Explain codeine dependence and OAT to a sceptical patient — CASC communication station

Open. Name role/time; ask her main concerns (liver, job, stigma). Reflect emotion: fear of the addict label is common when medicines start in a pharmacy (Cooper).[1]

Explain dependence. Daily codeine can produce tolerance and withdrawal; needing more tablets and failed cut-downs is the medical syndrome clinicians call opioid dependence — it is about control and harm, not moral failure or injecting.[2]

Combination risk. The paracetamol (or ibuprofen in other brands) can damage organs even when the person “only” wants the codeine effect; her LFT signal is a reason to change course, not a punishment.[5]

Policy context (if asked). Australia made codeine prescription-only in 2018 because population harms were recognised; that policy reduced some community harms but people already dependent still deserve treatment.[4]

Options. (1) Structured supported taper with addiction follow-up if appropriate; (2) buprenorphine or methadone programmes — medicines that reduce craving and withdrawal and are used for dependence on pharmaceutical opioids as well as heroin (Cochrane frame in clinician language: “research supports these treatments for people dependent on strong pain/codeine medicines, not only street heroin”). Address methadone stigma honestly; offer buprenorphine if preferred and suitable. Provide take-home naloxone teaching.[3]

Boundaries. One prescriber, one pharmacy, monitoring for safety — framed as protecting her licence to work and her liver, not as police work.[2]

Close. Summarise agreed next step (clinic appointment, bloods, naloxone kit), written info, crisis contacts; teach-back of one key safety message.[1][3]