Repeated dispensing of codeine is associated with high consumption of benzodiazepines

Abstract

Aims: Our objective was to explore the use of codeine analgesics in individual patients in Norway, giving special attention to the 10% who consume the highest amounts. Methods: We retrieved data from the Norwegian Prescription Database on patients who were dispensed at least one codeine analgesic prescription during 2006. We looked at age and gender specific 1-year periodic prevalence. The 10% of codeine users who were prescribed the highest amounts of the drug that year were further characterized. Age and gender distribution and concurrent high consumption of other potential drugs of abuse were also considered. Results: In the year 2006, a total of 386,836 individuals filled at least one prescription for codeine analgesics from Norwegian pharmacies, excluding cancer patients. The crude prevalence for the use of codeine analgesics was 7.3% and 9.3% of the male and female Norwegian population, respectively. Twelve percent of women and 9% of men who filled a codeine prescription received 120 defined daily doses (DDD) or more of codeine analgesics in 2006 (moderate to high consumers). Fifty percent of those patients (21,759) were also dispensed large amounts of benzodiazepines or carisoprodol over the same period. In comparison, only ten percent of patients who received fewer than 120 DDD of codeine analgesics were dispensed large amounts of benzodiazepines or carisoprodol. Conclusions: A high percentage of the Norwegian population used codeine analgesics. One-year prevalence use of codeine increased with age and was higher for women at all ages. Our study showed that codeine use was mainly sporadic, but that a relatively large sub-group of users were dispensed repeated prescriptions of the drug in combination with other potential drugs of abuse.

Risks, Management, and Monitoring of Combination Opioid, Benzodiazepines, and/or Alcohol Use

“…48,49 Among patients with noncancer pain, in particular, concomitant use of BZD was associated with more total months of prescribed opioid, higher mean daily doses, and a greater risk of a psychogenic chronic pain diagnosis and alcohol abuse/dependence. 48 Similarly, Bachs et al 50 found that users who were dispensed the highest doses of codeine (according to prescription records) were significantly more likely to use high doses of BZDs as well. In fact, BZD use was a stronger predictor of future prescription opioid use than musculoskeletal or chronic pain.…”

Disability pension is associated with the use of benzodiazepines 20 years later: A prospective study

“…Recent literature, however, adds to the growing evidence that these substances have a similar potential for negative effects as traditional benzodiazepines [20][21][22]. Still we wanted to restrict our analysis to the prescription of the traditional benzodiazepines, which constitute a better documented marker of an addictive use pattern [14,20,23].…”

Polydrug abuse: A review of opioid and benzodiazepine combination use

“…In an analysis of prescription records, Bachs et al (2008) found that those codeine users dispensed the highest amounts of the opioid, were significantly more likely to be co-using large amounts of BZDs. Using a more determinate method, Heltsey et al (2011) found that 15.7% of oral fluid specimens from 6,441 U.S. pain clinic patients were positive for benzodiazepine drugs.…”