title: Serious morbidity associated with misuse of over-the-counter codeine-ibuprofen analgesics: a series of 27 cases.
abstract: OBJECTIVE
  To investigate morbidity related to misuse of over-the-counter (OTC) codeine-ibuprofen analgesics.
  
  
  METHODS
  Prospective case series collected from Victorian hospital-based addiction medicine specialists between May 2005 and December 2008.
  
  
  METHODS
  Morbidity associated with codeine-ibuprofen misuse.
  
  
  RESULTS
  Twenty-seven patients with serious morbidity were included, mainly with gastrointestinal haemorrhage and opioid dependence. The patients were taking mean daily doses of 435-602 mg of codeine phosphate and 6800-9400 mg ibuprofen. Most patients had no previous history of substance use disorder. The main treatment was opioid substitution treatment with buprenorphine-naloxone or methadone.
  
  
  CONCLUSIONS
  Although codeine can be considered a relatively weak opioid analgesic, it is nevertheless addictive, and the significant morbidity and specific patient characteristics associated with overuse of codeine-ibuprofen analgesics support further awareness, investigation and monitoring of OTC codeine-ibuprofen analgesic use.
authors.affiliation: Turning Point Alcohol and Drug Centre, Eastern Health, Melbourne, VIC, Australia. matthew.frei@easternhealth.org.au
authors.forename: Matthew Y
authors.initials: MY
authors.lastname: Frei
authors.forename: Suzanne
authors.initials: S
authors.lastname: Nielsen
authors.forename: Malcolm D H
authors.initials: MD
authors.lastname: Dobbin
authors.forename: Claire L
authors.initials: CL
authors.lastname: Tobin
mesh_terms: D000328:Adult; D000700:Analgesics / Q000009:adverse effects*; D003061:Codeine / Q000009:adverse effects*; D004338:Drug Combinations; D062787:Drug Overdose / Q000453:epidemiology; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000009:adverse effects*; D015994:Incidence; D008297:Male; D004366:Nonprescription Drugs / Q000009:adverse effects*; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology; D014739:Victoria / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000700:Analgesics; D004338:Drug Combinations; D004366:Nonprescription Drugs; D003061:Codeine; D007052:Ibuprofen