Misuse of over-the-counter painkillers ‘costing Australia millions’

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  Last updated January 31, 2018 at 1:42 pm

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A University of South Australia study looking at the health impacts of over-the-counter painkillers has revealed the high costs of the nation’s growing dependency on codeine.



The results of the study appear to justify a Federal Government decision to ban over-the-counter (OTC) access to combination painkillers containing codeine (CACC) from Australian pharmacies from 1 February 2018.


After that date, these products will only be available on prescription.


In a five-year review of hospital admissions relating to the misuse of OTC painkillers containing codeine, UniSA researchers identified a million dollar cost for the health care system.


Lead investigator Dr Jacinta Johnson said “serious misuse” of codeine-combination products such as Nurofen Plus, Panadeine Extra and Mersyndol had led to increasing numbers of people being admitted to hospital with stomach ulcers and gastric bleeding, and acute kidney and liver failure.


Dr Johnson, a lecturer in UniSA’s School of Pharmacy and Medical Sciences, led the Australian-first study analysing the costs of 99 hospital admissions related to over-the-counter combination painkillers containing codeine (OTC-CACC) from 2010-2015 at a South Australian Hospital.


Thirty patients – many with multiple readmissions – cost taxpayers an average of $10,000 per hospital stay, amounting to a million dollar bill.


Almost 70 per cent were admitted with health issues relating to taking excessive amounts of ibuprofen-codeine products, while 20 per cent reported using paracetamol-codeine products and almost 9.4 per cent used both. In some cases patients were taking up to 90 tablets a day – the average was 28 which is almost five times the recommended daily dose.


Health costs were blown out by many patients’ initial reluctance to admit to using excessive doses of OTC-CACC products when admitted to hospital, leading to difficulties and delays in diagnosis and high readmission rates.


Of the 30 patients surveyed, 83 per cent were women, with an average age of 36, and 60 per cent were from low socio-economic areas. The majority were also smokers.


People used the codeine-combined painkillers mainly for back pain, migraine and headaches.


“Apart from serious health issues relating to misuse of these over-the-counter painkillers, data shows us that lower doses of codeine found in OTC combination products don’t actually provide any additional pain relief,” Dr Johnson says.


“There is no clear evidence that taking a low dose of codeine in combination with paracetamol or ibuprofen is any better than just taking the single-ingredient products without the codeine.”


This is the first study in Australia to look at the costs associated with hospital admissions due to the misuse of OTC-CACC products.


“When the Therapeutic Goods Administration announced its decision to reschedule all low dose CACC preparations to prescription-only, there were some arguments made against the move,” Dr Johnson said.


“It is possible that doctor visits will spike, adding costs to Medicare. That remains to be seen and will no doubt be analysed in due course.”


Additional notes


Counting the cost of over-the-counter codeine containing analgesic misuse: A retrospective review of hospital admissions over a 5-year period” is published in the Drug and Alcohol Review.


The paper is authored by Dr Jacinta Johnson and Dr Libby Hotham from UniSA’s School of Pharmacy and Medical Sciences, Deanna Mill from SA Health, and Dr Victoria Cock and Emily Monaghan from Drug and Alcohol Services South Australia.




About the Author

Candy Gibson

Published By

The University of South Australia is Australia’s University of Enterprise. Our culture of innovation is anchored around global and national links to academic, research and industry partners. Our graduates are the new urban professionals, global citizens at ease with the world and ready to create and respond to change. Our research is inventive and adventurous and we create new knowledge that is central to global economic and social prosperity.


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