The Royal Melbourne Hospital, 300 Grattan Street, Parkville, 3050, Australia.
Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, VIC, 3006, Australia; Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, VIC, 3006, Australia.
Drug Alcohol Depend. 2021 Sep 1;226:108837. doi: 10.1016/j.drugalcdep.2021.108837. Epub 2021 Jun 24.
Prior to February 2018, codeine was available over-the-counter (OTC) in Australia as a pharmacist-only medicine (Schedule 3) in low-strength formulations when in combination with simple analgesics. In February 2018, The Advisory Committee on Medicines Scheduling (ACMS) upscheduled codeine-containing medicines (CCM) to Schedule 4 (prescription-only medicine). This study aimed to determine the impact of upscheduling on prescriptions, overdoses and deaths.
This study used interrupted time series analysis, a quasi-experimental design, to retrospectively evaluate the impact of upscheduling on overdose poisoning calls to the Victorian Poisons Information Centre (VPIC), Emergency Department (ED) presentations to Austin Health, and deaths reported to the Victorian Coroner from 1 January 2013-31 December 2019.
There was a significant reduction in the trend of high-strength codeine poisoning calls by 0.36 (P = 0.03, 95 % CI = [-0.69, -0.04]). Low-strength codeine poisoning calls to the VPIC reduced by 13.31 (P <0.001, 95 % CI = [-16.80, 9.82]]) calls in February 2018, followed by continued reduction of 0.12 calls per month. High-strength codeine overdose ED presentations reduced in the first quarter of 2018 by 3.72 presentations (P = 0.004, 95 % CI = [-6.13, -1.31]). Low-strength codeine overdose ED presentations after the first quarter of 2018 by 0.33 (P = 0.03, 95 % CI = [-0.63, -0.03]) presentations per month. Codeine-related deaths reduced by 7.19 (P < 0.001, 95 % CI = [-9.44, -4.94]) deaths in February 2018.
Codeine upscheduling to prescription-only medicine has reduced codeine-related poisoning calls, overdoses and unnatural death in Victoria.
在 2018 年 2 月之前，可待因在澳大利亚作为药剂师只能开的药物（附表 3）以低剂量配方与简单的镇痛药联合出售，可在柜台购买。2018 年 2 月，药物管制咨询委员会（ACMS）将含可待因的药物（CCM）调整为附表 4（处方药物）。本研究旨在确定调整时间表对处方、过量用药和死亡的影响。
本研究使用中断时间序列分析，一种准实验设计，回顾性评估 2018 年 2 月调整时间表对维多利亚毒物信息中心（VPIC）过量中毒电话、奥斯汀健康急救部就诊和维多利亚验尸官报告的死亡人数的影响，时间为 2013 年 1 月 1 日至 2019 年 12 月 31 日。
高强度可待因中毒电话的趋势明显减少了 0.36（P = 0.03，95 % CI = [-0.69，-0.04]）。VPIC 接到的低强度可待因中毒电话在 2018 年 2 月减少了 13.31（P <0.001，95 % CI = [-16.80，9.82]），随后每月继续减少 0.12 个电话。2018 年第一季度，高强度可待因过量急诊就诊减少了 3.72 次就诊（P = 0.004，95 % CI = [-6.13，-1.31]）。2018 年第一季度后，低强度可待因过量急诊就诊每月减少 0.33 次就诊（P = 0.03，95 % CI = [-0.63，-0.03]）。2018 年 2 月，与可待因相关的死亡人数减少了 7.19（P <0.001，95 % CI = [-9.44，-4.94]）。
将可待因调整为处方药物后，维多利亚州与可待因相关的中毒、过量用药和非自然死亡人数有所减少。
