Sales of codeine have halved in Australia since it became a prescription-only drug, and fears that the change would drive people toward stronger opioids appear to be unfounded.
The decision to ban over-the-counter sales of the opiate painkiller came amid a growing concern about the opioid epidemic sweeping through the US. Similar problems were emerging in Australia as codeine-related deaths had more than doubled in the decade to 2009.
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Before February 2018, Australians could buy low-dose codeine in combination with other painkillers such as paracetamol and ibuprofen without a prescription.
But codeine, like other opioids, can lead to dependence and tolerance. Consuming large amounts of codeine in these formulations also puts people at risk of harms from the other ingredients, including liver and gastrointestinal damage, blood potassium imbalances and heart attack.
While the ban was popular among doctor groups, critics warned it would put pressure on addiction services and lead to an uptick in demand for high-strength opioids.
Decreasing sales
Now an analysis of codeine sales by Australia鈥檚 Therapeutic Goods Administration has found that Australians only bought half as many packets of codeine-containing products once they became prescription-only, from an average of 35 million per year between 2014 and 2017, down to 17 million in 2018.
This is equivalent to 7000 kilograms of codeine less than would have been expected without the ban.
Nevertheless, sales of the higher strength, 30 milligram packets remained similar.
鈥淥ur analysis does not support the assertion that many patients were switched from low- to high-strength codeine medicines after up-scheduling,鈥� the Therapeutic Goods Administration said in a statement.
Suzanne Nielsen at Monash University, Australia, says her recent analysis of prescription data found no increase in other opioids being prescribed in the year following the ban compared to the two years prior either.
Codeine-based medications currently require prescriptions in countries such as the US, Germany and Japan, but can be purchased over-the-counter in the UK.
Aside from safety concerns, one of the reasons the Australian regulator gave for its decision was that evidence indicated low-dose codeine was no more effective than other available painkillers.
