Rates of reported codeine-related poisonings and codeine prescribing following new national guidance in Ireland

作     者：Kennedy, Cormac Duggan, Edel Bennett, Kathleen Williams, David J. 

作者机构：Royal Coll Surgeons Ireland Dept Geriatr & Stroke Med Dublin 2 Ireland Beaumont Hosp Natl Poisons Informat Ctr Dublin Ireland Royal Coll Surgeons Ireland Div Populat Hlth Sci Dublin 2 Ireland Beaumont Hosp Dept Geriatr & Stroke Med Dublin 9 Ireland 

出 版 物：《PHARMACOEPIDEMIOLOGY AND DRUG SAFETY》 (药物流行病学与药品安全)

年 卷 期：2019年第28卷第1期

页      面：106-111页

核心收录：

学科分类：1007[医学-药学(可授医学、理学学位)] 1004[医学-公共卫生与预防医学(可授医学、理学学位)] 10[医学] 

基　　金：Health Research Board [HRB RL-15-1579] 

主　　题：codeine guidance misuse opioid over-the-counter pharmacoepidemiology poisonings 

摘      要：Purpose The aims of this study were to examine a national database to assess codeine poisonings before and after the new guidance for pharmacists while also evaluating rates of codeine prescriptions following the introduction of restrictions on supply. Methods Anonymised enquiry data of reported poisoning cases were reviewed for a period from 2005 to 2016 inclusive. The rate of pharmacy claims for codeine containing products was also examined using the national pharmacy claims database. Segmented regression analysis was used to detect changes in poisonings and claims before and after the new guidance. Results There were 1851 codeine-related poisonings reported over the study period. An annual decline was evident with a significant 33% reduction from 2010 to 2011 (beta 2 coefficient for level change, 42.1;95% CI, -68.1 to -16.0;P = 0.006). Following 2011, the declining rate of codeine poisonings plateaued. Analysis of the national pharmacy claims data revealed no change in the reimbursement rate for co-codamol products restricted by the guidance in 2010 (Incidence rate ratio 1.04, 95% CI, 0.997-1.08;P = 0.07). There was no corresponding increase in the reimbursement of alternative opioid medications. Conclusions New guidance on codeine supply coincided with an initial reduction in reported codeine poisoning cases. This reduction was in keeping with the previous trend. However, this was without an increase in the prevailing rate of prescription claims for these products or potential substitutes. Policymakers may consider further restriction of codeine products to improve public health outcomes.