Codeine-related deaths more than doubled in nine years; most accidental overdose, researchers say

There has been a significant jump in the number of codeine-related deaths in Australia, new research has revealed. A study, published in the Medical Journal of Australia, found fatalities involving the pain medicine more than doubled between 2000 and 2009. The deaths increased from 53 in 2000 to more than 155 in 2009. Australian Medical Association vice president Dr Stephen Parnis said many of the deaths were caused when patients were on several strong pain medications. “We have people on multiple medications because it actually does improve a number of chronic problems and averts things getting worse and keeps them alive and well,” he said. “But the problem is the more drugs you are on, the more interactions you have. That is a challenge for doctors, let alone patients who have less of an understanding of medications.” Report author Amanda Roxburgh, from the National Drug and Alcohol Research Centre at the University of New South Wales, said the biggest increase was in the number of accidental overdoses. “Of the 1,437 deaths in the study, just under half were attributed to accidental overdose,” Ms Roxburgh said. Many of the patients who died were taking other drugs including alcohol, and other strong painkillers that act on the central nervous system. “Those who accidentally overdosed were more likely to have a history of substance use problems, chronic pain and injecting drug use,” Ms Roxburgh said. People who use codeine-based pain medications for long periods can develop dependence on the drug. It can also lead to gastrointestinal disease and liver toxicity. Dr Parnis said mitigating those risks involved improving both doctor and patient education. “We need better education within the community,” he said. “We need better opportunities, I think, for doctors to understand the harms of polypharmacy and we need a greater deal of controls and resourcing into managing the harms of not just codeine but other narcotics.” The Federal Government’s medicines regulator — the Therapeutic Goods Administration (TGA) — has been considering whether to reclassify drugs such as Nurofen Plus or Panadeine Extra because of the risk of harm, addiction or overdose. The interim report from its Advisory Committee on Medicines Scheduling recommends making codeine-based products prescription-only from June next year. Dr Parnis said that would be a step in the right direction, but it must be accompanied by other measures. “There needs to be real time prescription monitoring of codeine use and there also needs to be improved services in the community for the management of chronic pain,” he said. But the Consumers Health Forum said it believed restricting access to codeine-based painkillers would work against some patients. Acting chief executive Jo Root said it could disadvantage patients with chronic pain who could not get an appointment to see a doctor. “We believe the majority of users, particularly those using it for ongoing or chronic pain, are using it reasonably, and they would be unnecessarily penalised by this move,” she said. The final decision on access to codeine will be made in late November.

ABC News, 6 October 2015 ; ;