title: Trends and characteristics of accidental and intentional codeine overdose deaths in Australia.
abstract: OBJECTIVE
  To examine trends in codeine-related mortality rates in Australia, and the clinical and toxicological characteristics of codeine-related deaths.
  
  
  METHODS
  Analysis of prospectively collected data from the National Coronial Information System on deaths where codeine toxicity was determined to be an underlying or contributory cause of death. The study period was 2000-2013.
  
  
  METHODS
  Population-adjusted numbers (per million persons) of (1) codeine-related deaths, classified by intent (accidental or intentional); and (2) heroin- and Schedule 8 opioid-related deaths (as a comparator).
  
  
  RESULTS
  The overall rate of codeine-related deaths increased from 3.5 per million in 2000 to 8.7 per million in 2009. Deaths attributed to accidental overdoses were more common (48.8%) than intentional deaths (34.7%), and their proportion increased during the study period. High rates of prior comorbid mental health (53.6%), substance use (36.1%) and chronic pain (35.8%) problems were recorded for these deaths. For every two Schedule 8 opioid-related deaths in 2009, there was one codeine-related death. Most codeine-related deaths (83.7%) were the result of multiple drug toxicity.
  
  
  CONCLUSIONS
  Codeine-related deaths (with and without other drug toxicity) are increasing as the consumption of codeine-based products increases. Educational messages are needed to better inform the public about the potential harms of chronic codeine use, especially in the context of polypharmacy.
authors.affiliation: University of New South Wales, Sydney, NSW a.roxburgh@unsw.edu.au.
authors.forename: Amanda
authors.initials: A
authors.lastname: Roxburgh
authors.affiliation: University of New South Wales, Sydney, NSW.
authors.forename: Wayne D
authors.initials: WD
authors.lastname: Hall
authors.affiliation: University of New South Wales, Sydney, NSW.
authors.forename: Lucinda
authors.initials: L
authors.lastname: Burns
authors.affiliation: Monash University, Melbourne, VIC.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Pilgrim
authors.affiliation: Monash University, Melbourne, VIC.
authors.forename: Eva
authors.initials: E
authors.lastname: Saar
authors.affiliation: University of New South Wales, Sydney, NSW.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Nielsen
authors.affiliation: University of New South Wales, Sydney, NSW.
authors.forename: Louisa
authors.initials: L
authors.lastname: Degenhardt
mesh_terms: D000701:Analgesics, Opioid / Q000506:poisoning*; D001315:Australia; D002423:Cause of Death / Q000639:trends; D003061:Codeine / Q000506:poisoning*; D062787:Drug Overdose / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D009026:Mortality / Q000639:trends*; D009294:Narcotics / Q000506:poisoning*; D011159:Population Surveillance; D011446:Prospective Studies; D019966:Substance-Related Disorders / Q000401:mortality; D013405:Suicide / Q000639:trends
chemical_list: D000701:Analgesics, Opioid; D009294:Narcotics; D003061:Codeine