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The association between the availability of over the counter codeine and the prevalence of non-medical use

  • Pharmacoepidemiology and Prescription
  • Published:
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Abstract

Purpose

To investigate the prevalence of non-medical use (NMU) of codeine in Germany, Italy, Spain and the UK and whether availability of OTC codeine has any association with NMU of the drug.

Methods

Data collected in the online Survey of Non-Medical Use of Prescription Drugs, in surveys launched in the second half of 2018 from (Germany (n = 14,969), Italy, (n = 9974), Spain (n = 9912) and the UK (n = 9819) were analysed. For each survey, the estimated prevalence and 95% confidence interval (CI) of respondents reporting NMU of prescription and/or OTC codeine within the last 12 months were calculated and compared.

Results

The prevalence of last 12-month NMU in Spain was 12.6% (95% CI 11.7–13.6) for prescription codeine, 6.3% (5.6–7.0) for OTC codeine and 16.1% (15.1–17.3) for any codeine (prescription and/or OTC). The prevalence of last 12-month NMU in the UK was 5.4% (4.9–5.8) for prescription codeine, 4.5% (4.1–5.0) for OTC codeine and 8.3% (7.8–8.9) for any codeine (prescription and/or OTC). The prevalence of last 12-month NMU for prescription codeine was 2.1% (1.9–2.4) in Germany and 1.9% (1.7–2.2) in Italy.

Conclusion

The prevalence of last 12-month NMU of any codeine product is approximately eight times greater in Spain and four times greater in the UK compared to Germany and Italy where the drug is only available by prescription. While other factors may contribute, these findings suggest that availability of codeine OTC is associated with greater NMU.

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Funding

The RADARS System is supported by subscriptions from pharmaceutical manufacturers, government and non-government agencies for surveillance, research and reporting services. RADARS System is the property of Denver Health and Hospital Authority, a political subdivision of the State of Colorado. Denver Health retains exclusive ownership of all data, databases and systems. Subscribers do not participate in data collection nor do they have access to the raw data

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Authors and Affiliations

  1. Clinical Toxicology Guy’s and St Thomas’ NHS Foundation Trust, London, UK

    Joanna Hockenhull, David M. Wood & Paul I. Dargan

  2. Faculty of Life Sciences and Medicine, King’s College, London, UK

    David M. Wood & Paul I. Dargan

  3. Institute of Neuropsychiatry and Addictions, Parc de Salut Mar, Barcelona, Spain

    Francina Fonseca

  4. Associazione per l’Utilizzo delle Conoscenze Neuroscientifiche a fini Sociali (AU-CNS), Pietrasanta, Italy

    Marilena Guareschi

  5. Department of Neurosciences, Santa Chiara University Hospital, Pisa, Italy

    Marilena Guareschi

  6. LVR-Klinikum Essen, Essen, Germany

    Norbert Scherbaum

  7. Rocky Mountain Poison & Drug Center - Denver Health, Denver, CO, USA

    Janetta L. Iwanicki & Richard C. Dart

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  1. Joanna Hockenhull
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  2. David M. Wood
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Contributions

JB, JH, and KR undertook the data analysis and interpretation; JH had the leading role in writing the first draft of the paper. All the authors corrected and approved the final version of the article.

Corresponding author

Correspondence to Paul I. Dargan.

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Ethics approval

The survey was approved by the Colorado Multiple Institutional Review Board (Protocol Number: 13–2394).

Conflict of interest

PD and DW have acted as scientific advisors to the UK Advisory Council on the Misuse of Drugs (ACMD) and the European Monitoring Centre for Drugs and Drug Abuse (EMCDDA). NS has received honoraria for several activities (e.g. advisory board membership, lectures, manuscripts) from AbbVie, Camurus, Hexal, Janssen-Cilag, MSD, Medice, Mundipharma, Reckitt-Benckiser/Indivior and Sanofi-Aventis. During the last 3 years, he has participated in clinical trials financed by the pharmaceutical industry. All other authors declare no conflict of interest.

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Hockenhull, J., Wood, D.M., Fonseca, F. et al. The association between the availability of over the counter codeine and the prevalence of non-medical use. Eur J Clin Pharmacol 78, 1011–1018 (2022). https://doi.org/10.1007/s00228-021-03158-1

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