Skip to main content

Advertisement

SpringerLink
Log in

Buprenorphine-Naloxone in the Treatment of Codeine Dependence: a Scoping Review of Clinical Case Presentations

  • Published:
International Journal of Mental Health and Addiction Aims and scope Submit manuscript

Abstract

Misuse of prescribed and over the counter (OTC) codeine containing medicines is an increasing public health concern in recent times. Studies have called for low threshold treatment services for individuals experiencing codeine dependence using buprenorphine naloxone therapy. We present a scoping review of clinical case presentation literature on the use of buprenorphine-naloxone in the treatment of codeine dependence. Seven records (four single case studies and three case series) on codeine dependence treated with buprenorphine-naloxone were included. Five themes emerged following a review of the cases for the treatment of codeine dependence with buprenorphine-naloxone. They are: (1) Patient Profiles; (2) History of Codeine Misuse; (3) Medical Problems; (4) Use of Other Substances; and (5) Buprenorphine-naloxone in the treatment of Codeine Dependence. The review highlights the complexities of patients with regards to pain, psychiatric illness, poly substance use and iatrogenic dependence, with findings encouraging in terms of patient stabilisation and recovery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Anderson, S., Allen, P., Peckham, S., & Goodwin, N. (2008). Asking the right questions: scoping studies in the commissioning of research on the organization and delivery of health services. Health Research Policy and Systems, 6, 1–12.

    Article  Google Scholar 

  • Arskey, H., & O’Malley, L. (2005). Scoping studies: towards a methodological framework. International Journal of Social Research Methodology, 8(1), 9–32.

    Google Scholar 

  • Babalonis, S., Lofwall, M. R., Nuzzo, P. A., Siegel, A. J., & Walsh, S. L. (2013). Abuse liability and reinforcing efficacy of oral tramadol in humans. Drug and Alcohol Dependence, 129(1–2), 116–124.

    Article  CAS  PubMed  Google Scholar 

  • Bergin, M., Norman, I., Foley, M., Harris, R., Rapca, A., Rich, E., & Van Hout, M. C. (2015). Practice implications and recommendations for managing codeine misuse and dependence. Acta Pharmaceutica, 65(4), 351–364.

    Article  CAS  PubMed  Google Scholar 

  • Brien, S. E., Lorenzetti, D. L., Lewis, S., Kennedy, J., & Ghali, W. A. (2010). Overview of a formal scoping review on health system report cards. Implementation Science, 15(5), 2.

    Article  Google Scholar 

  • Casati, A., Sedefov, R., & Pfeiffer-Gerschel, T. (2012). Misuse of medicines in the European Union: a systematic review of the literature. European Addiction Research, 18(5), 228–245. doi:10.1159/000337028.

    Article  PubMed  Google Scholar 

  • Conroy, S., & Hill, D. (2014). Failure to identify or effectively manage prescription opioid dependence acted as a gateway to heroin use—buprenorphine/naloxone treatment and recovery in a surgical patient. BMJ Case Reports, 17. doi:10.1136/bcr-2014-207458.

  • Cooper, R. J. (2011). ‘Respectable addiction’—A qualitative study of over the counter medicine abuse in the UK. London: Pharmacy Practice Research Trust.

    Google Scholar 

  • Cooper, R. J. (2013). ‘I can’t be an addict. I am.’ Over-the-counter medicine abuse: a qualitative study. BMJ Open, 3(6), e002913.

    Article  PubMed  PubMed Central  Google Scholar 

  • Daudt, H. M. L., van Mossel, C., & Scott, S. J. (2013). Enhancing the scoping study methodology: a large, inter-professional team’s experience with Arksey and O’Malley’s framework. BMC Medical Research Methodology, 13, 48.

    Article  PubMed  PubMed Central  Google Scholar 

  • Department of Health (England) and the developed administrations. (2007). Drug misuse and dependence: UK guidelines on clinical management. London: Department of Health (England), the Scottish Government, Welsh Assembly Government and Northern Ireland Executive.

    Google Scholar 

  • Derry, S., Karlin, S. M., & Moore, R. A. (2013). Single dose oral ibuprofen plus codeine for acute postoperative pain in adults. The Cochrane Database Systematic Review, 3. doi:10.1002/14651858.CD010107.pub2.

  • Dobbin, M., & Tobin, C. (2008). Over-the-counter (OTC) ibuprofen/codeine analgesics: Misuse and harm. Melbourne: Drugs Policy and Services Branch, Department of Human Services, Victoria.

    Google Scholar 

  • Dutch, M. J. (2008). Nurofen Plus misuse: an emerging cause of perforated gastric ulcer. Medical Journal of Australia, 188(1), 56–57.

    PubMed  Google Scholar 

  • Ernest, D., Chia, M., & Corallo, C. E. (2010). Profound hypokalaemia due to Nurofen Plus and Red Bull. Critical Care and Resuscitation, 12(2), 109–110.

    PubMed  Google Scholar 

  • Evans, C., Chalmers-Watson, T. A., & Gearry, R. B. (2010). Combination NSAID-codeine preparations and gastrointestinal toxicity. New Zealand Medical Journal, 123(1324), 92–93.

    PubMed  Google Scholar 

  • Fareed, A., Vayalapalli, S., Casarella, J., & Drexler, K. (2012). Effect of burprenorphine dose on treatment outcome. Journal of Addictive Diseases, 31(1), 8–18. doi:10.1080/10550887.2011.642758.

    Article  PubMed  Google Scholar 

  • Fiellin, D. A., Schottenfeld, R. S., Cutter, C. J., Moore, B. A., Barry, D. T., & O’Connor, P. G. (2014). Primary care-based buprenorphine taper vs maintenance therapy for prescription opioid dependence: a randomized clinical trial. JAMA Internal Medicine, 174(12), 1947–1954. doi:10.1001/jamainternmed.2014.5302.

    Article  PubMed  Google Scholar 

  • Fine, P. G., Portenoy, R. K., & Ad Hoc Expert Panel on Evidence Review and Guidelines for Opioid Rotation. (2009). Establishing ‘best practices’ for opioid rotation: conclusions of an expert panel. Journal of Pain and Symptom Management, 38(3), 418–425.

    Article  PubMed  PubMed Central  Google Scholar 

  • Frei, M. Y., Nielsen, S., Dobbin, M. D., & Tobin, C. L. (2010). Serious morbidity associated with misuse of over-the-counter codeine-ibuprofen analgesics: a series of 27 cases. The Medical Journal of Australia, 193(5), 294–296.

    PubMed  Google Scholar 

  • Gowing, L., Ali, R., Dunlop, A., Farrell, M., & Lintzeris, N. (2014). National guidelines for medication-assisted treatment of opioid dependence. Canberra: National Drug Strategy.

    Google Scholar 

  • Handley, S. A., & Flanagan, R. J. (2014). Drugs and other chemicals involved in fatal poisoning in England and Wales during 2000–2011. Clinical Toxicology (Philadelphia, Pa.), 52(1), 1–12. doi:10.3109/15563650.2013.872791.

    Article  CAS  Google Scholar 

  • Hard, B. (2014). Management of opioid painkiller dependence in primary care: ongoing recovery with buprenorphine/naloxone. BMJ Case Reports. doi:10.1136/bcr-2014-207308.

    PubMed  PubMed Central  Google Scholar 

  • Hidalgo Landa, A., Szabo, I., Le Brun, L., Owen, I., & Fletcher, G. (2011). Evidence based scoping reviews. The Electronic Journal Information Systems Evaluation, 14, 46–52.

    Google Scholar 

  • Ingelman-Sundberg, M., Sim, S. C., Gomez, A., & Rodriguez-Antona, C. (2007). Influence of cytochrome P450 polymorphisms on drug therapies: pharmacogenetic, pharmacoepigenetic and clinical aspects. Pharmacology and Therapeutics, 116(3), 496–526.

    Article  CAS  PubMed  Google Scholar 

  • Kean, J. (2015). Illicit and over-the-counter codeine dependence after acute back pain-successful treatment and ongoing recovery after buprenorphine/naloxone taper. Heroin Addiction and Related Clinical Problems, Published Ahead of Print, October 18, 2015.

  • Kelly, L. E., & Madadi, P. (2012). Is there a role for therapeutic drug monitoring with codeine? Therapeutic Drug Monitoring, 34(3), 249–256.

    Article  CAS  PubMed  Google Scholar 

  • Lambert, A. P., & Close, C. (2005). Life-threatening hypokalaemia from abuse of nurofen plus. Journal of the Royal Society of Medicine, 98(1), 21.

    Article  PubMed  PubMed Central  Google Scholar 

  • Levac, D., Colquhoun, H., & O’Brien, K. K. (2010). Scoping studies: advancing the methodology. Implementation Science, 5, 69.

    Article  PubMed  PubMed Central  Google Scholar 

  • Manchia, M., Alda, M., & Clakin, C. (2013). Repeated erythromycin/codeine-induced psychotic mania. Clinical Neuropharmacology, 36(5), 177–178.

    Article  PubMed  Google Scholar 

  • Marr, E., & Hill, D. (2015). Optimising service provision for prescribed opioid analgesic dependence. Heroin Addiction and Related Clinical Problems, 17(5).

  • McAvoy, B. R., Dobbin, M., & Tobin, C. (2011). Over-the-counter codeine analgesic misuse and harm: characteristics of cases in Australia and New Zealand. New Zealand Medical Journal, 124(1346), 29–33.

    PubMed  Google Scholar 

  • McDonough, M. A. (2011). Misuse of codeine-containing combination analgesics. Medical Journal of Australia, 194(9), 486.

    PubMed  Google Scholar 

  • Ministry of Health. (2014). New Zealand practice guidelines for opioid substitution treatment. Wellington: Ministry of Health.

    Google Scholar 

  • Myers, B., Siegfried, N., & Parry, C. D. (2003). Over-the-counter and prescription medicine misuse in Cape Town-findings from specialist treatment centres. South African Medical Journal, 93(5), 367.

    PubMed  Google Scholar 

  • National Institute for Health and Clinical Excellence. (2007). Methadone and buprenorphine for the management of opioid dependence. NICE technology appraisal guidance [TA114]. https://www.nice.org.uk/guidance/ta114. Accessed 15 Feb 2016.

  • Ng, J., Morgan, D., Loh, N., Gan, S., Coleman, P., Ong, G., & Prentice, D. (2011). Life-threatening hypokalaemia associated with ibuprofen-induced renal tubular acidosis. Medical Journal of Australia, 194(6), 313–316.

    PubMed  Google Scholar 

  • Nielsen, S., Cameron, J., & Lee, N. (2011). Characteristics of a non-treatment-seeking sample of over-the-counter codeine users: implications for intervention and prevention. Journal of Opioid Management, 7(5), 363–370.

  • Nielsen, S., Cameron, J., & Pahoki, S. (2010). Over the counter codeine dependence. Victoria: Turning Point Drug and Alcohol Centre.

    Google Scholar 

  • Nielsen, S., Hillhouse, M., Mooney, L., Fahey, J., & Ling, W. (2012). Comparing buprenorphine induction experience with heroin and prescription opioid users. Journal of Substance Abuse Treatment, 43(3), 285–290. doi:10.1016/j.jsat.2011.12.009.

    Article  PubMed  PubMed Central  Google Scholar 

  • Nielsen, S., Cameron, J., & Pahoki, S. (2013). Opportunities and challenges: over the counter codeine supply from the codeine consumer perspective. International Journal of Pharmacy Practice, 21(3), 161–168.

    Article  PubMed  Google Scholar 

  • Nielsen, S., Roxburgh, A., Bruno, R., Lintzeris, N., Jefferson, A., & Degenhardt, L. (2015a). Changes in non-opioid substitution treatment episodes for pharmaceutical opioids and heroin from 2002 to 2011. Drug and Alcohol Dependence, 149, 212–219. doi:10.1016/j.drugalcdep.2015.02.004.

    Article  CAS  PubMed  Google Scholar 

  • Nielsen, S., Bruno, R., Murnion, B., Dunlop, A., Degenhardt, L., Demirkol, A., Muhleisen, P., & Lintzeris, N. (2015b). Treating codeine dependence with buprenorphine: dose requirements and induction outcomes from a retrospective case series in New South Wales, Australia. Drug and Alcohol Review. doi:10.1111/dar.12315. Early Online.

    Google Scholar 

  • Nielsen, S., Murnion, B., Dunlop, A., Degenhardt, L., Demirkol, A., Muhleisen, P., Litzeris, N., & Litzeris, N. (2015c). Comparing treatment-seeking codeine users and strong opioid users: findings from a novel case series. Drug and Alcohol Review, 34(3), 30a4–30a11. doi:10.1111/dar.12315.

    Article  Google Scholar 

  • Nielsen, S., Murnion, B., Dunlop, A., Degenhardt, L., Demirkol, A., Muhleisen, P., & Lintzeris, N. (2015d). Comparing treatment-seeking codeine users and strong opioid users: findings from a novel case series. Drug and Alcohol Review, 34(3), 304–311. doi:10.1111/dar.12224.

    Article  PubMed  Google Scholar 

  • Nielsen, S., Bruno, R., Murnion, B., Dunlop, A., Degenhardt, L., Demirkol, A., Muhleisen, P., & Lintzeris, N. (2015e). Treating codeine dependence with buprenorphine: dose requirements and induction outcomes from a retrospective case series in New South Wales, Australia. Drug and Alcohol Review. doi:10.1111/dar.12315.

    Google Scholar 

  • Pham, M. T., Rajić, A., Greig, J. D., Sargeant, J. M., Papadopoulos, A., & McEwen, S. A. (2014). A scoping review of scoping reviews: advancing the approach and enhancing the consistency. Research Synthesis Methods, 5, 371–385.

    Article  PubMed  PubMed Central  Google Scholar 

  • Pilgrim, J. L., Dobbin, M., & Drummer, O. H. (2013). Fatal misuse of codeine-ibuprofen analgesics in Victoria, Australia. Medical Journal of Australia, 199(5), 329–331.

    Article  PubMed  Google Scholar 

  • Reed, K., Bond, A., Witton, J., Cornish, R., Hickman, M., & Strang, J. (2011). The changing use of prescribed benzodiazepines and z-drugs and of over-the-counter codeine-containing products in England: A structured review of published English and international evidence and available data to inform consideration of the extent of dependence and harm. London: National Addiction Centre.

  • Romach, M. K., Sproule, B. A., Sellers, E. M., Somer, G., & Busto, U. E. (1999). Long-term codeine use is associated with depressive symptoms. Journal of Clinical Psychopharmacology, 19(4), 373–376.

    Article  CAS  PubMed  Google Scholar 

  • Rumrill, P. D., Fitzgerald, S. M., & Merchant, W. (2010). Speaking of research: using scoping literature reviews as a means of understanding and interpreting existing literature. Work, 35(3), 399–404.

    PubMed  Google Scholar 

  • Sigmon, S. C., Dunn, K. E., Badger, G. J., Heil, S. H., & Higgins, S. T. (2009). Brief buprenorphine detoxification for the treatment of prescription opioid dependence: a pilot study. Addictive Behaviors, 34, 304–311.

    Article  PubMed  Google Scholar 

  • Sproule, B. A., Busto, U. E., Somer, G., Romach, M. K., & Sellers, E. M. (1999). Characteristics of dependent and nondependent regular users of codeine. Journal of Clinical Psychopharmacology, 19(4), 367–372.

    Article  CAS  PubMed  Google Scholar 

  • Stannard, C. (2013). Opioids in the UK: what’s the problem? BMJ, 15(347), f5108. doi:10.1136/bmj.f5108.

    Article  Google Scholar 

  • The Royal College of General Practitioners. (2014a). Prescription and over-the-counter medicines misuse and dependence. Fact Sheet 1. The Problem. The Royal College of General Practitioners Substance Misuse and Associated Health unit Public Health England.

  • The Royal College of General Practitioners. (2014b). Prescription and over-the-counter medicines misuse and dependence. Fact Sheet 2. Prevention. The Royal College of General Practitioners Substance Misuse and Associated Health unit Public Health England.

  • The Royal College of General Practitioners. (2014c). Prescription and over-the-counter medicines misuse and dependence. Fact Sheet 3. Identification. The Royal College of General Practitioners Substance Misuse and Associated Health unit Public Health England. The Royal College of General Practitioners. (2014d). Prescription and over-the-counter medicines misuse and dependence. Fact Sheet 4. Treatment. The Royal College of General Practitioners Substance Misuse and Associated Health unit Public Health England.

  • Tobin, C., Dobbin, M., & McAvoy, B. (2013). Regulatory responses to over-the-counter codeine analgesic misuse in Australia, New Zealand and the United Kingdom. Australian and New Zealand Journal of Public Health, 37, 483–488.

    Article  PubMed  Google Scholar 

  • Tremlett, M., Anderson, B. J., & Wolf, A. (2010). Pro-con debate: is codeine a drug that still has a useful role in pediatric practice? Paediatric Anaesthesia, 20(2), 183–194.

    Article  PubMed  Google Scholar 

  • Van Hout, M. C. (2015). Nod and wave: an internet study of the codeine intoxication phenomenon. The International Journal on Drug Policy, 26(1), 67–77.

    Article  PubMed  Google Scholar 

  • Van Hout, M. C., & Norman, I. (2015). Misuse of non-prescription codeine containing products: recommendations for detection and reduction of risk in community pharmacies. The International Journal on Drug Policy, 27, 17–22.

    Article  PubMed  Google Scholar 

  • Van Hout, M. C., Bergin, M., Foley, M., Rich, E., Rapca, A. I., Harris, R., & Norman, I. (2014). A scoping review of codeine use, misuse and dependence, final report. Brussels: CODEMISUSED Project European Commission 7th Framework Programme.

    Google Scholar 

  • Van Hout, M. C., Horan, A., Santlal, K., Rich, E., & Bergin, M. (2015a). ‘Codeine is my Companion’: Misuse and dependence on codeine containing medicines in Ireland. Irish Journal of Psychological Medicine. Early Online.

  • Van Hout, M. C., Rich, E., Dada, S., & Bergin, M. (2015b). Codeine is my helper: a qualitative study of pharmacy access and codeine misuse in South Africa. Qualitative Health Research. doi:10.1177/1049732315613764. Early Online.

    PubMed  Google Scholar 

  • Van Hout, M. C., Delargy, I., Ryan, G., Flanagan, S., & Gallagher, H. (2015c). Dependence on over the counter (otc) codeine containing analgesics: treatment and recovery with buprenorphine naloxone. International Journal of Mental Health and Addiction, First online: 14 December 2015, 1–11.

  • Weiss, R. D., Potter, J. S., Fiellin, D., Byrne, M., Connery, H. S., Diskinson, W., & Ling, W. (2011). A two-phase randomized controlled TRIAL of adjunctive counselling during brief and extended buprenorphine-naloxone treatment for prescription opioid dependence. Archives of General Psychiatry, 68(12), 1238–1246.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

The research leading to these results has received funding from the European Community's Seventh Framework Programme FP7/2007-2013 under grant agreement no 611736.

Author information

Authors and Affiliations

  1. School of Health Sciences, Waterford Institute of Technology, Waterford, Ireland

    Marie Claire Van Hout, Evelyn Hearne & Michael Bergin

Authors
  1. Marie Claire Van Hout
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Evelyn Hearne
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Bergin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marie Claire Van Hout.

Ethics declarations

Conflict of Interest

Authors Marie Claire Van Hout, Evelyn Hearne and Michael Bergin declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Van Hout, M.C., Hearne, E. & Bergin, M. Buprenorphine-Naloxone in the Treatment of Codeine Dependence: a Scoping Review of Clinical Case Presentations. Int J Ment Health Addiction 15, 224–237 (2017). https://doi.org/10.1007/s11469-016-9655-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11469-016-9655-5

Keywords

Search

Navigation