Codeine use and harms in Australia: evaluating the effects of re-scheduling.
codeine
legislative change
opioids
poisons centres
policy
re-scheduling
substance misuse
Journal
Addiction (Abingdon, England)
ISSN: 1360-0443
Titre abrégé: Addiction
Pays: England
ID NLM: 9304118
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
received:
26
05
2019
revised:
16
08
2019
accepted:
26
08
2019
pubmed:
3
10
2019
medline:
20
2
2021
entrez:
3
10
2019
Statut:
ppublish
Résumé
Globally, codeine is the most-used opioid. 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. 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. Intentional opioid overdoses resulting in a call to NSWPIC. 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. We observed an abrupt -50.8 percentage [95% confidence interval (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%). Codeine re-scheduling in Australia appears to have reduced codeine misuse and sales.
Sections du résumé
BACKGROUND AND AIMS
Globally, codeine is the most-used opioid. 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% confidence interval (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.
Substances chimiques
Prescription Drugs
0
Codeine
UX6OWY2V7J
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
451-459Subventions
Organisme : National Health and Medical Research Council
ID : 1055176
Pays : International
Organisme : National Health and Medical Research Council
ID : 1060407
Pays : International
Organisme : National Health and Medical Research Council
ID : 1158763
Pays : International
Organisme : NHMRC Early Career Fellowship
ID : ID 1158763
Pays : International
Organisme : NHMRC Centre of Research Excellence in Medicines and Ageing
ID : ID 1060407
Pays : International
Organisme : National Health and Medical Research Council (NHMRC) Translational Australian Clinical Toxicology (TACT) Program
ID : ID 1055176
Pays : International
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2019 Society for the Study of Addiction.
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