Sales of Over-the-Counter Products Containing Codeine in 31 Countries, 2013–2019: A Retrospective Observational Study

Richards, Georgia C; Aronson, Jeffrey K; MacKenna, Brian; Goldacre, Ben; Hobbs, FD Richard; Heneghan, Carl

doi:10.1007/s40264-021-01143-2

Cited by 18 publications

(19 citation statements)

References 75 publications

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“…In line with this research, we found that tramadol and codeine were the fourth and fifth most common opioids implicated in deaths. An analysis of over-the-counter sales of codeine in 31 countries also showed that the UK had the fourth highest rates of sales, 28 which may have contributed to the one in ten codeine-related PFD deaths we identified. A retrospective cohort study of adults in Glasgow, Scotland, showed that the co-occurrence of opioid dependence with homelessness, involvement with criminal justice services, and psychosis was associated with higher rates of premature mortality.…”

Section: Discussionmentioning

confidence: 82%

Preventable deaths involving opioids in England and Wales, 2013-2022: a systematic case series of coroners’ reports

Dernie

Thomas

Bilip³

et al. 2022

Preprint

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Background: Deaths from opioids have increased in England and Wales, despite recognition of their harms. Coroners Prevention of Future Death reports (PFDs) provide important insights that may enable safer use and avert harms, yet these reports involving opioids have not been synthesised. We, therefore, aimed to identify opioid-related PFDs and explore concerns expressed by coroners to prevent future deaths. Methods: In this systematic case series, we screened 3897 coronial PFDs dated between 01 July 2013 and 23 February 2022. These were obtained by web scraping the UKs Courts and Tribunals Judiciary website to create an openly available database: https://preventabledeathstracker.net/. PFDs were included when an opioid was implicated in the death. Included PFDs were descriptively analysed, and content analysis was used to assess concerns reported by coroners and responses to such concerns. Findings: Opioids were involved in 219 deaths reported by coroners in PFDs (6% of all PFDs), equating to 4418 years of life lost (mean 32 years/person). Morphine (29%), methadone (23%), and diamorphine (16%) were the most common implicated opioids. Coroners most frequently raised concerns regarding systems and protocols (52%) or safety issues (15%). These concerns were most often addressed to NHS organisations (51%), but response rates were low overall (47%). Interpretation: Opioids could be used more safely and appropriately if coroners' concerns in PFDs were addressed by national organisations such as NHS bodies, government agencies, and policymakers, as well as individual prescribing clinicians.

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Section: Discussionmentioning

confidence: 82%

Preventable deaths involving opioids in England and Wales, 2013-2022: a systematic case series of coroners’ reports

Dernie

Thomas

Bilip³

et al. 2022

Preprint

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“…The codeine OTC drug sales in 31 countries between 2013 and 2018 [ 12 ] show that what the Japanese spent per capita on codeine purchases ranked fourth, after Ireland, the United Kingdom, and Croatia. The increase in purchases per capita between 2013 and 2018 was the largest among the 31 countries, at over 1000%.…”

Section: Case Study Resultsmentioning

confidence: 99%

Over-the-Counter Drug Misuse and Dependence: Public Health Ethics’ Foray into Fight against the Codeine Crisis

Ino

Nakazawa

2022

Pharmacy

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Over-the-counter (OTC) drugs, such as codeine, are available as an OTC drug at common drugstores and major e-commerce platforms, despite their known propensity for causing psychological dependence and harm from overuse. Misuse of and dependence on over-the-counter drugs are serious public health issues. Possible measures include stricter regulation and control, as well as regulation of access to information and awareness activities, but their effectiveness is limited. Up-scheduling, in which OTC drugs are placed under prescription or full regulation, is expected to have a definite effect. However, up-scheduling poses public health ethical challenges. Up-scheduling restricts the freedom of consumers to purchase OTC drugs, and the economic right of manufacturers and sellers. Up-scheduling may also interfere with people’s right to seek self-care through the proper use of OTC drugs. Limited up-scheduling with respect to age may be an effective way to implement up-scheduling while avoiding ethical issues. However, from a public health perspective, it is necessary to improve the information infrastructure so that prescription drug information can be shared electronically, and to strengthen measures to prevent mental health problems among young people that lead to OTC drug misuse, even after up-scheduling.

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“…at pharmacies), purchased online or obtained illicitly. [2][3][4] There are also various conditions that opioids can be used for, including but not limited to, cancer pain, postoperative pain, chronic non-cancer pain, opioid dependence and withdrawal. [5][6][7][8][9] Despite being essential, opioids can cause a number of adverse events from minor (e.g.…”

Section: Introductionmentioning

confidence: 99%

Artificial intelligence and opioid use: a narrative review

Gadhia

Richards

Marriott

et al. 2022

Preprint

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BackgroundThere are concerns about the balance of benefits and harms in people using opioids for chronic non-cancer pain. Technologies using artificial intelligence (AI) are being developed to examine and optimise the use of opioids. Yet, this research has not been synthesised to determine the types of AI models being developed and the application of these models.MethodsWe aimed to synthesise studies exploring the use of AI in people taking opioids. We searched three databases: the Cochrane Database of Systematic Reviews, EMBASE, and Medline, on 4 January 2021. Studies were included if they were published after 2010, conducted in a real-life community setting involving humans, and used AI to understand opioid use. Data on the types and applications of AI models were extracted and descriptively analysed.ResultsEighty-one articles were included in our review, representing over 5.3 million participants and 14.6 million social media posts. Most (93%) studies were conducted in the USA. The types of AI technologies included natural language processing (46%) and a range of machine learning algorithms, the most common being random forest algorithms (36%). AI was predominately applied for the surveillance and monitoring of opioids (46%), followed by risk prediction (42%), pain management (10%), and patient support (2%). Few of the AI models were ready for adoption, with most (62%) being in preliminary stages.ConclusionsA variety of AI models are being developed and applied to understand opioid use. However, there is a need for these AI technologies to be externally validated and robustly evaluated to determine whether they can improve the use and safety of opioids.SUMMARY BOXKey PointsAcross the landscape of opioid research, natural language processing models (46%) and ensemble algorithms, particularly random forest algorithms (36%), were the most common types of AI technologies studied.There were four main domains that AI was applied to assess the use of opioids, including surveillance and monitoring (46%), risk prediction (42%), pain management (10%), and patient support (2%).The AI technologies were at various stages of development, validation, and deployment, with most (62%) models in preliminary stages, 11% required external validation, and few models were openly available to access (6%).

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Sales of Over-the-Counter Products Containing Codeine in 31 Countries, 2013–2019: A Retrospective Observational Study

Cited by 18 publications

References 75 publications

Preventable deaths involving opioids in England and Wales, 2013-2022: a systematic case series of coroners’ reports

Preventable deaths involving opioids in England and Wales, 2013-2022: a systematic case series of coroners’ reports

Over-the-Counter Drug Misuse and Dependence: Public Health Ethics’ Foray into Fight against the Codeine Crisis

Artificial intelligence and opioid use: a narrative review

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