Why codeine should be prescription only
Harmful drug use continues to be a serious public health issue in Australia with 1,808 drug induced deaths registered in 2016 according to the latest records of the Australian Bureau of Statistics.
This is the highest number of drug deaths in 20 years, and is similar to the number recorded in the late 1990s when a steep increase in opioid use, specifically heroin, led to deaths peaking at 1,740 in 1999.
Substantial evidence from published studies shows that codeine contributes to both accidental and intentional deaths.
Many of these deaths can be attributed to the misuse of combination codeine medicines, particularly related to paracetamol-induced liver toxicity and ibuprofen-induced stomach ulceration.
In 2014, the TGA database of adverse event notifications contained 59 cases of stomach ulcers or bleeding related to codeine/ibuprofen combination and 57 cases of liver toxicity from combination codeine/paracetamol products.
A study in the Medical Journal of Australia 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.
Other relevant data includes:
- codeine toxicity was a contributory factor in 1,437 deaths between 2000 and 2013;
- paracetamol or ibuprofen was involved in 55 per cent of the 1200 codeine-related deaths recorded in Australia between 2000 and 2013;
- The underlying cause of death was determined to be codeine toxicity in 7.8 per cent of cases (113 deaths), and multiple drug toxicity (including codeine) in 83.7 per cent of cases (1,201 deaths);
- approximately 24 per cent (343 deaths) were related to a prescription codeine product (usually Panadeine Forte), 16 per cent (229 deaths) included an OTC codeine product, and in the remaining 60 per cent of deaths there was no information about whether the codeine consumed before death was prescribed or OTC;
- codeine-related deaths increased from 3.5 to 8.7 deaths per million persons between 2000 and 2009, with just under half of the deaths attributed to accidental overdose. The rate of these deaths also increased; and
- researchers found the increase was driven mainly by accidental deaths. Almost half were attributed to accidental overdose and a third to intentional self-harm.