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Treating codeine dependence with buprenorphine: Dose requirements and induction outcomes from a retrospective case series in New South Wales, Australia


Nielsen, S and Bruno, R and Murnion, B and Dunlop, A and Degenhardt, L and Demirkol, A and Muhleisen, P and Lintzeris, N, Treating codeine dependence with buprenorphine: Dose requirements and induction outcomes from a retrospective case series in New South Wales, Australia, Drug and Alcohol Review, 35, (1) pp. 70-75. ISSN 0959-5236 (2016) [Refereed Article]

Copyright Statement

Copyright 2015 Australasian Professional Society on Alcohol and other Drugs

DOI: doi:10.1111/dar.12315


Introduction and Aims: Codeine dependence is an emerging public health concern, yet no studies have specifically examined the treatment of codeine dependence. Given the lower potency of codeine it cannot be assumed that buprenorphine dose requirements for heroin dependence will generalise to codeine. This is the first study to examine buprenorphine treatment for codeine dependence.

Design and Methods: Retrospective case series of 19 codeine-dependent treatment entrants who received sublingual buprenorphine maintenance treatment through six specialist inpatient and outpatient treatment centres. Baseline codeine doses and buprenorphine dose at days 7 and 28 were collected, in addition to details on general demographics, pain and mental health, substance use and outcomes after 28 days of buprenorphine treatment.

Results: A significant linear relationship was found between initial codeine dose and dose of buprenorphine given at days 7 and 28 for the codeine dose range of 50960 mg day−1 (mean: 564 mg; 95% confidence interval 431696 mg). Median buprenorphine dose was 12.0 mg (interquartile range 9.5 mg, range 432 mg) at day 7 and 16.0 mg (interquartile range 13.5 mg, range 432 mg) at day 28. Buprenorphine doses received were markedly higher than estimated codeine doses based on standard dose conversion tables.

Discussion and Conclusions: With increasing presentations relating to codeine dependence, these findings provide important guidance to clinicians. Buprenorphine doses were consistently higher than doses estimated based on the dose of codeine consumed, and were comparable with doses used in the treatment of dependence with heroin and more potent prescription opioids.

Item Details

Item Type:Refereed Article
Keywords:codeine dependence, buprenorphine maintenance, induction, opioid analgesic, opioid misuse
Research Division:Psychology
Research Group:Other psychology
Research Field:Other psychology not elsewhere classified
Objective Division:Health
Objective Group:Public health (excl. specific population health)
Objective Field:Public health (excl. specific population health) not elsewhere classified
UTAS Author:Bruno, R (Associate Professor Raimondo Bruno)
ID Code:106560
Year Published:2016 (online first 2015)
Web of Science® Times Cited:6
Deposited By:Psychology
Deposited On:2016-02-13
Last Modified:2017-11-07

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