European Journal of Clinical Pharmacology

, Volume 72, Issue 4, pp 469–494 | Cite as

An ecological study of the extent and factors associated with the use of prescription and over-the-counter codeine in Australia

  • Natasa GisevEmail author
  • Suzanne Nielsen
  • Elena Cama
  • Briony Larance
  • Raimondo Bruno
  • Louisa Degenhardt
Pharmacoepidemiology and Prescription



The extent and factors associated with codeine use in the community remain poorly understood despite the widespread global use of codeine. The aim of this study was to examine the use of prescription and over-the-counter (OTC) codeine in Australia and identify the geographic and socio-demographic characteristics associated with prescription and OTC codeine use.


National sales data for prescription and OTC codeine (supplied by IMS Health) were used to estimate codeine utilisation (in pack sales and milligrammes) in Australia during 2013, mapped to Australian Bureau of Statistics (ABS) Statistical Local Areas (SLAs) and Remoteness Areas. Socio-demographic characteristics and total population estimates of SLAs were obtained from the ABS. SLA-level data on sex, age distribution, income, occupations involving physical labour and number of pharmacies were included in linear regression analyses to examine their association with total, prescription and OTC codeine use.


In total, 27,780,234 packs of codeine were sold in Australia during 2013, equating to 12,376 kg. OTC codeine preparations accounted for 15,490,207 packs (55.8 %) or 4967.30 kg (40.1 %). Nationally, an estimated 1.24 packs (or 554.10 mg) of codeine were sold per person; utilisation was higher in more remote areas. SLAs with a higher percentage of low-income earning households had the highest rates of prescription codeine use (β 0.16, p < 0.001), whereas SLAs with a higher percentage of males had the highest rates of OTC codeine use (β 0.22, p < 0.001).


Codeine use is common in Australia, with clear distinctions in the geographic and socio-demographic characteristics associated with prescription and OTC codeine use.


Analgesics Opioids Non-prescription drugs Codeine Pharmacoepidemiology Drug utilisation 



The authors are very grateful for Billy Henderson’s (Mundipharma) advice and assistance in facilitating access to the data analysed in this study. NG, SN, BL and LD are supported by NHMRC research fellowships (#1091878, #1013803, #1073858 and #1041472). The National Drug and Alcohol Research Centre at UNSW Australia is supported by funding from the Australian Government under the Substance Misuse Prevention and Service Improvements Grant Fund.

Author contributions

LD, BL and RB originally conceptualised the study and gained access to the data. NG designed the study, undertook part of the data analysis and prepared the first draft of the manuscript. LD and RB led the planning of analyses, SN performed the literature review and EC undertook part of the data analysis. All authors were involved in interpreting data, reviewing analyses and critically revising drafts of the manuscript. All authors approved the final manuscript prior to submission.

Compliance with ethical standards

Competing interests

SN, BL, RB and LD have received untied educational grants from Reckitt Benckiser for post-marketing surveillance of buprenorphine-naloxone tablets and film in the treatment of opioid dependence in Australia, development of an opioid-related behaviour scale and/or a study examining opioid substitution therapy among chronic non-cancer pain patients. RB, BL and LD have received untied educational grant funding from Mundipharma for post-marketing surveillance of Reformulated OxyContin® in Australia.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Natasa Gisev
    • 1
    Email author
  • Suzanne Nielsen
    • 1
  • Elena Cama
    • 1
  • Briony Larance
    • 1
  • Raimondo Bruno
    • 1
    • 2
  • Louisa Degenhardt
    • 1
  1. 1.National Drug and Alcohol Research CentreUNSW, AustraliaSydneyAustralia
  2. 2.School of MedicineUniversity of TasmaniaHobartAustralia

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