Treatment-seeking codeine users: A different kettle of fish?

S. Nielsen^1,2, B. Murnion², A. Dunlop^3,4, L. Degenhardt^1,5, A. Demirkol^2,6, N. Lintzeris^2,6. ¹National Drug and Alcohol Centre, University of New South Wales, Australia; ²University of Sydney, Australia; ³Hunter New England Area Health Service, Australia; ⁴University of Newcastle, Australia; ⁵Centre for Population Health, Burnet Institute, Australia; ⁶South Eastern Sydney Local Health District, Australia

Background: Codeine is available without prescription in a number of countries such as Australia, New Zealand, the UK and Canada. This study aimed to compare codeine users seeking drug and alcohol treatment with prescription opioid users (morphine and oxycodone) to determine if codeine users differ from other pharmaceutical opioid users. Methods: Data were collected from 134 case files from consecutive pharmaceutical opioid dependent treatment presentations across three geographical regions in New South Wales, Australia. The primary drug problem on treatment presentation was used to identify two groups of opioid users, codeine users and strong opioid users (morphine and oxycodone). Results: Codeine users clearly differ from strong prescription opioid (morphine and oxycocdone) users in a number of important ways. Codeine users were more likely to be female (66% vs 37%, p = .001), employed (43% vs 22%, p = .009), use only one opioid (91% vs 49%, p < .001), and to have been using their current opioid for longer (6.2yrs, SD 4.8yrs compared with 3.4ys, SD 5.5yrs). Codeine users also reported less current stimulant and cannabis use (p < .05). Differences were not detected on average doses of methadone or buprenorphine used at week 1 or 4 of treatment, or on treatment retention. Conclusions: Pharmaceutical opioid related treatment presentations in this sample appear to be a heterogeneous group. Those using codeine were considerably different on demographic characteristics such as gender and employment, as well as substance use histories. How these differences may impact on treatment needs and outcomes requires further investigation.