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Suzanne Nielsen - One of the best experts on this subject based on the ideXlab platform.
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identifying and treating Codeine dependence a systematic review
The Medical Journal of Australia, 2018Co-Authors: Suzanne Nielsen, Tim Macdonald, Jacinta L JohnsonAbstract:OBJECTIVES: Codeine dependence is a significant public health problem, motivating the recent rescheduling of Codeine in Australia (1 February 2018). To provide information for informing clinical responses, we undertook a systematic review of what is known about identifying and treating Codeine dependence. STUDY DESIGN: Articles published in English that described people who were Codeine-dependent or a clinical approach to treating people who were Codeine-dependent, without restriction on year of publication, were reviewed. Articles not including empirical data were excluded. One researcher screened each abstract; two researchers independently reviewed full text articles. Study quality was assessed, and data were extracted with standardised tools. DATA SOURCES: MEDLINE and EMBASE were searched for relevant publications on 22 November 2016. The reference lists of eligible studies were searched to identify further relevant publications. 2150 articles were initially identified, of which 41 were eligible for inclusion in our analysis. DATA SYNTHESIS: Studies consistently reported specific characteristics associated with Codeine dependence, including mental health comorbidity and escalation of Codeine use attributed to psychiatric problems. Case reports and series described Codeine dependence masked by complications associated with overusing simple analgesics and delayed detection. Ten studies described the treatment of Codeine dependence. Three reports identified a role for behavioural therapy; the efficacy of CYP inhibitors in a small open label trial was not confirmed in a randomised controlled trial; four case series/chart reviews described opioid agonist therapy and medicated inpatient withdrawal; two qualitative studies identified barriers related to perceptions of Codeine-dependent people and treatment providers, and confirmed positive perceptions and treatment outcomes achieved with opioid agonist treatments. CONCLUSION: Strategies for identifying problematic Codeine use are needed. Identifying Codeine dependence in clinical settings is often delayed, contributing to serious morbidity. Commonly described approaches for managing Codeine dependence include opioid taper, opioid agonist treatment, and psychological therapies. These approaches are consistent with published evidence for pharmaceutical opioid dependence treatment and with broader frameworks for treating opioid dependence. PROSPERO registration: CRD42016052129.
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an ecological study of the extent and factors associated with the use of prescription and over the counter Codeine in australia
European Journal of Clinical Pharmacology, 2016Co-Authors: Natasa Gisev, Suzanne Nielsen, Raimondo Bruno, Elena Cama, Briony Larance, Louisa DegenhardtAbstract:Purpose The extent and factors associated with Codeine use in the community remain poorly understood despite the widespread global use of Codeine. The aim of this study was to examine the use of prescription and over-the-counter (OTC) Codeine in Australia and identify the geographic and socio-demographic characteristics associated with prescription and OTC Codeine use.
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treating Codeine dependence with buprenorphine dose requirements and induction outcomes from a retrospective case series in new south wales australia
Drug and Alcohol Review, 2016Co-Authors: Suzanne Nielsen, Raimondo Bruno, Bridin Murnion, Adrian Dunlop, Louisa Degenhardt, Apo Demirkol, Peter Muhleisen, Nicholas LintzerisAbstract:Introduction and Aims Codeine dependence is an emerging public health concern, yet no studies have specifically examined the treatment of Codeine dependence. Given the lower potency of Codeine it cannot be assumed that buprenorphine dose requirements for heroin dependence will generalise to Codeine. This is the first study to examine buprenorphine treatment for Codeine dependence. Design and Methods Retrospective case series of 19 Codeine-dependent treatment entrants who received sublingual buprenorphine maintenance treatment through six specialist inpatient and outpatient treatment centres. Baseline Codeine doses and buprenorphine dose at days 7 and 28 were collected, in addition to details on general demographics, pain and mental health, substance use and outcomes after 28 days of buprenorphine treatment. Results A significant linear relationship was found between initial Codeine dose and dose of buprenorphine given at days 7 and 28 for the Codeine dose range of 50–960 mg day−1 (mean: 564 mg; 95% confidence interval 431–696 mg). Median buprenorphine dose was 12.0 mg (interquartile range 9.5 mg, range 4–32 mg) at day 7 and 16.0 mg (interquartile range 13.5 mg, range 4–32 mg) at day 28. Buprenorphine doses received were markedly higher than estimated Codeine doses based on standard dose conversion tables. Discussion and Conclusions With increasing presentations relating to Codeine dependence, these findings provide important guidance to clinicians. Buprenorphine doses were consistently higher than doses estimated based on the dose of Codeine consumed, and were comparable with doses used in the treatment of dependence with heroin and more potent prescription opioids. [Nielsen S, Bruno R, Murnion B, Dunlop A, Degenhardt L, Demirkol A, Muhleisen P, Lintzeris N. Treating Codeine dependence with buprenorphine: Dose requirements and induction outcomes from a retrospective case series in New South Wales, Australia. Drug Alcohol Rev 2015]
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comparing treatment seeking Codeine users and strong opioid users findings from a novel case series
Drug and Alcohol Review, 2015Co-Authors: Suzanne Nielsen, Bridin Murnion, Adrian Dunlop, Louisa Degenhardt, Apo Demirkol, Peter Muhleisen, Nicholas LintzerisAbstract:Introduction and Aims Few studies have described those seeking treatment for Codeine dependence. This study aimed to compare patients presenting for treatment where either Codeine or a strong pharmaceutical opioid (oxycodone or morphine) was the principal drug of concern to understand if Codeine users may have unique treatment needs. Design and Methods Retrospective case review of 135 patients from three geographical areas in New South Wales, Australia. Cases where the principal drug of concern was Codeine (n = 53) or a strong pharmaceutical opioid (oxycodone or morphine, n = 82) were compared. Differences in demographic characteristics, pain history, mental health, substance use history and, subsequently, the treatment that was received were examined. Results People whose principal drug of concern was Codeine were more likely to be female (66% vs. 37%, P < 0.001), employed (43% vs. 22%, P < 0.01) and use only one pharmaceutical opioid (91% vs. 49%, P < 0.001). There was no difference in age between the Codeine group (mean 38.6 years) and the strong opioid group (39.3 years). Opioid substitution therapy was the most common treatment received by both groups although Codeine patients were more likely to be treated with buprenorphine than methadone (odds ratio = 7.7, 95% confidence interval 2.2–27.2, P < 0.001) and more likely to attempt withdrawal (odds ratio = 2.6, 95% confidence interval 1.2–5.3, P = 0.010). Discussion and Conclusions There are important differences between Codeine-dependent patients and strong prescription opioid-dependent patients. Further work should explore the outcomes of withdrawal versus maintenance treatment for Codeine users. [Nielsen S, Murnion B, Dunlop A, Degenhardt L, Demirkol A, Muhleisen P, Lintzeris N. Comparing treatment-seeking Codeine users and strong opioid users: Findings from a novel case series. Drug Alcohol Rev 2014]
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Opportunities and challenges: over-the-counter Codeine supply from the Codeine consumer's perspective.
International Journal of Pharmacy Practice, 2012Co-Authors: Suzanne Nielsen, Jacqueline J Cameron, Sanja PahokiAbstract:Objectives This study aimed to gain a better understanding on perspectives of over-the-counter (OTC) Codeine users and issues relating to Codeine dependence in the community pharmacy setting. Examining OTC Codeine users' experiences aimed to promote better understanding of OTC Codeine dependence, and inform pharmacy practices. Methods Utilising a qualitative research methodology we conducted interviews with 20 participants who were OTC Codeine users and met DSM IV criteria for Codeine dependence. Key findings Key themes identified included experience of participants acquiring OTC Codeine and participants' interactions with pharmacists. The OTC Codeine-dependent participants found it generally easy to access OTC Codeine, describing ‘standard’ questioning, minimal intervention from pharmacists and only occasional refusal to supply. A better appearance and presentation was generally linked to easy Codeine supply. Conclusions The experiences of participants suggest a number of barriers exist to effective intervention for OTC Codeine dependence in the community pharmacy setting. Identification of these barriers will provide an opportunity to more effectively target interventions to reduce harm related to OTC Codeine products. Increased involvement of pharmacists in OTC Codeine sales was associated with help-seeking by Codeine users.
Nicholas A Buckley - One of the best experts on this subject based on the ideXlab platform.
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Codeine use and harms in australia evaluating the effects of re scheduling
Addiction, 2020Co-Authors: Rose Cairns, Jared A Brown, Nicholas A Buckley, Andrea L Schaffer, Sallieanne PearsonAbstract:BACKGROUND AND AIMS: Globally, Codeine is the most-used opioid. In December 2016, Australia announced that low-strength Codeine (≤ 15 mg) would be re-scheduled and no longer available for purchase over-the-counter; this was implemented in February 2018. We aimed to evaluate the effect of this scheduling change on Codeine misuse and use and misuse of other opioids. DESIGN AND SETTING: Interrupted time-series analysis of monthly opioid exposure calls to New South Wales Poisons Information Centre (NSWPIC, captures 50% of Australia's poisoning calls), January 2015- January 2019 and monthly national Codeine sales, March 2015-March 2019. We incorporated a washout period (January 2017 - January 2018) between the announcement and implementation, when prescriber/consumer behaviour may have been influenced. PARTICIPANTS: Intentional opioid overdoses resulting in a call to NSWPIC. MEASUREMENTS: We used linear segmented regression to identify abrupt changes in level and slope of fitted lines. Codeine poisonings and sales were stratified into high strength (> 15 mg per dose unit) and low strength (≤ 15 mg). Only low-strength formulations were re-scheduled. FINDINGS: We observed an abrupt -50.8 percentage [95% confidence interval (CI) = -79.0 to -22.6%] level change in monthly Codeine-related poisonings and no change in slope in the 12 months after February 2018. There was no increase in calls to the NSWPIC for high-strength products, level change: -37.2% (95% CI = -82.3 to 8%) or non-Codeine opioids, level change: -4.4% (95% CI = -33.3 to 24.4%). Overall, the re-scheduling resulted in a level change in opioid calls of -35.8% calls/month (95% CI = -51.2 to -20.4%). Low-strength Codeine sales decreased by 87.3% (95% CI = -88.5 to -85.9%), with no increase in high-strength Codeine sales in the 14 months following re-scheduling, -4.0% (95% CI = -19.6 to 14.6%). CONCLUSIONS: Codeine re-scheduling in Australia appears to have reduced Codeine misuse and sales.
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the impact of Codeine re scheduling on misuse a retrospective review of calls to australia s largest poisons centre
Addiction, 2016Co-Authors: Rose Cairns, Jared A Brown, Nicholas A BuckleyAbstract:Background and aims Codeine is the most commonly used opioid in the world, and is available over the counter (OTC) in many countries, including Australia. Several countries are reconsidering Codeine's OTC status due to concerns over addiction and misuse, with serious morbidity and mortality being reported. Australia's Therapeutic Goods Administration restricted Codeine containing analgesics to ‘Pharmacist Only’ in 2010, and has recently been considering further up-scheduling to make Codeine ‘Prescription Only’. This paper estimated Australian trends of Codeine misuse over the past 12 years, and examined whether trends changed following previous rescheduling efforts in 2010. Design A retrospective review of calls regarding Codeine misuse made to the New South Wales Poisons Information Centre (NSWPIC, Australia's largest poisons centre), 2004–15. Joinpoint software was used to quantify the average annual change in calls, and whether there was a significant change in trend at any time, including following rescheduling. Setting Australia. Participants Four hundred patients about whom a call was made to the NSWPIC. Measures Calls per year, patient age, gender, tablets taken per day, formulation used, symptom disposition. Findings The NSWPIC database contained 400 cases of Codeine combination analgesic misuse from 2004 to 2015. Joinpoint analysis showed that the frequency of cases increased significantly from 2004 to 2015, with an average annual percentage change (AAPC) of 19.5% [95% confidence interval (CI) = 13.8–25.5% P < 0.0001] for paracetamol/Codeine and 17.9% (95% CI = 7.9–28.9%, P < 0.01) for ibuprofen/Codeine. No significant change in trend was seen at any time, including following 2010 rescheduling. The median age of patients was 34 and 27 years for paracetamol/Codeine and ibuprofen/Codeine cases, respectively. Gender distribution was approximately equal. Clinical features reported were consistent with Codeine, paracetamol and ibuprofen toxicity. Conclusions Misuse of Codeine combination products appears to be increasing in Australia. Limited rescheduling in 2010 failed to curb this increase.
Rose Cairns - One of the best experts on this subject based on the ideXlab platform.
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Codeine use and harms in australia evaluating the effects of re scheduling
Addiction, 2020Co-Authors: Rose Cairns, Jared A Brown, Nicholas A Buckley, Andrea L Schaffer, Sallieanne PearsonAbstract:BACKGROUND AND AIMS: Globally, Codeine is the most-used opioid. In December 2016, Australia announced that low-strength Codeine (≤ 15 mg) would be re-scheduled and no longer available for purchase over-the-counter; this was implemented in February 2018. We aimed to evaluate the effect of this scheduling change on Codeine misuse and use and misuse of other opioids. DESIGN AND SETTING: Interrupted time-series analysis of monthly opioid exposure calls to New South Wales Poisons Information Centre (NSWPIC, captures 50% of Australia's poisoning calls), January 2015- January 2019 and monthly national Codeine sales, March 2015-March 2019. We incorporated a washout period (January 2017 - January 2018) between the announcement and implementation, when prescriber/consumer behaviour may have been influenced. PARTICIPANTS: Intentional opioid overdoses resulting in a call to NSWPIC. MEASUREMENTS: We used linear segmented regression to identify abrupt changes in level and slope of fitted lines. Codeine poisonings and sales were stratified into high strength (> 15 mg per dose unit) and low strength (≤ 15 mg). Only low-strength formulations were re-scheduled. FINDINGS: We observed an abrupt -50.8 percentage [95% confidence interval (CI) = -79.0 to -22.6%] level change in monthly Codeine-related poisonings and no change in slope in the 12 months after February 2018. There was no increase in calls to the NSWPIC for high-strength products, level change: -37.2% (95% CI = -82.3 to 8%) or non-Codeine opioids, level change: -4.4% (95% CI = -33.3 to 24.4%). Overall, the re-scheduling resulted in a level change in opioid calls of -35.8% calls/month (95% CI = -51.2 to -20.4%). Low-strength Codeine sales decreased by 87.3% (95% CI = -88.5 to -85.9%), with no increase in high-strength Codeine sales in the 14 months following re-scheduling, -4.0% (95% CI = -19.6 to 14.6%). CONCLUSIONS: Codeine re-scheduling in Australia appears to have reduced Codeine misuse and sales.
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the impact of Codeine re scheduling on misuse a retrospective review of calls to australia s largest poisons centre
Addiction, 2016Co-Authors: Rose Cairns, Jared A Brown, Nicholas A BuckleyAbstract:Background and aims Codeine is the most commonly used opioid in the world, and is available over the counter (OTC) in many countries, including Australia. Several countries are reconsidering Codeine's OTC status due to concerns over addiction and misuse, with serious morbidity and mortality being reported. Australia's Therapeutic Goods Administration restricted Codeine containing analgesics to ‘Pharmacist Only’ in 2010, and has recently been considering further up-scheduling to make Codeine ‘Prescription Only’. This paper estimated Australian trends of Codeine misuse over the past 12 years, and examined whether trends changed following previous rescheduling efforts in 2010. Design A retrospective review of calls regarding Codeine misuse made to the New South Wales Poisons Information Centre (NSWPIC, Australia's largest poisons centre), 2004–15. Joinpoint software was used to quantify the average annual change in calls, and whether there was a significant change in trend at any time, including following rescheduling. Setting Australia. Participants Four hundred patients about whom a call was made to the NSWPIC. Measures Calls per year, patient age, gender, tablets taken per day, formulation used, symptom disposition. Findings The NSWPIC database contained 400 cases of Codeine combination analgesic misuse from 2004 to 2015. Joinpoint analysis showed that the frequency of cases increased significantly from 2004 to 2015, with an average annual percentage change (AAPC) of 19.5% [95% confidence interval (CI) = 13.8–25.5% P < 0.0001] for paracetamol/Codeine and 17.9% (95% CI = 7.9–28.9%, P < 0.01) for ibuprofen/Codeine. No significant change in trend was seen at any time, including following 2010 rescheduling. The median age of patients was 34 and 27 years for paracetamol/Codeine and ibuprofen/Codeine cases, respectively. Gender distribution was approximately equal. Clinical features reported were consistent with Codeine, paracetamol and ibuprofen toxicity. Conclusions Misuse of Codeine combination products appears to be increasing in Australia. Limited rescheduling in 2010 failed to curb this increase.
Alastair J J Wood - One of the best experts on this subject based on the ideXlab platform.
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pharmacogenetic determinants of Codeine induction by rifampin the impact on Codeine s respiratory psychomotor and miotic effects
Journal of Pharmacology and Experimental Therapeutics, 1997Co-Authors: Yoseph Caraco, James R Sheller, Alastair J J WoodAbstract:Our objective was to examine the effect of rifampin on Codeine’s pharmacodynamics and pharmacokinetics in extensive (EMs) and poor (PMs) metabolizers of debrisoquin. Fifteen healthy, nonsmoking males, 9 EMs and 6 PMs of debrisoquin, received Codeine (120 mg) before and after rifampin (600 mg/d) for 3 weeks. The effects of Codeine on respiration, pupil diameter and psychomotor performance were measured before Codeine administration and during each study day. The pharmacokinetics of Codeine were determined from the respective plasma and urine concentrations. Before the administration of rifampin, the pharmacodynamic effects of Codeine were more prominent in the EMs (P < .01). Rifampin significantly enhanced Codeine oral clearance by increasing its metabolic clearances through N-demethylation and glucuronidation in both phenotypes, but its O-demethylation was induced only in EMs. Relative to base-line values, Codeine N-demethylation was induced to a greater extent, resulting in a marked reduction in the plasma concentrations of Codeine and Codeine metabolites and elevated plasma concentrations of norCodeine, norCodeine-glucuronide, and normorphine. The reduction in morphine plasma concentration was associated in the EMs with a significant attenuation of Codeine’s respiratory and psychomotor effects, whereas its miotic effect was unaltered. In PMs, Codeine’s respiratory and psychomotor effects were unaltered by rifampin, but its pupillary effect was reduced. Codeine O-demethylation to produce morphine can be significantly induced by rifampin, but this induction is phenotypically determined. However, because (relative to base-line values) rifampin enhanced Codeine N-demethylation more than Codeine O-demethylation, morphine plasma concentrations were reduced—and hence Codeine’s pharmacodynamic effects were attenuated—in EMs of debrisoquin.
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Pharmacogenetic Determinants of Codeine Induction by Rifampin: The Impact on Codeine’s Respiratory, Psychomotor and Miotic Effects
Journal of Pharmacology and Experimental Therapeutics, 1997Co-Authors: Yoseph Caraco, James R Sheller, Alastair J J WoodAbstract:Our objective was to examine the effect of rifampin on Codeine’s pharmacodynamics and pharmacokinetics in extensive (EMs) and poor (PMs) metabolizers of debrisoquin. Fifteen healthy, nonsmoking males, 9 EMs and 6 PMs of debrisoquin, received Codeine (120 mg) before and after rifampin (600 mg/d) for 3 weeks. The effects of Codeine on respiration, pupil diameter and psychomotor performance were measured before Codeine administration and during each study day. The pharmacokinetics of Codeine were determined from the respective plasma and urine concentrations. Before the administration of rifampin, the pharmacodynamic effects of Codeine were more prominent in the EMs (P < .01). Rifampin significantly enhanced Codeine oral clearance by increasing its metabolic clearances through N-demethylation and glucuronidation in both phenotypes, but its O-demethylation was induced only in EMs. Relative to base-line values, Codeine N-demethylation was induced to a greater extent, resulting in a marked reduction in the plasma concentrations of Codeine and Codeine metabolites and elevated plasma concentrations of norCodeine, norCodeine-glucuronide, and normorphine. The reduction in morphine plasma concentration was associated in the EMs with a significant attenuation of Codeine’s respiratory and psychomotor effects, whereas its miotic effect was unaltered. In PMs, Codeine’s respiratory and psychomotor effects were unaltered by rifampin, but its pupillary effect was reduced. Codeine O-demethylation to produce morphine can be significantly induced by rifampin, but this induction is phenotypically determined. However, because (relative to base-line values) rifampin enhanced Codeine N-demethylation more than Codeine O-demethylation, morphine plasma concentrations were reduced—and hence Codeine’s pharmacodynamic effects were attenuated—in EMs of debrisoquin.
Louisa Degenhardt - One of the best experts on this subject based on the ideXlab platform.
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an ecological study of the extent and factors associated with the use of prescription and over the counter Codeine in australia
European Journal of Clinical Pharmacology, 2016Co-Authors: Natasa Gisev, Suzanne Nielsen, Raimondo Bruno, Elena Cama, Briony Larance, Louisa DegenhardtAbstract:Purpose The extent and factors associated with Codeine use in the community remain poorly understood despite the widespread global use of Codeine. The aim of this study was to examine the use of prescription and over-the-counter (OTC) Codeine in Australia and identify the geographic and socio-demographic characteristics associated with prescription and OTC Codeine use.
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treating Codeine dependence with buprenorphine dose requirements and induction outcomes from a retrospective case series in new south wales australia
Drug and Alcohol Review, 2016Co-Authors: Suzanne Nielsen, Raimondo Bruno, Bridin Murnion, Adrian Dunlop, Louisa Degenhardt, Apo Demirkol, Peter Muhleisen, Nicholas LintzerisAbstract:Introduction and Aims Codeine dependence is an emerging public health concern, yet no studies have specifically examined the treatment of Codeine dependence. Given the lower potency of Codeine it cannot be assumed that buprenorphine dose requirements for heroin dependence will generalise to Codeine. This is the first study to examine buprenorphine treatment for Codeine dependence. Design and Methods Retrospective case series of 19 Codeine-dependent treatment entrants who received sublingual buprenorphine maintenance treatment through six specialist inpatient and outpatient treatment centres. Baseline Codeine doses and buprenorphine dose at days 7 and 28 were collected, in addition to details on general demographics, pain and mental health, substance use and outcomes after 28 days of buprenorphine treatment. Results A significant linear relationship was found between initial Codeine dose and dose of buprenorphine given at days 7 and 28 for the Codeine dose range of 50–960 mg day−1 (mean: 564 mg; 95% confidence interval 431–696 mg). Median buprenorphine dose was 12.0 mg (interquartile range 9.5 mg, range 4–32 mg) at day 7 and 16.0 mg (interquartile range 13.5 mg, range 4–32 mg) at day 28. Buprenorphine doses received were markedly higher than estimated Codeine doses based on standard dose conversion tables. Discussion and Conclusions With increasing presentations relating to Codeine dependence, these findings provide important guidance to clinicians. Buprenorphine doses were consistently higher than doses estimated based on the dose of Codeine consumed, and were comparable with doses used in the treatment of dependence with heroin and more potent prescription opioids. [Nielsen S, Bruno R, Murnion B, Dunlop A, Degenhardt L, Demirkol A, Muhleisen P, Lintzeris N. Treating Codeine dependence with buprenorphine: Dose requirements and induction outcomes from a retrospective case series in New South Wales, Australia. Drug Alcohol Rev 2015]
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comparing treatment seeking Codeine users and strong opioid users findings from a novel case series
Drug and Alcohol Review, 2015Co-Authors: Suzanne Nielsen, Bridin Murnion, Adrian Dunlop, Louisa Degenhardt, Apo Demirkol, Peter Muhleisen, Nicholas LintzerisAbstract:Introduction and Aims Few studies have described those seeking treatment for Codeine dependence. This study aimed to compare patients presenting for treatment where either Codeine or a strong pharmaceutical opioid (oxycodone or morphine) was the principal drug of concern to understand if Codeine users may have unique treatment needs. Design and Methods Retrospective case review of 135 patients from three geographical areas in New South Wales, Australia. Cases where the principal drug of concern was Codeine (n = 53) or a strong pharmaceutical opioid (oxycodone or morphine, n = 82) were compared. Differences in demographic characteristics, pain history, mental health, substance use history and, subsequently, the treatment that was received were examined. Results People whose principal drug of concern was Codeine were more likely to be female (66% vs. 37%, P < 0.001), employed (43% vs. 22%, P < 0.01) and use only one pharmaceutical opioid (91% vs. 49%, P < 0.001). There was no difference in age between the Codeine group (mean 38.6 years) and the strong opioid group (39.3 years). Opioid substitution therapy was the most common treatment received by both groups although Codeine patients were more likely to be treated with buprenorphine than methadone (odds ratio = 7.7, 95% confidence interval 2.2–27.2, P < 0.001) and more likely to attempt withdrawal (odds ratio = 2.6, 95% confidence interval 1.2–5.3, P = 0.010). Discussion and Conclusions There are important differences between Codeine-dependent patients and strong prescription opioid-dependent patients. Further work should explore the outcomes of withdrawal versus maintenance treatment for Codeine users. [Nielsen S, Murnion B, Dunlop A, Degenhardt L, Demirkol A, Muhleisen P, Lintzeris N. Comparing treatment-seeking Codeine users and strong opioid users: Findings from a novel case series. Drug Alcohol Rev 2014]