OBJECTIVES:   Medicine abuse is defined as the recurrent use of a medicine in a non-medical manner for non-medicinal purposes.  The potential for abuse of combination (polycomponent) analgesics is high.  The primary aim was to detect the potential abuse of combination analgesics using a medicine claims database.  METHODS:   An analysis of the South African combination analgesic market was made.  Thereafter, a retrospective, exposure-cohort drug utilisation study was conducted on a medicine claims database of a medical aid administrator.  The medicine file contained 1,357,717 records for 2007.  RESULTS:   From the analysis of the combination analgesics available, it was found that there were 21 Schedule 5 (prescription-only) tablet formulations (trade names) containing the following identical active ingredients:  320 mg paracetamol, 8 mg codeine phosphate, 32 mg caffeine and 50 mg meprobamate.  From the database study, a total of 145,372 analgesics were prescribed (36.82% were available without a prescription).  Combination analgesics accounted for 30.21% of all analgesics prescribed (92,181 products at a cost of R2,784,484).  Analgesics were often prescribed on an acute basis in excessive quantities, for example 200 tablets.  Combination analgesic tablets and capsules were also often dispensed to children in large quantities.  For example, 10 prescriptions for 100 tablets of an over-the-counter combination analgesic and eight prescriptions for 100 capsules of a prescription-only combination analgesic, were dispensed to children under seven years, while a syrup (a more suitable dosage form) was available.  There was furthermore concern about the quantities of analgesics prescribed to specific families and it was clear that if the medical aid benefit of one family member was exhausted, the analgesic was claimed under another family member’s name.  A number of prescribers were identified who were over-prescribing specific analgesics.  CONCLUSIONS:   A medical aid database can be used to detect analgesic abuse and guidelines to control abuse and cost were proposed.