@article{ref1,
title="Codeine use and harms in Australia: evaluating the effects of re-scheduling",
journal="Addiction",
year="2019",
author="Cairns, R. and Schaffer, A. L. and Brown, J. A. and Pearson, S-a and Buckley, N. A.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
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. <br><br>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%). <br><br>CONCLUSIONS: Codeine re-scheduling in Australia appears to have reduced codeine misuse and sales.<br><br>This article is protected by copyright. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="0965-2140",
doi="10.1111/add.14798",
url="http://dx.doi.org/10.1111/add.14798"
}