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Trends and characteristics of accidental and intentional codeine overdose deaths in Australia

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Research has found that increased prescribing of opioid analgesics during the past decade has resulted in rises in mortality caused by overdose in many developed countries.14 One opioid analgesic that has not received much attention is codeine, which is often used in the belief that it is a weaker opioid, less likely to cause dependence and fatal overdose than morphine, for example. It is important to test this assumption, as more codeine is consumed in the United Kingdom, Canada and Australia than any other opioid.5 Codeine is also one of the most accessible opioids, available without prescription (over-the-counter) in the UK, Canada, France, New Zealand and Australia.6

Concerns have been raised in a number of countries about the adverse consequences of codeine use. Use among children has been limited in several countries, and there have been calls to completely remove codeine from the market.7,8

There are documented risks associated with prolonged codeine use. It can produce tolerance, which may lead to escalating doses and dependence, particularly among patients whose pain is not well managed.6,9