Article]

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DOI: doi:10.1016/j.drugpo.2019.10.002


Background: Dependence on over-the-counter (OTC) codeine is recognised internationally as a rising public health issue. The effectiveness of health intervention strategies may be influenced by the beliefs held by those who are dependent. Applying Q methodology, this study aimed to identify shared accounts of OTC codeine dependence.

Methods: Twenty-six participants from Tasmania, Australia, met eligibility criteria for the study as long-term OTC codeine users with a Severity of Dependence Score of five or higher. Forty-six opinion statements about OTC codeine dependence were sourced from the literature and online discussion forums. These were rank-ordered by participants from least to most agree and explanatory comments for the most strongly positioned statements were provided. By-person factor analysis was used to group participants who had sorted the statements similarly.

Results: Two distinct accounts of OTC codeine dependence were identified. Participants representing Factor One, 'For pain, no shame', were not ashamed of their OTC codeine use, believed access should not be restricted and regarded it as necessary for the relief of physical pain. In contrast, Factor Two, 'My secret solace', was characterized by feelings of guilt and shame. Participants in this group intentionally used codeine for its effects on mood; to help them relax and to relieve stress, rather than solely for pain relief. They did not consider regular use of codeine to be socially acceptable and hid their use from others.

Conclusion: The way in which OTC codeine use is viewed by those who are dependent is not uniform. Two distinct accounts were identified in this sample. Participants from each group varied in their beliefs about access, causality, reasons for use and feelings of legitimacy and shame. An understanding of these differences can be used to better target interventions and guide policy for the prevention and management of OTC codeine dependence.

Item Details

Item Type:Refereed Article
Keywords:codeine, over-the-counter, drug dependence, substance abuse, Q methodology, attitudes
Research Division:Biomedical and Clinical Sciences
Research Group:Pharmacology and pharmaceutical sciences
Research Field:Clinical pharmacology and therapeutics
Objective Division:Health
Objective Group:Public health (excl. specific population health)
Objective Field:Substance abuse
UTAS Author:Kirschbaum, M (Mrs Melissa Kirschbaum)
UTAS Author:Barnett, T (Associate Professor Tony Barnett)
UTAS Author:Cross, M (Dr Merylin Cross)
ID Code:151845
Year Published:2019
Web of Science® Times Cited:3
Deposited By:UTAS Centre for Rural Health
Deposited On:2022-08-05
Last Modified:2022-08-05

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