Media release from the Medical Journal of Australia.
Identifying codeine-dependent patients as soon as possible is vital for preventing serious complications, report the authors of a systematic review published in the Medical Journal of Australia.
Dr Suzanne Nielsen, a Senior Research Fellow at the National Drug and Alcohol Research Centre at the University of New South Wales, and her co-authors analysed data from 41 eligible publications to identify key findings that could inform clinical responses to codeine dependence.
They found that the prevalence of mental health comorbidity was high in people who are codeine-dependent, that clinical identification of dependence was often delayed, and that patients experienced serious complications associated with excessive consumption of combination products that included codeine.
“The quality and methodology of the studies we assessed varied considerably, but their depictions of the features associated with codeine dependence were consistent, describing a clinically challenging area in which under-reporting is highly likely,” Nielsen and colleagues wrote.
“The reports highlight the importance of asking about the use of non-prescribed analgesics in a range of health care situations, particularly when gastrointestinal complications are identified.
“The diversity of those affected and the high level of morbidity suggest that population level interventions are required for screening and prevention wherever codeine is available over the counter. Careful questioning about recent patterns of use, the reasons for taking codeine, and withdrawal symptoms upon cessation may help identify when a patient should be comprehensively assessed for an opioid use disorder.”
The authors also reviewed approaches to treatment, which include self-management with internet support, psychological treatments, symptomatic medications for opioid withdrawal, and opioid agonist treatments.
“Codeine dependence can be identified by screening patients who present with acute complications associated with taking combination analgesics, and by routine questioning about over-the-counter medication use,” the authors concluded.
“Common treatment approaches include detoxification and opioid agonist treatment, with many treatment studies supporting the use of buprenorphine-naloxone in this clinical population Clinical leadership in responding to the treatment needs of those codeine dependence is required as a matter of public health, and is timely given the recent rescheduling of codeine in Australia.”
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The Medical Journal of Australia is a publication of the Australian Medical Association.
CONTACTS: Ms Marion Downey, 0401 713 850
Manager Media & Communications, National Drug and Alcohol Research Centre On behalf of Dr Suzanne Nielsen