Serious morbidity associated with misuse of over-the-counter codeine-ibuprofen analgesics: a series of 27 cases

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. MJA 2010; 193: 294-296