A cross-sectional analysis of over-the-counter codeine use amongst an Australian sample of people who regularly inject drugs
Arora, S and Roxburgh, A and Bruno, R and Nielsen, S and Burns, L, A cross-sectional analysis of over-the-counter codeine use amongst an Australian sample of people who regularly inject drugs, Drug and Alcohol Review, 32, (6) pp. 574-581. ISSN 0959-5236 (2013) [Refereed Article]
combination drugs in a sample of people who inject drugs; and to examine risk factors
associated with exceeding the recommended dose of OTC codeine, including the
experience of pain.
Design and Methods: Analysis of annual survey data from a convenience sample of
people who inject drugs in Australia who are interviewed for the Illicit Drug Reporting
System. People who have injected drugs (n=902) on at least a monthly basis in the
preceding six months across Australia were interviewed. Participants were asked about
their use of OTC codeine and their experience of pain.
Results: One-third (35%) of participants had used OTC codeine in the preceding six
months and 52% (95% confidence interval 48.7-55.3) of this group had exceeded the
recommended dose on their last occasion of use. This clearly places them at increased
risk of harms associated with toxicity from the accompanying analgesic found in
combination codeine products. Multivariate analyses demonstrated that those exceeding
the recommended codeine dose of OTC codeine were more likely to be experiencing
moderate to very severe pain.
Discussion: There is a need to evaluate the approach to pain management in this
population. Greater pharmacist involvement, real time monitoring of sales, the
development of screening tools to identify those at risk of harm and further education of
primary care practitioners could be beneficial in reducing the risk of harm associated with
these medications for all users of OTC codeine, including people who inject drugs.