OTC codeine: who’s addicted?


sad woman with pills

It’s possible that some people with codeine use disorder will emerge after February 2018 and present for help after their supplies run out, stakeholders say

In an editorial in Australian Prescriber Darren M Roberts and Suzanne Nielsen take a look at the characteristics and behaviours of people who have become dependent on OTC codeine.

The proportion of Australians seeking opioid substitution treatment for codeine dependence rose from 2.7% in 2014 to 4.6% in 2016, they write (MedsASSIST began to roll out, following a trial, nationwide in March 2016).

The authors cite a Sydney-based study which reported that codeine was the only substance used by 39% of patients with a pharmaceutical opioid dependence. Of these, 83% were using only OTC codeine.

Earlier, 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 authors write that the TGA and other stakeholders had hoped that Australians who have developed a dependence on OTC codeine would have presented to a health professional for help before the looming upschedule on 1 February 2018.

“However, due to stockpiling, shame, fear of stigma, and self-denial, it is possible that some people with codeine-use disorder will emerge after February 2018,” they write.

“Australian data show that the typical codeine user is well-educated and employed, and that codeine-use disorder is a largely hidden problem.

“People with substance use disorders are not always readily identified by stereotyped external features or behaviours, and such depictions can be detrimental in the context of substance use already being a highly stigmatised condition.

“They are often hesitant to disclose substance use, if indeed they acknowledge that their use is problematic.”

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