RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia.
School of Psychology, The University of Queensland, Brisbane, Australia.
Pain. 2021 Apr 1;162(4):1095-1103. doi: 10.1097/j.pain.0000000000002115.
Codeine is one of the most commonly used opioid analgesics. Significant codeine-related morbidity and mortality prompted regulatory responses, with the up-scheduling of codeine combination analgesics to prescription-only medicines implemented in Australia in February 2018. This study investigated the impact of codeine up-scheduling on the number of codeine and other (noncodeine) prescription opioid-related emergency department (ED) presentations in a large metropolitan tertiary hospital. Clinical features of these presentations were also examined. Interrupted time series analyses assessed monthly changes in ED presentations from June 2016 to November 2019. In the month immediately after up-scheduling, there was a significant reduction of 3.97 codeine-related presentations (B = -3.97, P = 0.022), indicating a 29.66% level change, followed by a significant change in trend to fewer monthly codeine-related presentations (B = -0.38, P = 0.005). Noncodeine prescription opioid-related (B = -1.90, P = 0.446) and ED presentations overall (B = -118.04, P = 0.140) remained unchanged immediately post-up-scheduling, with a significant change in trend from upward to downward for noncodeine (B = -0.76; P = 0.002) and ED presentations overall (B = -19.34, P = 0.022). A significant reduction of 4.58 (B = -4.58, P = 0.009) in codeine presentations involving subsequent hospital admission immediately post-up-scheduling was found; but no immediate reduction in codeine-related suicide-related overdoses, length of inpatient stay, or re-presentations (P > 0.0125; adjusted for multiple comparisons). Restricting supply of codeine to prescription-only may have resulted in less harmful codeine-related use in the community, without a corresponding immediate decrease in other opioid-related harms.
可待因是最常用的阿片类镇痛药之一。大量与可待因相关的发病率和死亡率促使监管部门做出反应，澳大利亚于 2018 年 2 月将可待因复方镇痛药升级为凭处方供应的药物。本研究调查了可待因升级对大型大都市三级医院急诊部（ED）因使用可待因和其他（非可待因）处方类阿片类药物就诊数量的影响。还检查了这些就诊的临床特征。中断时间序列分析评估了 2016 年 6 月至 2019 年 11 月期间 ED 就诊的每月变化。在升级后的第一个月，可待因相关就诊显著减少了 3.97 次（B = -3.97，P = 0.022），表明变化幅度为 29.66%，随后可待因相关就诊的趋势发生了显著变化，就诊次数逐月减少（B = -0.38，P = 0.005）。非可待因处方类阿片类药物相关（B = -1.90，P = 0.446）和 ED 就诊总体（B = -118.04，P = 0.140）在升级后立即没有变化，非可待因（B = -0.76；P = 0.002）和 ED 就诊总体（B = -19.34，P = 0.022）的趋势从上升变为下降。结果发现，升级后可待因就诊中有 4.58 例（B = -4.58，P = 0.009）需要随后住院治疗，立即减少；但与可待因相关的自杀过量、住院时间或再次就诊的人数没有立即减少（P > 0.0125；调整了多次比较）。将可待因供应限制为凭处方供应可能导致社区中危害性较小的可待因使用，而不会立即减少其他阿片类药物相关的伤害。
