Volume 200 - Issue 3
Fatal misuse of codeine–ibuprofen analgesics in Victoria, Australia
Authors: Jennifer L Pilgrim and Olaf H Drummer
Med J Aust 2014; 200 (3): 151. || doi: 10.5694/mja13.11335
Published online: 17 February 2014
Published online: 17 February 2014
Those addicted to OTC codeine often do not fit stereotypes of illicit drug users and may present as well groomed professionals
In reply: We welcome McAvoy and Tobin’s support of our recommendation that over-the-counter (OTC) codeine combination analgesics be available as prescription only. These products are the only narcotic analgesics available without prescription. Hundreds of people in Australia and New Zealand have now been treated for addiction to OTC codeine combination analgesics or the often life-threatening non-steroidal anti-inflammatory drug injury caused by the high-dose ibuprofen secondary to codeine addiction.1,2
In the United Kingdom, these problems have resulted in prominent mandatory warning labels on packs and patient information leaflets about addiction.3
People seeking OTC codeine compound analgesics are seldom if ever refused supply4 and may obtain multiple packs each day from multiple pharmacies over many years, regularly undertaking travel described as “codeine road trips”.5 Those addicted to OTC codeine often do not fit stereotypical perceptions of illicit drug users, and many present as well groomed professionals. Pharmacists describe feeling inadequate to assess requests and uncomfortable refusing supply.
There is little evidence that combining low-dose codeine with simple analgesics provides more than a trivial benefit for pain relief.
Competing interests
No relevant disclosures.
References
- Frei MY, Nielsen S, Dobbin MD, Tobin CL. Serious morbidity associated with misuse of over-the-counter codeine–ibuprofen analgesics: a series of 27 cases. Med J Aust 2010; 193: 294-296. BABFEFFD
- Storor D. National pharmaceutical drug misuse strategy [letter to National Centre for Education and Training on Addiction]. http://nceta.flinders. edu.au/files/7713/1423/8823/Damascus%20 Health%20Services%20web%20version.pdf (accessed Oct 2013).
- Medicines and Healthcare Products Regulatory Agency. MHRA public assessment report: codeine and dihydrocodeine-containing medicines: minimising the risk of addiction. http://www. mhra.gov.uk/home/groups/pl-p/documents/websiteresources/con057317.pdf (accessed Sep 2013).
- Nielsen S, Cameron J, Pahoki S. Final report 2010. Over the counter codeine dependence. Melbourne: Turning Point Alcohol and Drug Centre, 2010. http://atdc.org.au/wp-content/uploads/2011/02/OTC_CODEINE_REPORT.pdf (accessed Jan 2014).
- O’Donoghue N. Codeine road-trips demand Project STOP scheme. Pharmacy News 2012; Jan 11. http://www.pharmacynews.com.au/getmedia/51d4bf69-4f3a-45df-990f-48dd496e68a3/PN20120111.aspx?ext=.pdf (accessed Oct 2013).