Changes in sales of analgesics to pharmacies after codeine was rescheduled as a prescription only medicine

Schaffer, Andrea L; Cairns, Rose; Brown, Jared A; Gisev, Natasa; Buckley, Nicholas A; Pearson, Sallie‐Anne

doi:10.5694/mja2.50552

Cited by 28 publications

(25 citation statements)

References 17 publications

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“…Preliminary data checks suggested comparability of the annual pack numbers and monthly weight fluctuations with previously published IQVIA data [4,14,15]. The monthly series also demonstrated expected seasonal patterns.…”

Section: Discussionsupporting

confidence: 52%

“…The purpose of the study was to analyse codeine supply changes associated with up-scheduling in Australia. Previous analyses of pharmaceutical wholesale data found substantial reductions in codeine supply after February 2018 [13][14][15]. Under stable conditions, the wholesale supplies to retail outlets should reflect consumption.…”

Section: Introductionmentioning

confidence: 99%

“…Research into the illicit drug methamphetamine, for example, found that the purity of the drug decreased several months before restrictions on the precursor chemicals were put in place, suggesting precursor suppliers' anticipation of government regulations [16]. Codeine supplies fluctuated wildly in the months surrounding TGA's final decision and implementation of up-scheduling, but were not included in previous evaluation studies [13][14][15]. Thus, a complete picture of how Australia's codeine consumption responded to regulation was missing.…”

Section: Introductionmentioning

confidence: 99%

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Up‐scheduling and codeine supply in Australia: analysing the intervention and outliers

Yu¹,

Wilson²,

King³

et al. 2021

Addiction

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Background and aims Over-the-counter codeine products were up-scheduled to prescription only in Australia from February 2018. This trend study aimed to identify changes in codeine supply before and after the February 2018 implementation. Design, setting and cases Time-series regression analysis of monthly medicine supplies in Australia from 2014 to 2018. The February 2018 up-scheduling was pre-specified as the intervention; outlier analysis was used to detect automatically sudden unexpected changes before February 2018. Measurements Per-capita supplies based on national data for pharmaceutical wholesales and population exposure. Weight of supplies in milligrams for low-dose codeine (≤ 15 mg per tablet or ≤ 1.92 mg per ml, originally sold over the counter but up-scheduled after February 2018), high-dose combination codeine (30 mg per tablet, prescription only throughout the study period) and all codeine.Findings Several level shifts in supply occurred during the 5 years, led by one of À4.4% [95% confidence interval (CI) = À6.6 to À2.1%] in high-dose codeine in 2015, followed by shifts in low-dose codeine of À40.0% (CI = À46.9 to À32.3%) and À82.2% (CI = À84.3 to À79.9%), respectively, before and after February 2018. High-dose codeine supply increased by 4.4% (CI = 1.8-7.1%) immediately after up-scheduling. Also detected were transient increases and decreases in 2016 and 2017. Compared with pre-2015 levels, the February 2018 up-scheduling was associated with reductions of 45.7% (CI = 43.2-48.0%) and 89.3% (CI = 87.9-90.6%), respectively, in all and low-dose codeine supply but no change in high-dose codeine supply. The level shifts and transient changes were located around various regulatory activities, including public announcements and expert advisory meetings on up-scheduling. Conclusion Up-scheduling of over-the-counter codeine products in Australia in 2018 appears to have been associated with a near halving of Australia's national codeine supply. The transition occurred in multiple forms and phases.

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Section: Discussionsupporting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Up‐scheduling and codeine supply in Australia: analysing the intervention and outliers

Yu¹,

Wilson²,

King³

et al. 2021

Addiction

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“…As rates of problematic opioid use and overdose grow in high income countries, epidemiologic signals of exposure and harm have increased year by year. It is therefore encouraging to read evidence of a downward trend for one category of this complex crisis described in two papers in this issue of the Journal …”

mentioning

confidence: 98%

“…The two studies reported in this issue of the Journal provide preliminary indications that rescheduling has not led to the adverse outcomes feared by opponents of upscheduling. Schaffer and her colleagues examined national pharmaceutical sales data before and after rescheduling, and found that the loss of OTC codeine sales was largely offset by increases in those of over‐the‐counter non‐opioid analgesics (paracetamol, ibuprofen, and their combinations), with only a small increase in sales of prescription codeine and none in those of stronger opioids. This finding is consistent with another recent study that found a large decrease in overall codeine use and no marked increase in that of prescription codeine or stronger opioids …”

mentioning

confidence: 99%

From over‐the‐counter to prescription only: early results of the rescheduling of codeine combination analgesics

Dobbin

2020

Medical Journal of Australia

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2 Schaffer AL, Cairns R, Brown J, et al. Changes in pharmaceutical sales to pharmacies after codeine was rescheduled a prescription only medicine. Med J Aust 2020; 212: 321-327. 3 Harris K, Jiang A, Knoeckel R, Isoardi KZ. Rescheduling codeine-containing analgesics reduced codeine-related hospital presentations. Med J Aust 2020; 212: 328. 4 Degenhardt L, Gisev N, Cama M, et al. The extent and correlates of community-based pharmaceutical opioid utilisation in Australia. Pharmacoepidemiol Drug Saf 2016; 25: 521-538. 5 Annabel B, Scrymgeour M. Fork handles. Australas J Pharm 2017; 98: 74-75. 6 McAllister WB. The global political economy of scheduling: the international-historical context of the Controlled Substances Act. Drug Alcohol Depend 2014; 76: 3-8. 7 Derry S, Karlin SM, Moore RA. Single dose oral ibuprofen plus codeine for acute postoperative pain in adults. Cochrane Database Syst Rev 2015; CD010107. 8 Daniels SE, Goulder MA, Aspley S, Reader S. A randomised, five-parallelgroup, placebo-controlled trial comparing the efficacy and tolerability of analgesic combinations including a novel single-tablet combination of ibuprofen/paracetamol for postoperative dental pain. Pain 2011; 152: 632-642. 9 Cock V, Edmonds C, Cock C. Complications related to chronic supratherapeutic use of codeine containing compound analgesics in a cohort of patients presenting for codeine withdrawal. Drug Alcohol Rev 2018; 37: 731-737. 10 Frei MY, Nielsen S, Dobbin MDH, Tobin CL. Serious morbidity associated with misuse of over-the-counter codeine-ibuprofen analgesics: a series of 27 cases. Med J Aust 2010; 193: 294-296. https://www.mja.com.au/journ al/2010/193/5/serio us-morbi dity-assoc iated-misuse-over-count er-codei neibupr ofen-analg esics 11 Mill D, Johnson JL, Cock V, et al. Counting the cost of over-the-counter codeine containing analgesic misuse: a retrospective review of hospital admissions over a 5 year period. Drug Alcohol Rev 2018; 37: 247-256.

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Patterns of antidepressant use in people with low back pain: A retrospective study using workers' compensation data

Ferreira,

Di Donato,

Maher

et al. 2024

European Journal of Pain

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BackgroundAntidepressants are commonly used to treat low back pain (LBP), but little is known about patterns of antidepressant use in this population. This study aimed to identify patterns of antidepressant dispensing and switching in Australian workers with an accepted workers' compensation claim for LBP, and to investigate factors associated with dispensing and switching.MethodsThis retrospective study included data from accepted workers' compensation time loss claims for LBP between 2010 and 2018 with a 2‐year follow‐up. We described the type of antidepressant dispensed, the time for the index antidepressant to be dispensed, and whether people in the study switched to a different antidepressant. Logistic regression models investigated factors associated with antidepressants being dispensed for the first time and for switching to a different antidepressant.ResultsAntidepressants were dispensed to 2476 people with LBP (14%) at least once after a median (IQR) of 28 (10.9–54.7) weeks. Amitriptyline was the most dispensed antidepressant at any one point (47.8%), and the most common index antidepressant (42.9%). Also, 32.7% of people switched to a different antidepressant at least once. Sex, age, having been dispensed opioids, gabapentinoids or diazepam prior to antidepressants being dispensed, having used psychological services, and socioeconomic disadvantage were associated with antidepressant dispensing.ConclusionOne in seven people with LBP were dispensed an antidepressant, most commonly amitriptyline. Antidepressants were commonly used in combination with other pain medicines such as opioids, gabapentinoids and diazepam.SignificanceAntidepressants were dispensed to one in seven people with low back pain, most commonly amitriptyline followed by duloxetine. Antidepressants were typically dispensed after 6 months and after other medicines such as opioids, gabapentinoids and diazepam had been dispensed. Due to the administrative nature of the data, the study cannot infer whether antidepressants were dispensed to treat pain or other health problems, such as a mental health condition.

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Changes in sales of analgesics to pharmacies after codeine was rescheduled as a prescription only medicine

Abstract: Objective: To investigate changes in sales to pharmacies of over-the-counter (OTC) and prescription analgesics, cold and flu products, and cough suppressants after the rescheduling of codeine as a prescription only medicine in February 2018.

Cited by 28 publications

References 17 publications

Up‐scheduling and codeine supply in Australia: analysing the intervention and outliers

Up‐scheduling and codeine supply in Australia: analysing the intervention and outliers

From over‐the‐counter to prescription only: early results of the rescheduling of codeine combination analgesics

Patterns of antidepressant use in people with low back pain: A retrospective study using workers' compensation data

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