Pharmacy Daily | High-dose codeine spike ‘temporary’

INCREASED use of high-dose codeine medications funded through the Pharmaceutical Benefits Scheme (PBS), following the up-scheduling of low-dose products in 2018, has subsided, data from the Therapeutic Goods Administration (TGA) reveals.

Figures released by the TGA yesterday found there was a 6.5% increase in PBS dispensing of paracetamol 500mg in combination with 30mg codeine products in Feb 2018, when low-dose products were made Prescription Only.

"However, the increase was transitory," the TGA reported.

"It diminished in the succeeding months and, by 2019, the PBS dispensing of high-strength codeine had returned to the level before Feb 2018.

"For the first 11 months after up-scheduling in 2018, the estimated national total dispensing was 5,393kg, in comparison with a total of 5,237kg for the equivalent 11-month period in 2017.

"In 2019, the total dispensing was 4,721kg between January and October, in comparison with 4,679kg for the same period in 2017.

"The analysis used the quantity of codeine dispensed in the PBS scripts and population estimates made by the Australian Bureau of Statistics.

"The PBS dispensing data between 2014 and 2019 were extracted from the Australian Government Department of Health Enterprise Data Warehouse on 26 Feb 2020.

"Time series intervention analysis was used to model monthly per capita dispensing over the 70-month period.

"The 2017 national totals were standardised to the 2018 and 2019 populations respectively to control for population growth.

"In addition to the transitory increase after up-scheduling, we found decreases in the dispensing of high-strength codeine in the months leading up to Feb 2018.

"The first was a level shift starting in August 2015 when the PBS dispensing decreased by 6.3%, followed by a second level shift starting in 2017 when dispensing decreased further by 3.5%.

"Statistical modelling did not support a linear trend over the study period, or constant level shift occurring after Feb 2018.

"The increased dispensing of high-strength codeine after up-scheduling was consistent with a scenario of codeine consumers switching from low-strength to high-strength products."