Citation

Cairns R, Schaffer AL, Brown JA, Pearson SA, Buckley NA. Addiction 2019; ePub(ePub): ePub.

Affiliation

School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.

Copyright

(Copyright © 2019, John Wiley and Sons)

DOI

10.1111/add.14798

PMID

31577369

Abstract

BACKGROUND AND AIMS: Codeine is the most used opioid globally. In December 2016, Australia announced that low-strength codeine (≤15 mg) would be re-scheduled and no longer available for purchase over-the-counter; this was implemented in February 2018. We aimed to evaluate the effect of this scheduling change on codeine misuse and use, and misuse of other opioids. DESIGN AND SETTING: Interrupted time series analysis of monthly opioid exposure calls to New South Wales Poisons Information Centre (NSWPIC, captures 50% of Australia's poisoning calls), January 2015 - January 2019, and monthly national codeine sales, March 2015 - March 2019. We incorporated a washout period (January 2017 - January 2018) between the announcement and implementation, when prescriber/consumer behaviour may have been influenced. PARTICIPANTS: Intentional opioid overdoses resulting in a call to NSWPIC. MEASUREMENTS: We used linear segmented regression to identify abrupt changes in level and slope of fitted lines. Codeine poisonings and sales were stratified into high-strength (>15 mg per dose unit) and low-strength (≤15 mg). Only low-strength formulations were re-scheduled.

FINDINGS: We observed an abrupt -50.8 percentage (95%CI: -79.0 to -22.6%) level change in monthly codeine-related poisonings and no change in slope in the 12 months after February 2018. There was no increase in calls to the NSWPIC for high-strength products, level change: -37.2% (95%CI: -82.3% to 8%), or non-codeine opioids, level change: -4.4% (95%CI: -33.3% to 24.4%). Overall, the re-scheduling resulted in a level change in opioid calls of -35.8% calls/month (95%CI: -51.2% to -20.4%). Low-strength codeine sales decreased by 87.3% (95%CI: -88.5 to -85.9%), with no increase in high-strength codeine sales in the 14 months following re-scheduling, -4.0% (95%CI: -19.6% to 14.6%).

CONCLUSIONS: Codeine re-scheduling in Australia appears to have reduced codeine misuse and sales.

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Language: en