The study, conducted during the last quarter of 2021, surveyed pharmacists across community settings in Croatia to gain insights into their encounters with patients who regularly obtain high quantities of OTC codeine-containing medicines. Pharmacists are uniquely positioned as healthcare professionals who not only dispense these potentially addictive drugs but also engage with patients about their usage patterns. This dual role renders them vital contributors to early detection and intervention efforts, yet until now, comprehensive data regarding their experiences and perspectives on codeine misuse have been scarce.

Out of approximately 2,800 active community pharmacists registered with the Croatian Chamber of Pharmacists, 594 responded to the online survey, representing a 21% response rate. A remarkable 92% of these participants reported recognizing patients who habitually purchase large amounts of OTC codeine products, often triggering suspicion of addiction. This high prevalence underlines both the widespread availability of such medications and the potential scale of codeine-related misuse within the country. Pharmacists’ encounters with these at-risk patients offer a critical window into the misuse trends that may otherwise remain obscured from broader healthcare surveillance.

Despite their frontline position, however, the survey revealed significant gaps in pharmacists’ engagement with formal remedial actions. While many pharmacists admitted to occasionally discussing the risks of codeine dependency with patients, proactive communication appeared to be somewhat limited. Even more strikingly, two-thirds of pharmacists refrained from reporting suspected adverse reactions associated with codeine use to Croatia’s national pharmacovigilance system. This reluctance has considerable implications for public health monitoring, as underreporting restricts the ability of authorities to detect patterns of misuse, addiction, and related complications on a population level.

The pharmacists surveyed also voiced substantial support for regulatory reforms. Over half endorsed the idea that codeine-containing medicines should be transitioned from OTC availability to prescription-only status. Such a policy change would align Croatia with many other EU countries that have enacted stricter controls on codeine sales to curb misuse and its dangerous consequences. The pharmacists’ strong advocacy for this shift underscores their recognition of the risks inherent in unfettered access to codeine and reflects the perceived need for systemic interventions beyond individual pharmacist efforts.

The growing concern over OTC codeine misuse in Croatia echoes global patterns where opioid-containing preparations, even at low doses, have demonstrated dependency potential. Codeine’s psychoactive properties, metabolized into morphine within the body, provide temporary relief from pain and cough but can foster tolerance and addiction when misused. The availability of such compounds without prescription oversight raises ethical and practical questions about balancing easy access for legitimate therapeutic use against the risks of abuse.

Pharmacists’ pivotal role in harm reduction is further complicated by insufficient national guidelines and educational resources focused on identifying and managing codeine misuse. The study’s findings highlight an urgent need to equip pharmacists with more precise protocols, training, and support systems. Enhanced education would empower pharmacists to confidently initiate conversations about addiction risks, recognize warning signs earlier, and engage in effective intervention strategies, thereby improving patient outcomes and public health.

Croatia’s current pharmacovigilance reporting mechanisms appear underutilized, as the majority of pharmacists hesitate to report suspected adverse events linked to OTC codeine use. Addressing the barriers to reporting—whether due to a lack of awareness, perceived complexity, or time constraints—could strengthen surveillance of codeine-related harms. Streamlining these systems and raising awareness about their importance might encourage pharmacists to contribute more actively to national safety databases.

In addition to pharmacovigilance enhancements, multidisciplinary collaboration between healthcare professionals, policymakers, and patient advocacy groups will be essential to developing comprehensive approaches to OTC codeine misuse. Pharmacists, by virtue of their direct interface with patients and medication dispensing responsibilities, are essential stakeholders in these efforts. Their insights and frontline experiences can guide the design of pragmatic policies that balance access and safety.

Moreover, the Croatian study underscores a broader implication: reliance on pharmacists as informal monitors alone is insufficient to stem the tide of codeine misuse. Structural reforms, including rescheduling codeine products to require prescriptions, must be considered seriously. Such control has been shown in other jurisdictions to reduce availability for misuse while preserving access for patients with legitimate medical needs.

This evolving landscape places pharmacists at a crossroads, requiring a balance between patient advocacy, regulatory compliance, and public health responsibilities. Empowering pharmacists with tools, clearer guidelines, and legislative support is paramount to turning their frequent encounters with potentially addicted patients into opportunities for early intervention and harm reduction.

Ultimately, this comprehensive examination of Croatian pharmacists’ experiences with OTC codeine abuse provides a compelling call to action. It exposes critical gaps in the current system and offers a roadmap for enhancing pharmacists’ roles through education, reporting, and regulatory change. The study not only contributes valuable data to the global conversation on codeine misuse but also exemplifies the need for multifaceted, evidence-driven strategies in addressing over-the-counter opioid addiction risks.

As codeine misuse continues to present challenges worldwide, the Croatian case emphasizes that pharmacy professionals must be recognized and integrated as key actors in addiction prevention frameworks. Their firsthand observations and patient interactions provide invaluable intelligence that, if leveraged strategically, can inform policies and practices designed to safeguard public health without unduly restricting access to essential medicines.

The findings present an urgent opportunity to reevaluate OTC codeine management policies, enhance pharmacist education programs, improve adverse event reporting systems, and ultimately implement regulatory reforms that reduce misuse while supporting responsible patient care. Addressing these issues now will be crucial in preventing the escalation of codeine dependence and its associated health, social, and economic burdens in Croatia and beyond.

Subject of Research: Pharmacists’ experiences with suspected addiction to over-the-counter codeine-containing medications and their attitudes towards remediation strategies in Croatia.

Article Title: Pharmacists’ experience with patients suspected to be addicted to over-the-counter codeine and their attitudes towards potential remediation strategies: a cross-sectional study.

Article References:
Margan Koletić, Ž., Pavličić, B., Ključević, Ž. et al. Pharmacists’ experience with patients suspected to be addicted to over-the-counter codeine and their attitudes towards potential remediation strategies: a cross-sectional study. BMC Psychiatry 25, 442 (2025). https://doi.org/10.1186/s12888-025-06881-6

Image Credits: AI Generated

DOI: https://doi.org/10.1186/s12888-025-06881-6

Assertive self-expression is vital for pharmacists, as it enables them to communicate effectively with physicians and other healthcare professionals. Studies suggest that pharmacists who utilize assertive communication are significantly more likely to engage in discussions with doctors about medication therapies. This proactive approach can facilitate better patient outcomes, as pharmacological interventions often hinge upon the collaborative input from various healthcare providers. Thus, understanding the factors that contribute to assertive communication among community pharmacists is essential for enhancing the quality of pharmacological care.

To better understand these dynamics, a cross-sectional study was conducted in Japan. A comprehensive questionnaire was distributed to 3,446 community pharmacists across ten prefectures. This substantial sample size aimed to identify the variables that enhance assertive self-expression within professional interactions. The survey was meticulously designed to gather insights on various factors, including participant demographics such as age, educational background, years of professional experience, employment status, and attendance at multidisciplinary training sessions.

The survey yielded responses from 961 participants, providing a wealth of data for analysis. Notably, a significant correlation was established between regular participation in local multiprofessional workshops and elevated levels of assertiveness among pharmacists. Those who actively engaged in these educational sessions demonstrated a greater capacity for self-expression, implying that ongoing professional development fosters an environment where assertive communication can flourish.

The findings suggest that pharmacists who attend local workshops and collaborative meetings are better equipped to express their viewpoints and offer suggestions for medication management to their medical colleagues. This trend holds true even after controlling for various demographic factors, highlighting the potential significance of structured professional interactions in nurturing assertive communication skills.

While the study establishes a clear relationship between participation in multidisciplinary training and assertive self-expression, it also acknowledges the necessity for further research to solidify the causal mechanisms at play. Understanding whether assertiveness stems from enhanced knowledge acquired in workshops or from the collaborative nature of these meetings could provide valuable insights for pharmacy education and practice.

Additionally, the implications of assertiveness extend beyond individual professional interactions; they can foster a more collaborative healthcare environment. When pharmacists communicate effectively with physicians, it encourages a culture of mutual respect and shared decision-making, ultimately leading to improved patient safety and therapeutic outcomes.

As healthcare continues evolving amid challenges such as rapid technological advancements and increasing complexity in patient care, the role of community pharmacists will only grow more critical. Empowering them with assertive communication skills is not merely beneficial; it is essential for the future of collaborative healthcare.

This research underscores the importance of ongoing education and professional development for pharmacists. As the study illustrated, active participation in local workshops can be a powerful catalyst for developing soft skills that are crucial in an increasingly team-based healthcare landscape. Educators and policymakers should prioritize creating more opportunities for pharmacists to engage in collaborative training sessions.

Moreover, healthcare organizations must recognize the role pharmacists play in the therapeutic team. By supporting pharmacists in their efforts to communicate assertively, healthcare systems can enhance multidisciplinary collaboration that is increasingly necessary to navigate complex medical landscapes.

The study also reinforces the idea that assertive communication is not just a personal asset for pharmacists; it is a professional necessity. Encouraging a culture of assertiveness can manifest in a myriad of ways, from influencing prescribing patterns to directly improving patient health literacy. Pharmacists equipped with assertive skills can serve as advocates for their patients, ensuring that their concerns and needs are adequately addressed within the healthcare system.

Ultimately, fostering assertiveness among community pharmacists contributes to a more holistic approach to healthcare delivery. As these professionals assert their roles, they help to demystify medication use for patients and ensure seamless communication among healthcare providers. This dynamic is essential not just for patient safety but also for the establishment of trust and transparency within patient-provider interactions.

In conclusion, the exploration of assertive self-expression among community pharmacists in Japan reveals important insights into the interplay between professional development and communication skills. As the study demonstrates, active participation in multidisciplinary workshops can significantly enhance assertiveness, fostering a culture of collaboration that benefits patients and healthcare providers alike.

Such research underscores the need for continued evaluation of the roles pharmacists play in healthcare, particularly regarding communication. It paves the way for future investigations aimed at unveiling the intricacies of professional interactions within the medical team, ultimately contributing to better health outcomes for individuals and communities.

The role of community pharmacists in the healthcare ecosystem cannot be understated. Their ability to communicate assertively and effectively is critical, not only for the quality of care they provide but also for their integration into the broader medical community. As studies continue to elucidate the factors influencing this vital skill, it is essential for all stakeholders in healthcare to recognize, support, and promote assertive communication among pharmacists.

Subject of Research: Assertiveness among community pharmacists in Japan
Article Title: Factors associated with assertiveness among Japanese community pharmacists: A cross-sectional study
News Publication Date: 23-Jan-2025
Web References: Institute of Medicine, DOI
References: Original study published in the Journal of Pharmaceutical Health Care and Sciences
Image Credits: Not applicable

Keywords: Assertiveness, communication, community pharmacists, healthcare professionals, multidisciplinary collaboration, patient safety, professional development, pharmaceutical care.