Sheena Arora BCom, BSc, MPH, Research Fellow, Amanda Roxburgh BPscyh (Hons), MCrim, MPsychol (Clin), Senior Research Officer, Raimondo Bruno BSc (Hons), PhD, Senior Lecturer, Suzanne Nielsen BPharm, BPharmSc (Hons), PhD, NHMRC Research Fellow, Lucy Burns GradDip Health Policy, MPH, PhD, Senior Lecturer.
A cross-sectional analysis of over-the-counter codeine use among an Australian sample of people who regularly inject drugs
Article first published online: 10 JUN 2013
© 2013 Australasian Professional Society on Alcohol and other Drugs
Drug and Alcohol Review
Volume 32, Issue 6, pages 574–581, November 2013
How to Cite
Arora, S., Roxburgh, A., Bruno, R., Nielsen, S. and Burns, L. (2013), A cross-sectional analysis of over-the-counter codeine use among an Australian sample of people who regularly inject drugs. Drug and Alcohol Review, 32: 574–581. doi: 10.1111/dar.12059
- Issue published online: 12 NOV 2013
- Article first published online: 10 JUN 2013
- Manuscript Accepted: 19 MAY 2013
- Manuscript Received: 18 DEC 2012
- Australian Government Department of Health and Ageing
- substance abuse;
- opioid-related disorder;
- nonprescription drug
Introduction and Aims
The study aims to examine the medical and non-medical use of over-the-counter (OTC) codeine combination drugs in a sample of people who inject drugs; and to examine risk factors associated with exceeding the recommended dose of OTC codeine, including the experience of pain.
Design and Methods
This study analysed annual survey data from a convenience sample of people who inject drugs in Australia who are interviewed for the Illicit Drug Reporting System. People who have injected drugs (n = 902) on at least a monthly basis in the preceding six months across Australia were interviewed. Participants were asked about their use of OTC codeine and their experience of pain.
One third (35%) of participants had used OTC codeine in the preceding six months and 52% (95% confidence interval 48.7–55.3) of this group had exceeded the recommended dose on their last occasion of use. This clearly places them at increased risk of harms associated with toxicity from the accompanying analgesic found in combination codeine products. Multivariate analyses demonstrated that those exceeding the recommended codeine dose of OTC codeine were more likely to be experiencing moderate to very severe pain.
Discussion and Conclusion
There is a need to evaluate the approach to pain management in this population. Greater pharmacist involvement, real-time monitoring of sales, the development of screening tools to identify those at risk of harm and further education of primary care practitioners could be beneficial in reducing the risk of harm associated with these medications for all users of OTC codeine, including people who inject drugs. [Arora S, Roxburgh A, Bruno R, Nielsen S, Burns L. A cross-sectional analysis of over-the-counter codeine use among an Australian sample of people who regularly inject drugs. Drug Alcohol Rev 2013;32:574–581]