Objective: To investigate morbidity related to misuse of over‐the‐counter (OTC) codeine–ibuprofen analgesics. Design and setting: Prospective case series collected from Victorian hospital‐based addiction medicine specialists between May 2005 and December 2008. Main outcome measures: Morbidity associated with codeine–ibuprofen misuse. Results: Twenty‐seven patients with serious morbidity were included, mainly with gastrointestinal haemorrhage and opioid dependence. The patients were taking mean daily doses of 435–602 mg of codeine phosphate and 6800–9400 mg ibuprofen. Most patients had no previous history of substance use disorder. The main treatment was opioid substitution treatment with buprenorphine–naloxone or methadone. Conclusions: Although codeine can be considered a relatively weak opioid analgesic, it is nevertheless addictive, and the significant morbidity and specific patient characteristics associated with overuse of codeine–ibuprofen analgesics support further awareness, investigation and monitoring of OTC codeine–ibuprofen analgesic use.

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Introduction and Aims People with substance use problems frequently present to mainstream health services with a variety of health issues. However, many medical and allied health‐care providers feel under‐equipped to respond to this population. We describe the Drug and Alcohol Clinical Advisory Service (DACAS), an established 24/7 telephone‐delivered model of addiction specialist consultation, and examine recent call data to identify drug use issues for which health practitioners seek support. Design and Methods Methods of DACAS service provision and call data collection are provided. A retrospective review of routinely collected call data between July 2013 and June 2018 was performed, extracting information on call and caller characteristics, and consultation details. Results During 2013–2018, DACAS responded to 6565 calls, providing access to specialist alcohol and other drug support for more than 1200 practitioners across Victoria, Tasmania and the Northern Territory annually. Higher rates of service use were found among practitioners located in regional and remote areas, relative to those in metropolitan areas. Opioid agonist treatment was the most common drug class for which practitioners sought consultation (39.5%), followed by other opioids (19.4%). Advice‐seeking patterns differed according to caller profession, service setting and location. Discussion and Conclusions DACAS is providing a multistate‐level response to the challenges of accessing specialist addiction treatment, particularly for opioid agonist treatment and other opioid issues, with demonstrated uptake in regional and remote areas. This telephone‐delivered service provides an opportunity to expand access to treatment for opioid use disorder and other substance use problems, particularly in areas with less equitable access to specialist addiction care.

Case management by an independent physician health program may protect the health of the doctor and the community, and could be considered in other jurisdictions.

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