Fatal misuse of codeine–ibuprofen analgesics in Victoria, Australia

Brian R McAvoy and Claire L Tobin
Med J Aust 2014; 200 (3): . || doi: 10.5694/mja13.11268
Published online: 17 February 2014

To the Editor: Pilgrim and colleagues describe one of the most serious outcomes associated with misuse of over-the-counter (OTC) codeine–ibuprofen analgesics, namely death due to high-dose non-steroidal anti-inflammatory drug (NSAID) toxicity resulting from addiction to codeine.1 Three recent published reports describe harm arising from misuse of these products in New Zealand.2-4 Common factors were high prevalence of mental health disorder, history of alcoholism and other substance misuse. These conditions are prevalent in Australia and New Zealand, where OTC opioid availability exposes vulnerable individuals to a risk of dependence, dose escalation, and consequent high-dose NSAID toxicity. The high average number of tablets consumed (49–65 tablets per day) and the prolonged duration of misuse in the New Zealand cases4 and in an Australian cohort of 77 described cases5 indicates the addictive nature of these products, and the inability of pharmacists to identify drug-seeking and prevent prolonged high-dose NSAID misuse and harm.

  • 1 Capri Hospital, Auckland, New Zealand.
  • 2 School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC.


Competing interests:

No relevant disclosures.

  • 1. Pilgrim JL, Dobbin M, Drummer OH. Fatal misuse of codeine-ibuprofen analgesics in Victoria, Australia. Med J Aust 2013; 199: 329-331. <MJA full text>
  • 2. Robinson GM, Robinson S, McCarthy P, Cameron C. Misuse of over-the-counter codeine-containing analgesics: dependence and other adverse effects. N Z Med J 2010; 123: 59-64.
  • 3. Evans C, Chalmers-Watson TA, Gearry RB. Medical image. Combination NSAID-codeine preparations and gastrointestinal toxicity. N Z Med J 2010; 123: 92-93.
  • 4. McAvoy BR, Dobbin MDH, Tobin CL. Over-the-counter codeine - misuse and harm in Australia and New Zealand. N Z Med J 2011; 124: 29-33.
  • 5. Dobbin M, Tobin C. Over the counter (OTC) ibuprofen/codeine analgesics: misuse and harm. Paper prepared for the National Drugs and Poisons Schedule Committee (Australia); 2008 May 22.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.