Downside of codeine upscheduling hailed

The TGA’s upscheduling of codeine has produced a welcome downside, with researchers describing “a massive and abrupt reduction in codeine poisonings”, and data revealing codeine sales have halved.

This week, researchers from the University of Sydney published the first peer-reviewed research to examine the short-term implications of the February 2018 removal of over-the-counter sales of low-strength codeine.

At the time of the change, codeine was the most commonly used opioid analgesic in Australia, with consumption exceeding that of the US, despite Australia’s population being just seven per cent of the size of the US population.

Since then, researchers from the University of Sydney’s NSW Poisons Information Centre (NSWPIC) and UNSW have looked at purchase behaviour and intentional poisoning by analysing national sales and call data from the centre.

Lead author, NSWPIC Director of Research and Sydney Pharmacy School lecturer Dr Rose Cairns says the data paints a positive picture of the impact of the legislative changes.

“We saw a massive and abrupt reduction in codeine poisonings following the 2018 move to prescription only sales,” she said.

“Interestingly, and despite what many predicted, we didn’t see an increase in poisonings with higher strength codeine or stronger opioids, so it really is a good news story.

“The sales data also showed a similar picture. There were big reductions in sales of low strength codeine, with no increase in sales of higher strength codeine.”

Data from the 14 months following the changes show overall codeine sales halved with low strength codeine sales decreasing by 87 per cent. There was no change in sales of higher strength preparations.

Sales figures from IQVIA, a global company that provides pharmaceutical sales data, included national data on codeine purchases made through wholesalers and manufacturers by retail pharmacies and hospitals.

In the 12 months following the changes, the researchers also found:

  • Reduction of 50 per cent in the monthly rate of codeine-related poisoning calls.
  • A decrease of 79 per cent in low strength poisoning calls, with no significant change in high strength poisoning calls (only low strength codeine products containing ≤15mg codeine per dose unit were affected by the legislative change).
  • No significant increase in poisoning calls with other pharmaceutical opioids.
  • No significant change in the codeine dose taken in intentional poisonings.

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