Poster Presentation Sydney Spinal Symposium 2024

Trends in opioid dispensing to workers with workers’ compensation claims for musculoskeletal conditions following codeine scheduling changes in Australia (#26)

Michael Di Donato 1 , Stephanie Mathieson 2 , Giovanni E Ferreira 2 3 , Ting Xia 4 , Yonas Tefera 1 , Christina Abdel Shaheed 2 3 5 , Christopher G Maher 2 3 , Alex Collie 1
  1. School of Public Health and Preventive Medicine, Monash University, Melbourne, VICTORIA, Australia
  2. Sydney Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
  3. Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, New South Wales, Australia
  4. Monash Addiction Research Centre, Monash University, Melbourne, Victoria, Australia
  5. Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia

Background: We sought to describe the prevalence and patterns of opioid analgesic and pain medicine dispenses, and the impact of up-scheduling of low-dose (<15mg) codeine containing products, to Australians with accepted workers’ compensation time loss claims for musculoskeletal conditions between 2010 and 2019.

Methods: Descriptive statistics and Poisson regression were used to measure the number, proportion and factors associated with being dispensed pain medicines in the first year of claim. Interrupted time-series methods were used to measure changes in the monthly number, percentage of pain medicine dispenses, and mean morphine equivalent dispense dose.

Results: Nearly one third (28.4%, n=22,807) of our sample of 80,324 workers were dispensed any opioid in the first year since the workers’ compensation insurer received their claim. There were no significant step or trend changes in the number or percentage of pain medicines dispensed of up-scheduled low-dose codeine. Only 2.9% of workers were ever dispensed codeine, specifically 2.5% after up-scheduling (1st February 2018. After up-scheduling of low-dose codeine, workers were more likely to be dispensed opioids (excluding codeine) (PR 1.21, 99%CI 1.13, 1.31) or other pain medicines (e.g., pregabalin, paracetamol) (PR 1.11, 99%CI 1.03, 1.19) compared to the year prior codeine up-scheduling. There was a significant 28.5% (99%CI 16.3, 41.9) step increase (i.e., increase immediately after up-scheduling) in high-dose (>15mg) codeine with a significant trend decrease (-1.3%, 99%CI -2.5, -0.2).

Implications/Key message: Up-scheduling low-dose codeine to prescription only medicines did not significantly change the dispensing of low-dose codeine-containing products to workers with accepted workers’ compensation time loss claims for musculoskeletal conditions. It is possible workers not claiming for over-the-counter low-dose codeine switched to higher doses of codeine requiring a prescription, with those with more recent claims shifting to other prescription opioids and pain medicines.