title: An ecological study of the extent and factors associated with the use of prescription and over-the-counter codeine in Australia.
abstract: OBJECTIVE
  The extent and factors associated with codeine use in the community remain poorly understood despite the widespread global use of codeine. The aim of this study was to examine the use of prescription and over-the-counter (OTC) codeine in Australia and identify the geographic and socio-demographic characteristics associated with prescription and OTC codeine use.
  
  
  METHODS
  National sales data for prescription and OTC codeine (supplied by IMS Health) were used to estimate codeine utilisation (in pack sales and milligrammes) in Australia during 2013, mapped to Australian Bureau of Statistics (ABS) Statistical Local Areas (SLAs) and Remoteness Areas. Socio-demographic characteristics and total population estimates of SLAs were obtained from the ABS. SLA-level data on sex, age distribution, income, occupations involving physical labour and number of pharmacies were included in linear regression analyses to examine their association with total, prescription and OTC codeine use.
  
  
  RESULTS
  In total, 27,780,234 packs of codeine were sold in Australia during 2013, equating to 12,376 kg. OTC codeine preparations accounted for 15,490,207 packs (55.8 %) or 4967.30 kg (40.1 %). Nationally, an estimated 1.24 packs (or 554.10 mg) of codeine were sold per person; utilisation was higher in more remote areas. SLAs with a higher percentage of low-income earning households had the highest rates of prescription codeine use (β 0.16, p < 0.001), whereas SLAs with a higher percentage of males had the highest rates of OTC codeine use (β 0.22, p < 0.001).
  
  
  CONCLUSIONS
  Codeine use is common in Australia, with clear distinctions in the geographic and socio-demographic characteristics associated with prescription and OTC codeine use.
authors.affiliation: National Drug and Alcohol Research Centre, UNSW, Australia, Sydney, NSW, 2052, Australia. n.gisev@unsw.edu.au.
authors.forename: Natasa
authors.initials: N
authors.lastname: Gisev
authors.affiliation: National Drug and Alcohol Research Centre, UNSW, Australia, Sydney, NSW, 2052, Australia.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Nielsen
authors.affiliation: National Drug and Alcohol Research Centre, UNSW, Australia, Sydney, NSW, 2052, Australia.
authors.forename: Elena
authors.initials: E
authors.lastname: Cama
authors.affiliation: National Drug and Alcohol Research Centre, UNSW, Australia, Sydney, NSW, 2052, Australia.
authors.forename: Briony
authors.initials: B
authors.lastname: Larance
authors.affiliation: National Drug and Alcohol Research Centre, UNSW, Australia, Sydney, NSW, 2052, Australia.|School of Medicine, University of Tasmania, Hobart, Australia.
authors.forename: Raimondo
authors.initials: R
authors.lastname: Bruno
authors.affiliation: National Drug and Alcohol Research Centre, UNSW, Australia, Sydney, NSW, 2052, Australia.
authors.forename: Louisa
authors.initials: L
authors.lastname: Degenhardt
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001315:Australia; D003061:Codeine / Q000008:administration & dosage*; D055030:Drug Users / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D004366:Nonprescription Drugs / Q000008:administration & dosage*; D010594:Pharmacies; D055553:Prescription Drugs / Q000008:administration & dosage*; D024382:Professional Role
chemical_list: D000701:Analgesics, Opioid; D004366:Nonprescription Drugs; D055553:Prescription Drugs; D003061:Codeine
keywords: Analgesics; Codeine; Drug utilisation; Non-prescription drugs; Opioids; Pharmacoepidemiology