A total of 590 questionnaires was administered to the students, only 520 were completely filled, giving a response rate of 88.1%. Two hundred and sixty-three (50.6%) were male, 333 (64.0%) were aged 20 years and above, with a mean age of 20.7 ± 2.8 years. Most of the students 179 (34.4%) were in 3rd year, while the least 53 (10.2%) were in the first year. Medicine and surgery students were 335 (64.4%) and pharmacy students were 185 (35.6%). Codeine-containing cough syrup 163 (31.3%) was the most commonly used opioid containing products among the students, followed by Co-codamol 8 (1.5%) as shown in Table 1.
Table 2 shows the assessment of knowledge of the use of opioid-containing products among the respondents. About two-third (319, 61.3%) had poor knowledge. The perception of the respondents on the use of codeine-containing products, is shown in Table 3. Majority, 469 (90.2%) had good perception.
Relationship between the respondents’ year of study and perception to the use of codeine-containing products is shown in Table 4. The first year had the least perception with lower mean rank when compared with other year of study, (p < 0.05).
Association between relevant demographic characteristics of respondents’ knowledge and perception scores is shown in Table 5. Pharmacy students (87, 47%) had significantly better good knowledge about opioid usage when compared to their medical students’ counterpart (114, 34%), p= 0.004.
Table 6 shows the predictors of misuse/abuse of codeine-containing products among respondents. The odds of codeine abuse/misuse were 36.31[AOR=36.31, 95% CI: (10.89-121.12)] among those who experienced some side effects they would like to experience again. Respondents who were pressured into using codeine-containing product had about 12 times odds of misusing/abusing codeine 11.77[AOR=11.77, CI=95% (2.50-55.38)].
Table 1: Socio-demographic characteristics and profile of opioids-containing products used by respondents (n = 520)
Variable
|
Frequency (%)
|
Gender
|
|
Male
|
263 (50.6)
|
Female
|
257 (49.4)
|
Age (year)
|
|
16-20
|
187 (36.0)
|
≥20
|
333 (64.0)
|
Mean age ± Standard deviation
|
20.7 ± 2.8years
|
Level of study
|
|
100
|
53 (10.2)
|
200
|
137 (26.3)
|
300
|
179 (34.4)
|
500
|
151 (29.0)
|
Faculty
|
|
Medicine and surgery
|
185 (35.6)
|
Pharmacy
|
335 (64.4)
|
Profile of opioids-containing products
|
|
Diphenhydramine+dextromethorphan with codeine cough syrup (BenylinÒ)
|
91 (17.5)
|
Ammonium chloride+diphenyhydramine with codeine cough syrup (EmzolynÒ)
|
66 (12.7)
|
Paracetamol with codeine (Cocodamol Ò)
|
8 (1.5)
|
Dextromethorphan + diphenhydramine with codeine cough syrup (MyasedylÒ)
|
6 (1.1)
|
Hydrocodone
|
5 (0.9)
|
Oxycodone
|
2 (0.4)
|
Table 2: Knowledge on opioid-containing products among respondents (n = 520)
Knowledge question
|
Correct answer
n (%)
|
Wrong answer
n (%)
|
1.Category of people who can use opioid (Answer: adults and children)
|
242 (46.6)
|
278 (53.4)
|
2.Category of people who cannot use opioid.
(Answer: None of adults and children)
|
12 (2.3)
|
508 (96.7)
|
3.Can opioid use lead to dependence/addiction
(Answer: Yes)
|
472 (90.8)
|
48 (9.2)
|
4.Addiction is defined as a chronic relaxing brain disease that is characterized by compulsive drug seeking and use despite harmful consequences.
(Answer: Yes)
|
500 (96.2)
|
20 (3.8)
|
5.Drug dependence is a medical term that refers to the state of craving a certain drug in order to function normally.
(Answer: Yes)
|
479 (92.1)
|
41 (7.9)
|
Distribution of scores
|
Frequency (%)
|
|
0
|
3 (0.6)
|
|
1
|
7 (1.3)
|
|
2
|
35 (6.7)
|
|
3
|
274 (52.7)
|
|
4
|
199 (38.3)
|
|
5
|
2 (0.4)
|
|
Cut off score
|
Frequency (%)
|
Remark
|
< 4
|
319 (61.3)
|
Poor knowledge
|
³ 4
|
201 (38.7)
|
Good knowledge
|
*Maximum obtainable score = 5
Table 3: Respondents’ perception on the use of codeine-containing products (n = 520)
Variable
|
S A
|
A
|
U
|
D
|
S D
|
50th
percentile
|
|
n (%)
|
n (%)
|
n (%)
|
n (%)
|
n (%)
|
|
1.Codeine/codeine containing products can be abused
|
399 (76.7)
|
103 (19.8)
|
9 (1.7)
|
3 (0.6)
|
6 (1.2)
|
5
|
2.Codeine abuse/misuse can lead to dependency
|
397 (76.3)
|
115 (22.1)
|
7 (1.6)
|
0
|
1 (0.2)
|
5
|
3.Codeine abuse/misuse can affect psychological well-being
|
355 (68.3)
|
141 (27.1)
|
19 (3.7)
|
4 (0.8)
|
1 (0.2)
|
5
|
4.Codeine abuse/misuse can lead to neurological side effects
|
332 (63.8)
|
146 (28.1)
|
37 (7.1)
|
4 (0.8)
|
1(0.2)
|
5
|
5.Codeine abuse/misuse can lead to socially unacceptable behavior
|
336 (64.6)
|
147(28.3)
|
26 (5.0)
|
11 (2.1)
|
0
|
5
|
6.Codeine abuse/misuse can affect pattern of spending
|
278 (53.5)
|
161 (31.0)
|
66 (12.7)
|
13 (2.5)
|
2 (0.4)
|
5
|
7.Codeine abuse/misuse can result in accidental overdose
|
295 (56.7)
|
185 (35.6)
|
34 (6.5)
|
5 (1.0)
|
1(0.2)
|
5
|
8.Codeine abuse/misuse can result in life- threatening withdrawal symptoms
|
295 (56.7)
|
185 (35.6)
|
34 (6.5)
|
5 (1.0)
|
1(0.2)
|
5
|
9.Codeine abuse/misuse can cause reduced fertility in males and females
|
129 (24.8)
|
76 (14.6)
|
299 (57.5)
|
16 (3.1)
|
-
|
3
|
Distribution of scores (%) Frequency (%)
|
|
|
|
|
< 60
|
2 (0.4)
|
|
|
|
|
60-79
|
49 (9.4)
|
|
|
|
|
80-100
|
469 (90.2)
|
|
|
|
|
Cut-off
|
|
|
Remark
|
< 80%
|
51 (9.8)
|
|
Poor perception
|
³ 80%
|
469 (90.2)
|
|
Good perception
|
Maximum obtainable score = 45; %individual score= score obtained by an individual ¸ by total obtainable score x 100. Strongly agree (SA)= 5, agree (A) = 4, undecided (U)= 3, disagree(D) = 2, strongly disagree (SD) = 1
Table 4: Association between students’ year of study and perceptions on use of codeine-containing products (n = 520)
Statement
|
Level
|
N
|
Mean Rank
|
k-w, p-value
|
1.Codeine/codeine containing products can be abused
|
100
|
53
|
231.02*
|
0.005
|
|
200
|
137
|
240.28
|
|
|
300
|
179
|
274.41**
|
|
|
500
|
151
|
272.70
|
|
2.Codeine abuse/misuse can lead to dependency
|
100
|
53
|
206.08*
|
<0.001
|
|
200
|
137
|
246.90
|
|
|
300
|
179
|
274.12
|
|
|
500
|
151
|
275.79**
|
|
3.Codeine abuse/misuse can affect psychological well-being
|
100
|
53
|
262.78
|
0.624
|
|
200
|
137
|
255.58*
|
|
|
300
|
179
|
260.80
|
|
|
500
|
151
|
263.80**
|
|
4.Codeine abuse/misuse can lead to neurological side effects
|
100
|
53
|
210.64*
|
0.001
|
|
200
|
137
|
241.30
|
|
|
300
|
179
|
277.49**
|
|
|
500
|
151
|
275.28
|
|
5.Codeine abuse/misuse can lead to socially unacceptable behavior
|
100
|
53
|
201.79*
|
<0.001
|
|
200
|
137
|
233.83
|
|
|
300
|
179
|
278.55
|
|
|
500
|
151
|
283.90**
|
|
6.Codeine abuse/misuse can affect pattern of spending
|
100
|
53
|
206.20*
|
0.001
|
|
200
|
137
|
255.90
|
|
|
300
|
179
|
255.58
|
|
|
500
|
151
|
289.57**
|
|
7.Codeine abuse/misuse can result in accidental overdose
|
100
|
53
|
186.46*
|
<0.001
|
|
200
|
137
|
240.66
|
|
|
300
|
179
|
281.58**
|
|
|
500
|
151
|
279.50
|
|
8.Codeine abuse/misuse can result in life- threatening withdrawal symptoms
|
100
|
53
|
206.38*
|
<0.001
|
|
200
|
137
|
235.99
|
|
|
300
|
179
|
275.75
|
|
|
500
|
151
|
283.65**
|
|
9.Codeine abuse/misuse can cause reduced fertility in males and females
|
100
|
53
|
240.95
|
0.016
|
|
200
|
137
|
286.07**
|
|
|
300
|
179
|
264.94
|
|
|
500
|
151
|
238.90*
|
|
k-w: Kruskal-Wallis test
*Lowest mean rank indicates those who least agreed to the corresponding statement
**Highest mean rank indicates those who mostly agreed to the corresponding statement
Level of statistical significance p<0.05
Table 5: Association between relevant sociodemographic characteristics and knowledge and perception on use of codeine-containing products (n = 520)
Variable
|
Good perception
(Score ³ 80%)
n (%)
|
Poor perception
(Score < 80%)
n (%)
|
Good knowledge
(Score ³ 80%)
n (%)
|
Poor knowledge
(Score < 80%)
n (%)
|
Age (years)
|
|
|
|
|
16-20
|
167 (89.3)
|
20 (10.7)
|
88 (47.1)
|
99 (52.9)
|
≥20
|
302 (90.7)
|
31 (9.3)
|
113 (33.9)
|
220 (66.1)
|
|
[ x2 = 0.260 p value = 0.610]
|
[ x2 =8.699 p value = 0.003*]
|
Gender
|
|
|
|
|
Male
|
235 (89.4)
|
28 (10.6)
|
93 (35.4)
|
170 (64.6)
|
Female
|
234 (91.1)
|
23 (8.9)
|
108 (42.0)
|
149 (58.0)
|
|
[ x2 =0.423 p value =0.515]
|
[ x2 =2.433 p value =0.119]
|
Faculty
|
|
|
|
|
Pharmacy
|
171 (92.4)
|
14 (7.6)
|
87 (47.0)
|
98 (53.0)
|
Medicine and surgery
|
298 (89.0)
|
37 (11.0)
|
114 (34.0)
|
221 (66.0)
|
|
[ x2 =1.629 p value =0.202]
|
[ x2 =8.490 p value =0.004*]
|
*Significance difference with Chi-square (x2) test, level of significance P <0.05
Table 6: Predictors of misuse/abuse of codeine-containing products among respondents (n = 520)
Variable
|
Misused/abused
codeine/codeine-containing products
n (%)
|
Unadjusted Odds ratio
|
Adjusted Odds ratio
|
OR (95%CI)
|
p-value
|
AOR (95%CI)
|
p-value
|
|
Yes
|
No
|
|
|
|
|
Experienced some side effects I will like to experience again
|
|
|
|
|
|
|
Yes
|
12 (36.4)
|
21 (63.6)
|
39.02 (13.94-109.24)
|
<0.001
|
36.31 (10.89-121.12)
|
<0.001*
|
No
|
7 (1.4)
|
478 (98.6)
|
1
|
|
1
|
|
Pressured into using codeine-containing product
|
|
|
|
|
|
|
Yes
|
5 (25.0)
|
15 (75.0)
|
11.57 (3.69-36.29)
|
<0.001
|
11.77 (2.50-55.38)
|
0.002*
|
No
|
14 (2.8)
|
486 (97.2)
|
1
|
|
1
|
|
Need to use regular dose of these products to function well daily
|
|
|
|
|
|
|
Yes
|
3 (50.0)
|
3 (50.0)
|
31.13 (5.82-166.63)
|
<0.001
|
6.78 (0.48-95.46)
|
0.156
|
No
|
16 (3.7)
|
498 (96.3)
|
1
|
|
1
|
|
Addicted to the use of these products
|
|
|
|
|
|
|
Yes
|
4 (66.7)
|
2 (33.3)
|
66.40 (11.27-391.15)
|
<0.001
|
3.15 (0.36-27.35)
|
0.299
|
No
|
15 (2.1)
|
498 (97.1)
|
1
|
|
1
|
|
*P <0.05 is a significant difference