title: Over-the-counter codeine analgesic misuse and harm: characteristics of cases in Australia and New Zealand.
abstract: OBJECTIVE
  To describe the characteristics of clients addicted to over-the-counter (OTC) codeine analgesics presenting to an Auckland open-access clinic, and to compare them to clients admitted to a New Zealand detoxification unit, and in the Australian community.
  
  
  METHODS
  Cross-sectional study of clients presenting to a regional, open-access detoxification clinic covering the Greater Auckland area between 1 January and 31 March 2010.
  
  
  RESULTS
  Fifteen clients were analysed, and compared to 77 similar clients identified in Victoria and five other Australian States, and 7 clients admitted to a New Zealand detoxification unit. Cases in each cohort were consistent with those in the published literature, and appear to be similar to each other both demographically and in terms of the high average tablets consumption (49-65 tablets per day), the serious non-steroidal anti-inflammatory drug (NSAID) adverse drug reactions identified, and the long duration of misuse. Many had a history of alcohol or other drug use and mental health disorder.
  
  
  CONCLUSIONS
  This study has identified that controls on OTC codeine analgesics in both countries were not sufficient to limit non-medical use of these products. As a result, cases identified in these two countries escalated the number of self-administered tablets taken daily for misuse, resulting in codeine dependence and serious NSAID toxicity secondary to this dependence.
authors.affiliation: Tasmanian Department of Health and Human Services, Alcohol and Drug Services, Level 2, Carruthers Building, St Johns Park, New Town, Hobart, Tasmania 7008, Australia. brian.mcavoy@dhhs.tas.gov.au
authors.forename: Brian R
authors.initials: BR
authors.lastname: McAvoy
authors.forename: Malcolm D H
authors.initials: MD
authors.lastname: Dobbin
authors.forename: Claire L
authors.initials: CL
authors.lastname: Tobin
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000701:Analgesics, Opioid / Q000506:poisoning*; D001315:Australia / Q000453:epidemiology; D003061:Codeine / Q000009:adverse effects / Q000506:poisoning*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D004366:Nonprescription Drugs / Q000506:poisoning*; D018570:Risk Assessment; D017678:Sex Distribution; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000517:prevention & control; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D004366:Nonprescription Drugs; D003061:Codeine