Characteristics of a nontreatment-seeking sample of over-the-counter codeine users: Implications for intervention and prevention

Suzanne Nielsen, BPharm, BPharmSc (Hons), PhD; Jacqui Cameron, BA, BSW, MPhil (Social Science Research); Nicole Lee, BSc (Hons), GradCertEd (Tertiary), PhD, MAPS

doi:10.5055/jom.2011.0077

Authors

Suzanne Nielsen, BPharm, BPharmSc (Hons), PhD
Jacqui Cameron, BA, BSW, MPhil (Social Science Research)
Nicole Lee, BSc (Hons), GradCertEd (Tertiary), PhD, MAPS

DOI:

https://doi.org/10.5055/jom.2011.0077

Keywords:

codeine, dependence, nonprescription, opioid

Abstract

Objectives: Recently, there has been considerable policy and public interest in the availability of over-the-counter (OTC) codeine. Case reports demonstrating severe harm from OTC codeine have been published. However, few studies have examined how people use these products and who develops dependence. The aim of this study was to better understand who develops problematic use of OTC codeine.
Design and setting: The authors conducted a web-based survey with people who self-reported OTC codeine use. Eight hundred participants completed the survey that examined codeine use and dependence, pain, and general physical and mental health.
Results: Codeine-dependent people differed from nondependent codeine users on a range of characteristics. They were younger, had lower levels of employment and education, and were more likely to report family history of substance dependence. They were more likely to have taken well above recommended doses of OTC codeine and have taken codeine for considerably longer periods of time than recommended. Codeine-dependent people in this study differed markedly from other populations of opioid-dependent people recruited to research in Australia and were more similar to the general population, suggesting that a web-based survey may have reached an under-researched population of opioid-dependent people.
Conclusions: How best to use these findings to identify at-risk OTC codeine users requires consideration. Approaches aimed at reducing harm from prescription opioids may be difficult to implement in pharmacy settings. Implications for pharmacists and other health professionals are discussed.

Author Biographies

Suzanne Nielsen, BPharm, BPharmSc (Hons), PhD

Senior Research Fellow/Senior Pharmacist, NIDA Invest CTN Fellow, Department of Clinical Research, Turning Point Alcohol and Drug Centre and Monash University, Victoria, Australia.

Jacqui Cameron, BA, BSW, MPhil (Social Science Research)

Research Fellow, Department of Eastern Health Clinical school, Turning Point Alcohol and Drug Centre and Monash University, Victoria, Australia.

Nicole Lee, BSc (Hons), GradCertEd (Tertiary), PhD, MAPS

Associate Professor, LeeJenn Health Consultants Pty Ltd., National Centre for Education and Training of Addiction, Victoria, Australia.

References

Reay G: An Inquiry into Physical Dependence and Addiction to Prescription and Over-the-Counter Medication. UK: All-Party Parliamentary Drugs Misuse Group, 2008.

National Drugs and Poisons Schedule Committee: Record of Reasons. Canberra, Australia: Department of Health and Ageing, 2009.

Department of Health and Ageing: Codeine rescheduling. Canberra, Australia: Department of Health and Ageing; 2010. Available at http://www.tga.gov.au/npmeds/codeine.htm. Accessed September 3, 2010.

Dyer BT, Martin JL, Mitchell JL, et al.: Hypokalaemia in ibuprofen and codeine phosphate abuse. Int. J Clin Pract 2004; 58(11): 1061-1062.

Dutch MJ: Nurofen Plus misuse: An emerging cause of perforated gastric ulcer. Med J Aust. 2008; 188(1): 56-57.

Lambert AP, Close C: Life-threatening hypokalaemia from abuse of Nurofen Plus. J R Soc Med. 2005; 98(1): 21.

Romach MK, Sproule BA, Sellers EM, et al.: Long-term codeine use is associated with depressive symptoms. J Clin Psychopharmacol. 1999; 19(4): 373-376.

Adebayo D, Bjarnason I: Is non-steroidal anti-inflammatory drug (NSAID) enteropathy clinically more important than NSAID gastropathy? Postgrad Med J. 2006; 82(965): 186-191.

Langman M, Morgan L, Worrall A: Use of anti-inflammatory drugs by patients admitted with small or large bowel perforations and haemorrhage. Br Med J. 1985; 290(6465): 347-349.

Sproule B, Busto U, Somer G, et al.: Characteristics of dependent and nondependent regular users of codeine. J Clin Psychopharmacol. 1999; 19(4): 367-372.

Orriols L, Gaillard J, Lapeyre-Mestre M, et al.: Evaluation of abuse and dependence on drugs used for self-medication: A pharmacoepidemiological pilot study based on community pharmacies in France. Drug Saf. 2009; 32(10): 859-873.

Frei MY, Nielsen S, Dobbin MD, et al.: Serious morbidity associated with misuse of over-the-counter codeine-ibuprofen analgesics: A series of 27 cases. Med J Aust. 2010; 193(5): 294-296.

Fielding N, Lee RM, Blank B (eds.): Online Research Methods. London: Sage Publications, 2008.

Australian Bureau of Statistics: Patterns of Internet Access in Australia. Canberra, Australia: ABS, 2006.

Andrews G, Slade T: Interpreting scores on the Kessler Psychological Distress Scale (K10). Aust N Z J Public Health. 2001; 25(6): 494-497.

Gossop M, Darke S, Griffiths P, et al.: The Severity of Dependence Scale (SDS): Psychometric properties of the SDS in English and Australian samples of heroin, cocaine and amphetamine users. Addiction. 1995; 90(5): 607-614.

Ware JE, Kosinksi MMA, Keller SD: How to Score the SF-12 Physical and Mental Health Summary Scales. 2nd ed. Boston, MA: The Health Institute NEMC, 1995.

SPSS Inc: SPSS for Windows, Ver. 14.0. Chicago, IL: SPSS Inc, 2001.

Grande RB, Aaseth K, Saltyte BJ, et al.: The Severity of Dependence Scale detects people with medication overuse: The Akershus study of chronic headache. J Neurol Neurosurg Psychiatry. 2009; 80(7): 784-789.

Martin G, Copeland J, Gates P, et al.: The Severity of Dependence Scale (SDS) in an adolescent population of cannabis users: Reliability, validity and diagnostic cut-off. Drug Alcohol Depend. 2006; 83(1): 90-93.

Ross DJ, Darke S: Benzodiazepine Dependence and Psychopathology Among Heroin Users in Sydney. Sydney: National Drug and Alcohol Research Centre, 1997.

De Las Cuevas C, Sanz EJ, De La Fuente JA, et al.: The Severity of Dependence Scale (SDS) as screening test for benzodiazepine. Addiction. 2000; 95(2): 245-250.

Denscombe M: Item non-response rates: A comparison of online and paper questionnaires. Int J Soc Res Methodol. 2009; 12(4): 281-291.

Australian Bureau of Statistics: Population by age and sex, Australian states and territories. Canberra, Australia: Australian Bureau of Statistics; 2009. Available at http://www.abs.gov.au/ausstats/abs@.nsf/Products/3235.0~2009~Main+Features~Main+Features?OpenDocument#PARALINK5. Accessed August 27, 2010.

Australian Bureau of Statistics: Education and work. Canberra, Australia: Australian Bureau of Statistics; 2009. Available at http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/6227.0Main%20Features2May%202010?opendocument&tabname=Summary&prodno=6227.0&issue=May%202010&num=&view=. Accessed September 3, 2010.

Ross J, Teesson M, Darke S, et al.: The characteristics of heroin users entering treatment: Findings from the Australian Treatment Outcome Study (ATOS). Drug Alcohol Rev. 2005; 24(5): 411-418.

Stafford J, Sindicich N, Burns L, et al.: Australian Drug Trends 2008. Findings from the Illicit Drug Reporting System (IDRS). Sydney: National Drug and Alcohol Research Centre, University of New South Wales, 2009.

Nielsen S, Bruno R, Lintzeris N, et al.: Pharmaceutical opioid analgesic and heroin dependence: How do treatment seeking clients differ in Australia? Drug Alcohol Rev., in press.

Nielsen S, Lintzeris N, Mackie K, et al.: What is the pharmacist’s role in prevention of pharmaceutical opioid misuse? Aust Pharmacist. 2010; 29(2): 107-111.

Murnion BP: Combination analgesics in adults. Aust Prescriber. 2010; 33: 113-115.

Kahan M, Srivastava A, Wilson L, et al.: Misuse of and dependence on opioids: Study of chronic pain patients. Can Fam Physician. 2006; 52(9): 1081-1087.

Nielsen S, Cameron J, Lee N (eds.): Is there a new population of opioid users in Australia? A web-based survey on nonprescription codeine use. NIDA International Forum, Scottsdale, AZ, June 15, 2010.