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Camacho X, Schaffer AL, Brett J, Pratt N, Buckley NA, Henry D, Pearson SA. Quality use of publicly subsidised tapentadol in Australia: a population-based analysis. Intern Med J 2024; 54:941-950. [PMID: 38299430 DOI: 10.1111/imj.16335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 12/22/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Sustained-release (SR) tapentadol was listed on Australia's Pharmaceutical Benefits Scheme (PBS) in 2014 for chronic severe pain requiring long-term opioid treatment. Dispensings have increased since listing despite declining trends in other PBS-listed opioids. Preferential prescribing of SR opioids may increase the risk of dependence and accidental overdose, particularly when used to treat acute pain. AIMS To explore the quality use of publicly subsidised tapentadol in Australia. METHODS We examined annual initiation rates and patterns of use of tapentadol (SR) in the dispensing records of a 10% random sample of PBS-eligible Australians (2014-2021). We used national tapentadol sales data to assess the proportion of sales attributable to the PBS. RESULTS Tapentadol initiation increased from 2014, peaking at 7.5/1000 adult population in 2019 before declining to 5.3/1000 in 2021. We identified 63 766 new users between 2014 and 2020, of whom 92.8% discontinued in the first year following initiation, 58.0% had only a single dispensing and 34.3% had no other opioids dispensed in the 3 months before or after initiation. 27.8% of new users were dispensed tapentadol on the same day as potentially interacting medicines. There was a sustained drop in the proportion of sales attributable to the PBS from June 2020 onwards, from an average of 69.1%, to 63.9% of pack sales. CONCLUSIONS Patterns of use suggest tapentadol (SR) is generally used for short duration. Although most tapentadol sold in Australia is subsidised, there is evidence of a shift towards private sales.
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Affiliation(s)
- Ximena Camacho
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- NHMRC Centre of Research Excellence in Medicines Intelligence, Sydney, New South Wales, Australia
| | - Andrea L Schaffer
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- NHMRC Centre of Research Excellence in Medicines Intelligence, Sydney, New South Wales, Australia
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jonathan Brett
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- NHMRC Centre of Research Excellence in Medicines Intelligence, Sydney, New South Wales, Australia
- Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Nicole Pratt
- NHMRC Centre of Research Excellence in Medicines Intelligence, Sydney, New South Wales, Australia
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Nicholas A Buckley
- NHMRC Centre of Research Excellence in Medicines Intelligence, Sydney, New South Wales, Australia
- Biomedical Informatics and Digital Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David Henry
- NHMRC Centre of Research Excellence in Medicines Intelligence, Sydney, New South Wales, Australia
- Institute for Evidence Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Sallie-Anne Pearson
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- NHMRC Centre of Research Excellence in Medicines Intelligence, Sydney, New South Wales, Australia
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Koch FC, Olivier J, Brett J, Buckley NA, Gisev N, Pearson S, Daniels B. The impact of tightened prescribing restrictions for PBS-subsidised opioid medicines and the introduction of half-pack sizes, Australia, 2020-21: an interrupted time series analysis. Med J Aust 2024; 220:315-322. [PMID: 38522006 DOI: 10.5694/mja2.52257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/12/2023] [Indexed: 03/25/2024]
Abstract
OBJECTIVES To evaluate the impact of the tightened Pharmaceutical Benefits Scheme (PBS) prescribing rules for immediate release (IR) and controlled release (CR) opioid medicines (1 June 2020), which also eliminated repeat dispensing without authorisation for codeine/paracetamol and tramadol IR and introduced half-pack size item codes for IR formulations. DESIGN, SETTING Population-based interrupted time series analysis of PBS dispensing data claims for a 10% sample of PBS-eligible residents and IQVIA national opioid medicine sales data (PBS-subsidised and private prescriptions), 28 May 2018 - 6 June 2021. MAIN OUTCOME MEASURES Mean amount of PBS-subsidised opioid medicines dispensed per day and mean overall amount sold per day - each expressed as oral morphine equivalent milligrams (OME) - overall, by formulation type (IR, CR), and by specific formulation. RESULTS During the twelve months following the PBS changes, daily PBS-subsidised opioid medicine dispensing was 81 565 OME lower (95% CI, -106 146 to -56 984 OME) than the mean daily level for 2018-20, a decline of 3.8% after adjusting for the pre-intervention trend; the relative reduction was greater for IR (8.4%) than CR formulations (2.6%). Total daily sales of all, IR formulation, and CR formulation opioid medicines did not change significantly after the PBS changes. Repeat dispensing of prescriptions comprised 7.4% of PBS-subsidised opioid dispensing before 1 June 2020, and 1.3% after the changes. Half-pack sizes comprised 8.4% of PBS-subsidised IR opioid medicine dispensing and 2.8% of all opioid medicines sold in the twelve months after the PBS changes. CONCLUSIONS The introduction of new PBS rules for subsidised opioid medicines was followed by a decline in PBS-subsidised dispensing. Some people may have bypassed the new restrictions by switching to private prescriptions, but our findings suggest that opioid medicine use in Australia declined as a result of the new restrictions.
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Affiliation(s)
| | - Jake Olivier
- University of New South Wales, Sydney, NSW
- Transport and Road Safety Research Centre, University of New South Wales, Sydney, NSW
| | | | | | - Natasa Gisev
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
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Mathias R, Howes B, Cock V, Cock C. Reduced gastrointestinal-related hospitalisation costs following rescheduling of over-the-counter codeine-containing compound analgesics in Australia: results of a single hospital audit in South Australia. Intern Med J 2023; 53:2240-2246. [PMID: 37029690 DOI: 10.1111/imj.16080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 03/27/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Codeine-containing compound analgesics (CCCAs) are associated with dependence and, when taken in excess, significant risks of harm. A previous audit showed significant costs related to admissions for gastrointestinal (GI) complications of CCCA. Based on this and other evidence of harm, the Australian Therapeutic Goods Administration changed CCCAs to prescription only in 2018. AIMS We aimed to identify the costs associated with codeine-related GI complications and whether the schedule change in 2018 led to a reduced clinical and financial strain on the health care system. METHODS We conducted an audit of GI admissions and associated costs of CCCAs at a tertiary teaching hospital in Adelaide between 2016 and 2020. Patients were grouped by 2-year time periods before (group 1) and following (group 2) schedule change. Costs for the index presentation were multiplied for subsequent presentations. Costs and outcomes were compared for groups (standard statistics; P value < 0.05 significant.) RESULTS: Three hundred forty patients (group 1, n = 164; group 2, n = 119) were identified, with the majority of these admitted due to nonsteroidal anti-inflammatory drugs (NSAIDs) only. For CCCAs (NSAID-containing), the same patients were admitted repeatedly with a reduction from 31 to eight admissions (P = 0.005), following rescheduling. The total cost of CCCA admissions was reduced from AU$ 561 691 for group 1 to AU$ 261 764 for group 2 (P < 0.001). CONCLUSIONS Australian rescheduling of CCCAs in 2018 resulted in a reduction in hospital admissions and costs related to GI complications. The cost savings, even in a single hospital department, were substantial.
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Affiliation(s)
- Ryan Mathias
- Department of Gastroenterology & Hepatology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Bejamin Howes
- Department of Gastroenterology & Hepatology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Victoria Cock
- Drug and Alcohol Services South Australia (DASSA), Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Charles Cock
- Department of Gastroenterology & Hepatology, Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, South Australia, Australia
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Bradlow RC, Hicks B, Mu T, Pham D, Sharkey M, Plumley N, Lubman DI, Arunogiri S. Management of opiate dependence related to dihydrocodeine-sorbitol misuse. Med J Aust 2023; 219:200-201. [PMID: 37543846 DOI: 10.5694/mja2.52060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/10/2023] [Accepted: 07/03/2023] [Indexed: 08/07/2023]
Affiliation(s)
| | | | | | | | | | | | - Dan I Lubman
- Turning Point, Melbourne, VIC
- Monash University, Melbourne, VIC
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Wijeratne T, Jenkins B, Stark RJ, Sun-Edelstein C. Assessing and managing medication overuse headache in Australian clinical practice. BMJ Neurol Open 2023; 5:e000418. [PMID: 37304309 PMCID: PMC10255228 DOI: 10.1136/bmjno-2023-000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/30/2023] [Indexed: 06/13/2023] Open
Abstract
More than 3 million Australians are estimated to have migraine disorders, and over a quarter of a million Australians are estimated to have medication overuse headache (MOH). The personal, societal and economic burden of MOH is high. MOH impacts an individual's ability to work or study, care for family or themselves, culminating in poor quality of life. Accurate and timely diagnosis and treatment of MOH are imperative. Withdrawal failures and relapse rates are high in MOH. Treatment of MOH is aimed at ceasing medication overuse and reducing monthly migraine days with the aim of achieving a pattern of well-controlled episodic migraine. Current treatment approaches in routine practice include withdrawal with preventive treatment, withdrawal with optional preventive treatment in the subsequent weeks and preventive treatment without withdrawal. This viewpoint article provides an overview of managing MOH in Australian clinical practice, with a focus on the importance of patient education and the role of preventive treatment in supporting patients as they withdraw from acute migraine medication(s).
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Affiliation(s)
- Tissa Wijeratne
- Department of Neurology, Sunshine Hospital, St Albans, Victoria, Australia
- Department of Medicine, Sunshine Hospital, St Albans, Victoria, Australia
- The Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
- Department of Psychology, RMIT University, Melbourne, Victoria, Australia
| | - Bronwyn Jenkins
- Department of Neurology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Richard J Stark
- Department of Neurology and Neurosciences, Alfred Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Neurology, Monash University, Clayton, Victoria, Australia
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Noghrehchi F, Cairns R, Buckley NA. Hospital admissions for paracetamol poisoning declined following codeine re-scheduling in Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 116:104040. [PMID: 37116402 DOI: 10.1016/j.drugpo.2023.104040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/30/2023] [Accepted: 04/18/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Codeine was restricted to prescription only in Australia in 2018. This intervention aimed to reduce harms from codeine dependance and use, including toxicity from co-formulated paracetamol. We aimed to quantify the impact of this intervention on paracetamol poisoning hospital admissions in a national hospital admissions database. METHODS We analyzed the number of paracetamol overdoses resulting in hospital admissions from the Australian Institute of Health and Welfare National Hospital Morbidity Database, January 2011 to June 2020. We used interrupted time series analysis to quantify the effect of codeine re-scheduling on the monthly number of paracetamol poisoning-related hospital admissions in Australia. We compared paracetamol poisonings with no opioid combinations, and poisonings with probable paracetamol-codeine combinations. RESULTS There was an immediate and sustained decrease (level shift) in the number of paracetamol poisoning-related hospital admissions following codeine re-scheduling (RR=0.85; 95% CI 0.80-0.89). This reduction was due to the decrease in poisonings with likely paracetamol-codeine combinations (RR=0.62; 95% CI 0.57-0.67) while there was no change in other paracetamol poisonings (RR=0.91; 95% CI 0.96-1.01). CONCLUSION Codeine re-scheduling in Australia appears to have reduced paracetamol poisoning-related hospital admissions.
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Affiliation(s)
- Firouzeh Noghrehchi
- Translational Australian Clinical Toxicology Research Group, Discipline of Biomedical Informatics & Digital Health, Sydney Medical School, University of Sydney, NSW, 2006, Australia.
| | - Rose Cairns
- NSW Poisons Information Centre, The Children's Hospital at Westmead, NSW, 2145, Australia; Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, NSW, 2006, Australia
| | - Nicholas A Buckley
- Translational Australian Clinical Toxicology Research Group, Discipline of Biomedical Informatics & Digital Health, Sydney Medical School, University of Sydney, NSW, 2006, Australia; NSW Poisons Information Centre, The Children's Hospital at Westmead, NSW, 2145, Australia
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Jung M, Cangadis‐Douglass H, Nielsen S, Lalic S, Dobbin M, Russell G, Prathivadi P, Wood P, Manias E, Lee CY, Arnold C, Kuleas M, Schumann JL, Ilomäki J, Bell JS. What are the research priorities for optimising the safe and effective use of opioids in Australian general practice? Drug Alcohol Rev 2023; 42:604-613. [PMID: 36065154 PMCID: PMC10946507 DOI: 10.1111/dar.13539] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/02/2022] [Accepted: 08/12/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Persistent high rates of prescription opioid use and harms remain a concern in Australia, Europe and North America. Research priority setting can inform the research agenda, strategic responses and evidence-based interventions. The objective of this study was to establish research priorities related to the safe and effective use of prescription opioids in general practice. METHODS Consumers, clinicians and policy makers were invited to participate in a structured consensus workshop in May 2021. A modified nominal group technique was used to explore research priorities for the safe and effective use of opioids in Australian general practice. Research priorities were identified, consolidated and prioritised using a structured process. RESULTS Seventeen consumer, medical, pharmacy, nursing, allied health and policy participants generated 26 consolidated priorities across three domains: (i) consumer-focused priorities; (ii) clinician and practice-focused priorities; and (iii) system and policy-focused priorities. The highest ranked research priorities in each of the domains were consumer characteristics that influence opioid prescribing and outcomes, opioid deprescribing strategies, and system-level barriers to prescribing alternatives to opioids, in the consumer, clinician and practice, and system and policy domains, respectively. DISCUSSION AND CONCLUSION The priorities reflect opportunities for research priority setting within Australian general practice. The priorities provide a map for future qualitative and quantitative research that will inform safe and effective opioid prescribing.
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Affiliation(s)
- Monica Jung
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityMelbourneAustralia
| | - Helena Cangadis‐Douglass
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityMelbourneAustralia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
| | - Samanta Lalic
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityMelbourneAustralia
- Pharmacy DepartmentMonash HealthMelbourneAustralia
| | - Malcolm Dobbin
- Department of Forensic MedicineMonash UniversityMelbourneAustralia
| | - Grant Russell
- Department of General PracticeMonash UniversityMelbourneAustralia
| | | | - Pene Wood
- Department of Pharmacy and Biomedical ScienceLa Trobe UniversityBendigoAustralia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health TransformationDeakin UniversityMelbourneAustralia
- Department of Nursing, School of Health SciencesThe University of MelbourneMelbourneAustralia
- Department of MedicineRoyal Melbourne HospitalMelbourneAustralia
| | - Cik Y. Lee
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityMelbourneAustralia
- Department of Nursing, School of Health SciencesThe University of MelbourneMelbourneAustralia
| | - Carolyn Arnold
- Caulfield Pain Management and Research CentreAlfred HealthMelbourneAustralia
- Department of Anaesthesiology and Perioperative Medicine, Central Clinical SchoolMonash UniversityMelbourneAustralia
| | | | - Jennifer L. Schumann
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
- Department of Forensic MedicineMonash UniversityMelbourneAustralia
- Drug Intelligence UnitVictorian Institute of Forensic MedicineMelbourneAustralia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityMelbourneAustralia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - J. Simon Bell
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityMelbourneAustralia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
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Tscharke BJ, O'Brien JW, Ahmed F, Nguyen L, Ghetia M, Chan G, Thai P, Gerber C, Bade R, Mueller J, Thomas KV, White J, Hall W. A wastewater-based evaluation of the effectiveness of codeine control measures in Australia. Addiction 2023; 118:480-488. [PMID: 36367203 PMCID: PMC10099390 DOI: 10.1111/add.16083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/24/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND AIM From 1 February 2018, codeine was rescheduled from an over-the-counter (OTC) to a prescription-only medicine in Australia. We used wastewater-based epidemiology to measure changes in population codeine consumption before and after rescheduling. METHODS We analysed 3703 wastewater samples from 48 wastewater treatment plants, taken between August 2016 and August 2019. Our samples represented 10.6 million people, 45% of the Australian population in state capitals and regional areas in each state or territory. Codeine concentrations were determined by liquid chromatography-tandem mass spectrometry and converted to per-capita consumption estimates using the site daily wastewater volume, catchment populations and codeine excretion kinetics. RESULTS Average per-capita consumption of codeine decreased by 37% nationally immediately after the rescheduling in February 2018 [95% confidence interval (CI) = 35.3-39.4%] and substantially in all states between 24 and 51% (95% CI = 22.4-27.0% and 41.8-59.4%). The decrease was sustained at the lower level to August 2019. Locations with least pharmacy access decreased by 51% (95% CI = 41.7-61.7%), a greater decrease than 37% observed for those with greater pharmacy access (95% CI = 35.1-39.4%). Regional areas decreased by a smaller margin to cities (32 versus 38%, 95% CI = 30.2-34.1% versus 34.9-40.4%, respectively) from a base per-capita usage approximately 40% higher than cities. CONCLUSION Wastewater analysis shows that codeine consumption in Australia decreased by approximately 37% following its rescheduling as a prescription-only medicine in 2018. Wastewater-based epidemiology can be used to evaluate changes in population pharmaceutical consumption in responses to changes in drug scheduling.
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Affiliation(s)
- Benjamin J Tscharke
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Queensland, Australia
| | - Jake W O'Brien
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Queensland, Australia
| | - Fahad Ahmed
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Queensland, Australia
| | - Lynn Nguyen
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Maulik Ghetia
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Gary Chan
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Queensland, Australia
| | - Phong Thai
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Queensland, Australia
| | - Cobus Gerber
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Richard Bade
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Jochen Mueller
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Queensland, Australia
| | - Kevin V Thomas
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Queensland, Australia
| | - Jason White
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Wayne Hall
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Queensland, Australia.,National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Queensland, Australia
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Chiappini S, Ceci F, Mosca A, Di Carlo F, Burkauskas J, Pettorruso M, Martinotti G, Guirguis A, Corkery JM, Scherbaum N, Schifano F, Di Giannantonio M. Knowledge and Use of Over-the-counter Drugs in Italy: An Exploratory Survey-based Study in the General Population. Curr Neuropharmacol 2023; 21:133-141. [PMID: 35838215 PMCID: PMC10193759 DOI: 10.2174/1570159x20666220714104231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/29/2022] [Accepted: 07/12/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND During the past decade, the misuse of over-the-counter (OTC) medicines has become a global public health concern, especially among young people. In this study, we aimed to explore the OTC consumption and related misuse in Italy and identify the demographic characteristics of people/individuals involved in this phenomenon, understanding eventual risk factors. METHODS The study consisted of an anonymous online survey distributed by direct contact and via the Internet between June-November 2021 to the general population living in Italy. Descriptive statistics were reported, and binary regression analyses were performed to identify risk factors for lifetime misuse of OTC. The University of Hertfordshire approved the study (aLMS/SF/UH/02951). RESULTS The final sample size was composed of 717 respondents. The sample was mainly represented by female (69.3%) students (39.9%) in the 20-25 years age group (30.0%). Based on the survey responses, study participants were divided into two groups according to the presence/absence of OTC abuse/misuse (127 versus 590), which were compared for possible predictors of OTC diversion. Multivariate regression showed that OTC abuse/misuse was associated with the knowledge of the effects of OTC [odds ratio/OR = 2.711, 95%Confidence Interval/CI 1.794-4.097, p <0.001]. On the contrary, the educational level appeared to be a protective factor [OR = 0.695, 95%CI 0.58-0.94, p = 0.016]. CONCLUSION Although, according to our data, the phenomenon of OTC abuse appeared to be limited, increasing attention is needed because of possible underestimation and high-risk outcomes. Preventive strategies, including simplified access to information, may play a key role in limiting OTC misuse.
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Affiliation(s)
- Stefania Chiappini
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti- Pescara, Italy
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9AB, UK
| | - Franca Ceci
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti- Pescara, Italy
| | - Alessio Mosca
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti- Pescara, Italy
| | - Francesco Di Carlo
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti- Pescara, Italy
| | - Julius Burkauskas
- Laboratory of Behavioural Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, 00142 Palanga, Lithuania
| | - Mauro Pettorruso
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti- Pescara, Italy
| | - Giovanni Martinotti
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti- Pescara, Italy
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9AB, UK
| | - Amira Guirguis
- Swansea University Medical School, The Grove, Swansea University, Swansea, SA2 8PP, UK
| | - John M Corkery
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9AB, UK
| | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Addictive Behaviour and Addiction Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9AB, UK
| | - Massimo Di Giannantonio
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti- Pescara, Italy
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10
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Sales of Over-the-Counter Products Containing Codeine in 31 Countries, 2013–2019: A Retrospective Observational Study. Drug Saf 2022; 45:237-247. [DOI: 10.1007/s40264-021-01143-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 12/13/2022]
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11
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Parkinson B, Cutler H. Application of an economic evaluation approach to making regulatory decisions regarding access to medicines: advantages, challenges and recommendations. AUST HEALTH REV 2021; 46:143-149. [PMID: 34903326 DOI: 10.1071/ah20208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 04/16/2021] [Indexed: 11/23/2022]
Abstract
Initially patients require a prescription to access most new medicines. Some medicines may later be reclassified, allowing patients to access them without a prescription. Currently, Australian Therapeutic Goods Administration guidelines regarding reclassification decisions focus on patient risk rather than on potential benefits to patient health and the healthcare system. We conducted two extensive case studies demonstrating an economic evaluation approach to medicine reclassification in Australia, which were presented at various conferences and to key stakeholders. This article discusses the advantages and challenges of using an economic evaluation approach to inform medicine reclassification decisions. Advantages identified include systematically and transparently synthesising evidence from multiple sources; predicting the overall expected impact of reclassification on health outcomes and costs before it occurs; considering a broader range of risks and benefits; aggregation of health impacts into a single measure (quality-adjusted life years); identification of drivers of uncertainty; insight into the effects of different regulatory decisions; and improved consistency of evidence. Challenges include data availability and quality, estimating behavioural changes, model complexity, the lack of an incremental cost-effectiveness ratio threshold, and funding of economic analyses. We recommend that regulatory decision makers use an economic evaluation approach to help inform reclassification decisions, although economic evaluation results should be considered as part of the broader body of evidence. Ultimately, the use of an economic evaluation approach will contribute to helping decision makers maximise population health outcomes in an efficient way.What is known about the topic?In the past, decisions regarding medicine reclassification have generally been made using a deliberative approach focusing on patient risk. However, there are also potential benefits to patient health and effects on the healthcare system. Increasing awareness of these benefits have led to the development of alternative approaches to decision making, including an economic evaluation approach.What does this paper add?This article discusses the advantages and challenges of using an economic evaluation approach to inform medicine reclassification decisions compared with alternative approaches.What are the implications for practitioners?Economic evaluation results should be considered as part of the broader body of evidence regarding the types of health impacts, the extent of the available evidence, who will be affected, and the role of medical practitioners and pharmacists in mitigating any risks. However, awareness of the advantages and challenges of this approach in advance will help mitigate some of the challenges and increase acceptance of the economic evaluation results by decision makers and stakeholders.
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Affiliation(s)
- Bonny Parkinson
- Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia; and Corresponding author
| | - Henry Cutler
- Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia
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Daniels B, Schaffer A, Buckley NA, Bruno C, Jun M, Pearson SA, Zoega H. The impact of tightened prescribing restrictions on proton pump inhibitor use in Australia: An evaluation using interrupted time series analysis. Pharmacoepidemiol Drug Saf 2021; 31:370-378. [PMID: 34894368 DOI: 10.1002/pds.5395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/23/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022]
Abstract
AIM In May 2019, Australia's Pharmaceutical Benefits Scheme (PBS) tightened the prescribing restrictions for publicly subsidized high and standard strength proton-pump inhibitors (PPIs). We aimed to determine the impacts on PPI use in Australia. METHODS Population-based interrupted time series analysis of PBS dispensing claims for a 10% sample of PBS-eligible Australian residents from January 2017 to December 2020 and national prescription and over-the-counter sales to pharmacies from January 2017 to October 2020. We examined trends in monthly PPI dispensings, switches from higher to lower strength formulations, and volume (kg) dispensed and sold. RESULTS From May 2019, we observed a small, immediate decrease (-7830 [95%CI: -8818 to -6842]) in standard strength PPI dispensings/month, which rebounded to exceed pre-intervention levels by December 2020. High strength dispensings decreased until the end of the study period to less than half their pre-intervention average/month; low strength dispensings/month increased until the end of the study period to more than double their pre-intervention average/month. We observed transient increases in switches to lower strength formulations post-intervention. The kilograms of PPIs sold/month followed a similar pattern to PBS kilograms dispensed/month with the exception of standard strength formulations where PBS dispensings decreased by -74 (95%CI: -93 to -55) but total sales remained unchanged (comprising PBS and private prescriptions, and over-the-counter sales). CONCLUSIONS Tightened prescribing restrictions had an immediate and sustained impact on PPI use in Australia, with decreased high strength use and increased low strength use. Some patients likely switched to private market prescriptions for standard strength PPI, given the observed patterns in total volume sold/dispensed.
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Affiliation(s)
- Benjamin Daniels
- Medicines Policy Research Unit, Centre for Big Data Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Andrea Schaffer
- Medicines Policy Research Unit, Centre for Big Data Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Nicholas A Buckley
- Clinical Pharmacology and Toxicology Research Group, Discipline of Pharmacology, University of Sydney, Sydney, New South Wales, Australia
| | - Claudia Bruno
- Medicines Policy Research Unit, Centre for Big Data Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Min Jun
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sallie-Anne Pearson
- Medicines Policy Research Unit, Centre for Big Data Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Helga Zoega
- Medicines Policy Research Unit, Centre for Big Data Research in Health, UNSW Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine, Centre of Public Health Sciences, University of Iceland, Reykjavík, Iceland
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Yu Y, Wilson M, King CE, Hill R. Up-scheduling and codeine supply in Australia: analysing the intervention and outliers. Addiction 2021; 116:3463-3472. [PMID: 33999465 DOI: 10.1111/add.15566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/24/2021] [Accepted: 04/30/2021] [Indexed: 11/27/2022]
Abstract
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 -4.4% [95% confidence interval (CI) = -6.6 to -2.1%] in high-dose codeine in 2015, followed by shifts in low-dose codeine of -40.0% (CI = -46.9 to -32.3%) and -82.2% (CI = -84.3 to -79.9%), 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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Affiliation(s)
- Yan Yu
- Medicines Regulation Division, Therapeutic Goods Administration, Department of Health, Australia
| | - Margaret Wilson
- Medicines Regulation Division, Therapeutic Goods Administration, Department of Health, Australia
| | - Clare E King
- Medicines Regulation Division, Therapeutic Goods Administration, Department of Health, Australia
| | - Richard Hill
- Medicines Regulation Division, Therapeutic Goods Administration, Department of Health, Australia
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Boone CG, Antoniou T, Juurlink DN, von den Baumen TR, Kitchen SA, Richards GC, Tadrous M, Gomes T. The impact of proposed regulatory changes and rescheduling on low-dose codeine purchasing in Canada: a time-series analysis. CMAJ Open 2021; 9:E1181-E1186. [PMID: 34906994 PMCID: PMC8687488 DOI: 10.9778/cmajo.20210173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Low-dose codeine products can be purchased without a prescription in most of Canada. We explored trends in the purchasing of these products across the Canadian provinces from 2014 to 2019, evaluating the impact of Health Canada's 2016 announcement of a proposed regulatory change and the 2017 opening of a 60-day public comment period, as well as the impact of Manitoba's 2016 policy change requiring a prescription for the purchase of all codeine products in that province. METHODS We evaluated population-adjusted monthly purchasing of codeine products from January 2014 to October 2019 using the IQVIA Canadian Drug Store and Hospital Purchases Audit database, stratified by province and over-the-counter (OTC) status. The primary outcomes were change in the monthly volume of low-dose codeine purchased after the 2016 federal regulatory proposal and the 2017 period of public comment across the provinces. Our secondary analysis was the impact of Manitoba's policy change in February 2016 requiring a prescription for low-dose codeine. We conducted a time-series analysis using interventional autoregressive integrated moving average models. RESULTS Over the study period, 24 120 kg of codeine (3.025 billion units) and 937 867 kg of acetaminophen were sold as OTC, low-dose codeine products across the Canadian provinces. Health Canada's 2016 announcement did not significantly affect OTC codeine purchasing (p = 0.57). The initiation of a 60-day public comment period was associated with a roughly 44% decrease in OTC codeine purchasing (p = 0.03). In Manitoba, purchasing of the same codeine formulations decreased after rescheduling in February 2016 (p < 0.001). We observed no significant change in the rate of purchasing of higher dose codeine formulations in response to scheduling changes in Manitoba (p = 0.22). INTERPRETATION Although Health Canada's 2016 announcement of a proposed regulatory change did not appear to have an effect on OTC codeine purchasing nationally, the 60-day comment period was associated with a decrease in purchasing. Further, Manitoba's 2016 policy change was associated with a significant and sustained decrease in the overall volume of codeine purchased. Given the potential risks of codeine dependence and acetaminophen toxicity with these products, a national rescheduling strategy should be considered.
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Affiliation(s)
- Charlotte G Boone
- Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael's Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women's College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont
| | - Tony Antoniou
- Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael's Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women's College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont
| | - David N Juurlink
- Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael's Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women's College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont
| | - Teagan Rolf von den Baumen
- Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael's Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women's College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont
| | - Sophie A Kitchen
- Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael's Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women's College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont
| | - Georgia C Richards
- Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael's Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women's College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont
| | - Mina Tadrous
- Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael's Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women's College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont
| | - Tara Gomes
- Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael's Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women's College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont.
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Bishop M, Schumann JL, Gerostamoulos D, Wong A. The impact of codeine upscheduling on overdoses, Emergency Department presentations and mortality in Victoria, Australia. Drug Alcohol Depend 2021; 226:108837. [PMID: 34216868 DOI: 10.1016/j.drugalcdep.2021.108837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/01/2021] [Accepted: 05/05/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND AIMS Prior to February 2018, codeine was available over-the-counter (OTC) in Australia as a pharmacist-only medicine (Schedule 3) in low-strength formulations when in combination with simple analgesics. In February 2018, The Advisory Committee on Medicines Scheduling (ACMS) upscheduled codeine-containing medicines (CCM) to Schedule 4 (prescription-only medicine). This study aimed to determine the impact of upscheduling on prescriptions, overdoses and deaths. METHODS This study used interrupted time series analysis, a quasi-experimental design, to retrospectively evaluate the impact of upscheduling on overdose poisoning calls to the Victorian Poisons Information Centre (VPIC), Emergency Department (ED) presentations to Austin Health, and deaths reported to the Victorian Coroner from 1 January 2013-31 December 2019. RESULTS There was a significant reduction in the trend of high-strength codeine poisoning calls by 0.36 (P = 0.03, 95 % CI = [-0.69, -0.04]). Low-strength codeine poisoning calls to the VPIC reduced by 13.31 (P <0.001, 95 % CI = [-16.80, 9.82]]) calls in February 2018, followed by continued reduction of 0.12 calls per month. High-strength codeine overdose ED presentations reduced in the first quarter of 2018 by 3.72 presentations (P = 0.004, 95 % CI = [-6.13, -1.31]). Low-strength codeine overdose ED presentations after the first quarter of 2018 by 0.33 (P = 0.03, 95 % CI = [-0.63, -0.03]) presentations per month. Codeine-related deaths reduced by 7.19 (P < 0.001, 95 % CI = [-9.44, -4.94]) deaths in February 2018. CONCLUSIONS Codeine upscheduling to prescription-only medicine has reduced codeine-related poisoning calls, overdoses and unnatural death in Victoria.
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Affiliation(s)
- Milly Bishop
- The Royal Melbourne Hospital, 300 Grattan Street, Parkville, 3050, Australia.
| | - Jennifer L Schumann
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, VIC, 3006, Australia; Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, VIC, 3006, Australia
| | - Dimitri Gerostamoulos
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, VIC, 3006, Australia; Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, VIC, 3006, Australia
| | - Anselm Wong
- Victorian Poisons Information Centre and Emergency Department, Austin Health, Victoria, Australia; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia; Centre for Integrated Critical Care, The University of Melbourne, Victoria, Australia
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Elphinston RA, Connor JP, de Andrade D, Hipper L, Freeman C, Chan G, Sterling M. Impact of a policy change restricting access to codeine on prescription opioid-related emergency department presentations: an interrupted time series analysis. Pain 2021; 162:1095-1103. [PMID: 33086287 DOI: 10.1097/j.pain.0000000000002115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/12/2020] [Indexed: 12/22/2022]
Abstract
ABSTRACT Codeine is one of the most commonly used opioid analgesics. Significant codeine-related morbidity and mortality prompted regulatory responses, with the up-scheduling of codeine combination analgesics to prescription-only medicines implemented in Australia in February 2018. This study investigated the impact of codeine up-scheduling on the number of codeine and other (noncodeine) prescription opioid-related emergency department (ED) presentations in a large metropolitan tertiary hospital. Clinical features of these presentations were also examined. Interrupted time series analyses assessed monthly changes in ED presentations from June 2016 to November 2019. In the month immediately after up-scheduling, there was a significant reduction of 3.97 codeine-related presentations (B = -3.97, P = 0.022), indicating a 29.66% level change, followed by a significant change in trend to fewer monthly codeine-related presentations (B = -0.38, P = 0.005). Noncodeine prescription opioid-related (B = -1.90, P = 0.446) and ED presentations overall (B = -118.04, P = 0.140) remained unchanged immediately post-up-scheduling, with a significant change in trend from upward to downward for noncodeine (B = -0.76; P = 0.002) and ED presentations overall (B = -19.34, P = 0.022). A significant reduction of 4.58 (B = -4.58, P = 0.009) in codeine presentations involving subsequent hospital admission immediately post-up-scheduling was found; but no immediate reduction in codeine-related suicide-related overdoses, length of inpatient stay, or re-presentations (P > 0.0125; adjusted for multiple comparisons). Restricting supply of codeine to prescription-only may have resulted in less harmful codeine-related use in the community, without a corresponding immediate decrease in other opioid-related harms.
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Affiliation(s)
- Rachel A Elphinston
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
- Addiction and Mental Health Service, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
- National Health and Medical Research Council Centre for Research Excellence in Road Traffic Injury Recovery, The University of Queensland, Brisbane, Australia
| | - Jason P Connor
- Discipline of Psychiatry, The University of Queensland, Brisbane, Australia
- National Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, Australia
| | - Dominique de Andrade
- School of Psychology, The University of Queensland, Brisbane, Australia
- School of Psychology, Deakin University, Geelong, Melbourne, Australia
| | - Linda Hipper
- Addiction and Mental Health Service, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Chris Freeman
- School of Pharmacy, The University of Queensland, Brisbane, Australia
| | - Gary Chan
- National Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
- National Health and Medical Research Council Centre for Research Excellence in Road Traffic Injury Recovery, The University of Queensland, Brisbane, Australia
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Outcomes associated with scheduling or up-scheduling controlled substances. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 91:103110. [PMID: 33476862 DOI: 10.1016/j.drugpo.2021.103110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/30/2020] [Accepted: 12/31/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Many nations place drugs into various "schedules" according to their risk of abuse and/or recognized medical value that vary in terms of their restrictions. To mitigate diversion or abuse, drugs sometimes get rescheduled or are scheduled for the first time. Until now, there have not been efforts to integrate lessons from across the range of such past events. METHODS AND DATA We searched for peer-reviewed evaluations of instances of (re-)scheduling drugs in the United States after 1969 and a comparably large set of instances from other countries. Those 109 articles were supplemented by 30 others found in other ways but not meeting those search criteria (e.g., because the information on rescheduling was a minor part of a more general article). FINDINGS Findings are reported for many outcomes and with diverse measures over different timelines, making standardization of outcomes difficult. For more than half of the events for which quantitative outcomes were reported, there were declines in use-related measures by at least 40 percent. It is common for there to be reports of increases in indicators pertaining to other substances, sometimes more dangerous but sometimes less dangerous; overall, substitution appears to occur, but be partial. CONCLUSION Scheduling and up-scheduling can - though does not always - have substantial effects on a range of outcomes. Substitution to other substances is a possibility and so should be anticipated.
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Dobbin MD. From over‐the‐counter to prescription only: early results of the rescheduling of codeine combination analgesics. Med J Aust 2020; 212:305-306. [DOI: 10.5694/mja2.50560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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