Historique
Article de Périodique
Codeine use and harms in Australia: evaluating the effects of re-scheduling (2020)
Auteur(s) :
CAIRNS, R. ;
SCHAFFER, A. L. ;
BROWN, J. A. ;
PEARSON, S. A. ;
BUCKLEY, N. A.
Année
2020
Page(s) :
451-459
Langue(s) :
Anglais
Refs biblio. :
39
Domaine :
Autres substances / Other substances
Discipline :
LOI (Loi et son application / Law enforcement)
Thésaurus géographique
AUSTRALIE
Thésaurus mots-clés
CODEINE
;
LEGISLATION
;
EVALUATION
;
OPIOIDES
;
MESUSAGE
;
VENTE
;
INTOXICATION
;
INTERVENTION
;
CENTRE ANTIPOISON
Note générale :
Commentary: Codeine rescheduling - where to from here? Nielsen S., p. 460-461.
Résumé :
BACKGROUND AND AIMS: Globally, codeine is the most-used opioid. In December 2016, Australia announced that low-strength codeine (<= 15 mg) would be re-scheduled and no longer available for purchase over-the-counter; this was implemented in February 2018. We aimed to evaluate the effect of this scheduling change on codeine misuse and use and misuse of other opioids.
DESIGN AND SETTING: Interrupted time-series analysis of monthly opioid exposure calls to New South Wales Poisons Information Centre (NSWPIC, captures 50% of Australia's poisoning calls), January 2015 - January 2019 and monthly national codeine sales, March 2015-March 2019. We incorporated a washout period (January 2017 - January 2018) between the announcement and implementation, when prescriber/consumer behaviour may have been influenced.
PARTICIPANTS: Intentional opioid overdoses resulting in a call to NSWPIC.
MEASUREMENTS: We used linear segmented regression to identify abrupt changes in level and slope of fitted lines. Codeine poisonings and sales were stratified into high strength (> 15 mg per dose unit) and low strength (<= 15 mg). Only low-strength formulations were re-scheduled.
FINDINGS: We observed an abrupt -50.8 percentage [95% confidence interval (CI) = -79.0 to -22.6%] level change in monthly codeine-related poisonings and no change in slope in the 12 months after February 2018. There was no increase in calls to the NSWPIC for high-strength products, level change: -37.2% (95% CI = -82.3 to 8%) or non-codeine opioids, level change: -4.4% (95% CI = -33.3 to 24.4%). Overall, the re-scheduling resulted in a level change in opioid calls of -35.8% calls/month (95% CI = -51.2 to -20.4%). Low-strength codeine sales decreased by 87.3% (95% CI = -88.5 to -85.9%), with no increase in high-strength codeine sales in the 14 months following re-scheduling, -4.0% (95% CI = -19.6 to 14.6%).
CONCLUSIONS: Codeine re-scheduling in Australia appears to have reduced codeine misuse and sales.
DESIGN AND SETTING: Interrupted time-series analysis of monthly opioid exposure calls to New South Wales Poisons Information Centre (NSWPIC, captures 50% of Australia's poisoning calls), January 2015 - January 2019 and monthly national codeine sales, March 2015-March 2019. We incorporated a washout period (January 2017 - January 2018) between the announcement and implementation, when prescriber/consumer behaviour may have been influenced.
PARTICIPANTS: Intentional opioid overdoses resulting in a call to NSWPIC.
MEASUREMENTS: We used linear segmented regression to identify abrupt changes in level and slope of fitted lines. Codeine poisonings and sales were stratified into high strength (> 15 mg per dose unit) and low strength (<= 15 mg). Only low-strength formulations were re-scheduled.
FINDINGS: We observed an abrupt -50.8 percentage [95% confidence interval (CI) = -79.0 to -22.6%] level change in monthly codeine-related poisonings and no change in slope in the 12 months after February 2018. There was no increase in calls to the NSWPIC for high-strength products, level change: -37.2% (95% CI = -82.3 to 8%) or non-codeine opioids, level change: -4.4% (95% CI = -33.3 to 24.4%). Overall, the re-scheduling resulted in a level change in opioid calls of -35.8% calls/month (95% CI = -51.2 to -20.4%). Low-strength codeine sales decreased by 87.3% (95% CI = -88.5 to -85.9%), with no increase in high-strength codeine sales in the 14 months following re-scheduling, -4.0% (95% CI = -19.6 to 14.6%).
CONCLUSIONS: Codeine re-scheduling in Australia appears to have reduced codeine misuse and sales.
Affiliation :
School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
Autre(s) lien(s) :
Commentary p. 460-1
Cote :
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