Changes for codeine

May 2018
Roberts DM, Nielsen S. (2018). Changes for codeine. Australian Prescriber, (1), 2-3. doi: 10.18773/austprescr.2018.006

On 1 February 2018 codeine was rescheduled to a prescription-only medicine.

Codeine is widely used in Australia, often in combination with other drugs. In 2013, more than 27 million packs of codeine-containing analgesic products were supplied by pharmacies, and 56% of these sales were over-the-counter without a prescription. National sales data show that over-the-counter codeine-containing analgesics account for 37% of all opioid purchases in the community.

Codeine is metabolised to morphine but there is marked interindividual variability in metabolism which contributes considerable differences in analgesic effects. Due to the opioid effects of codeine, people can become dependent with regular use.

The proportion of people seeking opioid substitution treatment for codeine dependence in Australia rose from 2.7% in 2014 to 4.6% in 2016. A study in Sydney reported that codeine was the sole substance used by 39% of patients with a pharmaceutical opioid dependence and 83% of these patients were using only over-the-counter codeine. At a drug dependence unit in South Australia, the annual incidence of codeine dependence requiring intervention increased from 31 people in 2003 to 174 in 2014. The estimated cost of treating 30 patients with codeine-related admissions in one Adelaide hospital was over $1 million. In 2013 the National Drug Strategy Household Survey reported that 33% of the people who had misused pharmaceuticals had used over-the-counter codeine-containing analgesics. This increased to 75% in 2016.

The reduced availability of codeine can be anticipated to reduce harms for many who are codeine dependent. Opioid substitution treatment (methadone or buprenorphine/naloxone) offers the opportunity to promote physical, social and psychological stability for patients who are willing to receive it.