title: Treating codeine dependence with buprenorphine: Dose requirements and induction outcomes from a retrospective case series in New South Wales, Australia.
abstract: OBJECTIVE
  Codeine dependence is an emerging public health concern, yet no studies have specifically examined the treatment of codeine dependence. Given the lower potency of codeine it cannot be assumed that buprenorphine dose requirements for heroin dependence will generalise to codeine. This is the first study to examine buprenorphine treatment for codeine dependence.
  
  
  METHODS
  Retrospective case series of 19 codeine-dependent treatment entrants who received sublingual buprenorphine maintenance treatment through six specialist inpatient and outpatient treatment centres. Baseline codeine doses and buprenorphine dose at days 7 and 28 were collected, in addition to details on general demographics, pain and mental health, substance use and outcomes after 28 days of buprenorphine treatment.
  
  
  RESULTS
  A significant linear relationship was found between initial codeine dose and dose of buprenorphine given at days 7 and 28 for the codeine dose range of 50-960 mg day-1(mean: 564 mg; 95% confidence interval 431-696 mg). Median buprenorphine dose was 12.0 mg (interquartile range 9.5 mg, range 4-32 mg) at day 7 and 16.0 mg (interquartile range 13.5 mg, range 4-32 mg) at day 28. Buprenorphine doses received were markedly higher than estimated codeine doses based on standard dose conversion tables.
  
  
  CONCLUSIONS
  With increasing presentations relating to codeine dependence, these findings provide important guidance to clinicians. Buprenorphine doses were consistently higher than doses estimated based on the dose of codeine consumed, and were comparable with doses used in the treatment of dependence with heroin and more potent prescription opioids. [Nielsen S, Bruno R, Murnion B, Dunlop A, Degenhardt L, Demirkol A, Muhleisen P, Lintzeris N. Treating codeine dependence with buprenorphine: Dose requirements and induction outcomes from a retrospective case series in New South Wales, Australia. Drug Alcohol Rev 2015].
authors.affiliation: National Drug and Alcohol Centre, University of New South Wales, Sydney, Australia.|Discipline of Addiction Medicine, University of Sydney, Sydney, Australia.|Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Nielsen
authors.affiliation: National Drug and Alcohol Centre, University of New South Wales, Sydney, Australia.|School of Medicine, University of Tasmania, Hobart, Australia.
authors.forename: Raimondo
authors.identifier: http://orcid.org/0000-0001-6673-833X
authors.initials: R
authors.lastname: Bruno
authors.affiliation: Discipline of Addiction Medicine, University of Sydney, Sydney, Australia.
authors.forename: Bridin
authors.initials: B
authors.lastname: Murnion
authors.affiliation: District Drug and Alcohol Clinical Services, Hunter New England Local Health Services, Newcastle West, Australia.|School of Medicine and Public Health (Medicine), University of Newcastle, Newcastle, Australia.
authors.forename: Adrian
authors.initials: A
authors.lastname: Dunlop
authors.affiliation: National Drug and Alcohol Centre, University of New South Wales, Sydney, Australia.|School of Population and Global Health, University of Melbourne, Melbourne, Australia.|Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia.|Department of Global Health, School of Public Health, University of Washington, Seattle, USA.
authors.forename: Louisa
authors.initials: L
authors.lastname: Degenhardt
authors.affiliation: Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia.|School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
authors.forename: Apo
authors.initials: A
authors.lastname: Demirkol
authors.affiliation: District Drug and Alcohol Clinical Services, Hunter New England Local Health Services, Newcastle West, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Muhleisen
authors.affiliation: Discipline of Addiction Medicine, University of Sydney, Sydney, Australia.|Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lintzeris
keywords: buprenorphine maintenance; codeine dependence; induction; opioid analgesic