Codeine re-scheduling has not led to increased opioid prescribing

By Michael Woodhead

22 Oct 2019

The 2018 ban on over-the-counter sales of codeine has not led to increased prescribing of higher strength codeine or switching of patients to other pharmaceutical opioids, PBS figures show.

In fact, overall opioid prescribing in Australia has declined since codeine was rescheduled contrary to fears expressed by some groups.

The up-scheduling of codeine by the TGA to prescription-only status in February 2018 was strongly resisted by pharmacy trade groups who warned that the removal of annual sales of 15.5 million packets of codeine would lead to increases in use of higher-dose prescription codeine products or other prescribed opioids.

But an analysis of PBS data by Monash University researchers has found no increasing trend for prescribed codeine or combined opioid supply during or after 2018.

The PBS data also showed a continuing declining trends in prescribing of most Schedule 8 pharmaceutical opioids such as oxycodone, tramadol, morphine, and fentanyl between 2016 and 2018, with no change after codeine rescheduling.

Only tapentadol showed a modest increase in prescribing over this time period, the researchers reported in the International Journal of Drug Policy.

“This suggests that, despite concerns that over-the-counter codeine products would be substituted for stronger variants, at a population level, substitution with prescribed codeine has not been observed, nor has a shift to other prescribed opioids occurred. This is despite the considerable use of OTC codeine amongst the community prior to the change,” they noted

The authors said PBS data accounted for more than 88% of opioid supply and it was unlikely that private prescription supply would change the overall picture  of a downward trend in opioid supply.

“This study demonstrates that a widely purported effect of the change, a large increase in people attending doctors to receive prescription codeine or other prescribed opioids was not observed,” they concluded.

The study results follow reports from Poisons Information  Centres in NSW, which found a 50% drop in calls related to codeine overdoses and sales following up-scheduling. There was also no increase in reports of overdoses with stronger opioids or high strength codeine.

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