More than three quarters of people who develop dependence on codeine do not seek help despite highly effective treatments being available, says National Drug and Alcohol Research Fellow Dr Suzanne Nielsen.
In an editorial in Australian Prescriber to be published tomorrow (1 February 2018) Dr Nielsen and co-author Dr Darren Roberts, a clinical pharmacologist at the Canberra Hospital, write that codeine use disorder is a largely hidden problem.
“Australian data show that the typical codeine user is well educated and employed,” write the authors. “However, because of stigma around drug use they are often reluctant to disclose their use or admit there is a problem.”
Speaking on the eve of codeine being rescheduled by the TGA to a prescription only medication, Dr Nielsen said that more than 27 million packs of painkillers containing codeine had been supplied by Australian pharmacies in 2013 and over half (56 per cent) were obtained over the counter. More than a third of opioids purchased in the community contained codeine and increased use had been accompanied by increased harms.
The 2013 National Drug Strategy Household Survey reported that a third of people who reported misusing pharmaceuticals had used over the counter codeine products. This increased to 75 percent in the 2016 Survey.
“We have seen increasing evidence of problematic use and harms with over-the-counter codeine. This includes increasing non-medical use, dependence, illness and accidental fatal overdose,” said Dr Nielsen.
As codeine is frequently combined with other products consumers also experience harms from the other medication when more than the recommended dose is taken. This includes liver disease, heart disease and gastrointestinal problems.
“Most people who develop dependence on codeine do not have a history of using other illicit substances.” said Dr Nielsen.
“Many are not familiar with where to access treatment for drug dependence and due to stigma around substance use access to treatment is often delayed.”
Treatments commonly prescribed for other opioid dependence, including heroin, have been shown to have very good outcomes in this population.
“Opioid substitution therapy such as methadone and buprenorphine/Naloxone offers a great opportunity to provide physical, social and psychological stability for patients who are dependent and might benefit from it.”
The NDARC codeine factsheet is available at: https://ndarc.med.unsw.edu.au/sites/default/files/ndarc/resources/NDA073%20Fact%20Sheet%20Codeine%20update.pdf