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The impact of proposed regulatory changes and rescheduling on low-dose codeine purchasing in Canada: a time-series analysis

Charlotte G. Boone, Tony Antoniou, David N. Juurlink, Teagan Rolf von den Baumen, Sophie A. Kitchen, Georgia C. Richards, Mina Tadrous and Tara Gomes
December 14, 2021 9 (4) E1181-E1186; DOI: https://doi.org/10.9778/cmajo.20210173
Charlotte G. Boone
Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael’s Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women’s College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont.
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Tony Antoniou
Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael’s Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women’s College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont.
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David N. Juurlink
Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael’s Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women’s College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont.
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Teagan Rolf von den Baumen
Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael’s Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women’s College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont.
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Sophie A. Kitchen
Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael’s Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women’s College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont.
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Georgia C. Richards
Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael’s Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women’s College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont.
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Mina Tadrous
Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael’s Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women’s College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont.
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Tara Gomes
Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael’s Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women’s College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont.
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  • Figure 1:
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    Figure 1:

    Low-dose codeine purchasing, in units per resident per month (1 unit = 8 mg), among the Canadian provinces from January 2014 to October 2019. Vertical bars indicate policy changes. Note: A = Health Canada’s proposal of regulatory changes on July 17, 2016; B = Health Canada’s 60-day public commenting period opened on Sept. 9, 2017.

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    Figure 2:

    Purchasing of over-the-counter (low-dose), prescription-strength codeine products, and total codeine purchased, in units per resident per month (1 unit = 8 mg) in Manitoba from January 2014 to October 2019. Vertical bar indicates policy change on Feb. 1, 2016, which required a prescription for all codeine products, regardless of strength.

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    Table 1:

    Descriptive characteristics for provincial sales of low-dose codeine products between November 2018 and October 2019

    ProvinceUnits of codeine*Codeine salesAcetaminophen sales
    No. of unitsRate, units per resident% of total codeine sold as OTC†Codeine, kgRate, mg per residentAcetaminophen, kgRate, mg per resident
    Alberta17 688 9554.06.914232.453751229.6
    British Columbia89 681 97517.738.0718141.526 5005225.3
    Manitoba2 175 12811.63.31712.7753549.7
    New Brunswick5 836 5907.521.54760.117882301.4
    Nova Scotia14 369 65914.840.5115118.344624593.8
    Ontario225 685 89215.544.61806123.969 6984784.8
    Prince Edward Island, Newfoundland and Labrador3 853 8735.711.93145.414432127.0
    Quebec13 570 4221.619.310912.83730439.6
    Saskatchewan2 984 5212.59.32420.3954812.6
    All provinces375 847 016‡10.021.73007§80.3114 7032451.5
    • Note: OTC = over-the-counter.

    • ↵* 1 unit = 8 mg.

    • ↵† Reported as a percent of total mass of codeine sold.

    • ↵‡ If the dosage form was not sold in 8 mg units, we converted the volume to these standard units. Therefore, the provincial total does not equal the sum of provinces because of rounding error.

    • ↵§ Weights have been rounded to the nearest kilogram.

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CMAJ Open: 9 (4)
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The impact of proposed regulatory changes and rescheduling on low-dose codeine purchasing in Canada: a time-series analysis
Charlotte G. Boone, Tony Antoniou, David N. Juurlink, Teagan Rolf von den Baumen, Sophie A. Kitchen, Georgia C. Richards, Mina Tadrous, Tara Gomes
Oct 2021, 9 (4) E1181-E1186; DOI: 10.9778/cmajo.20210173

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The impact of proposed regulatory changes and rescheduling on low-dose codeine purchasing in Canada: a time-series analysis
Charlotte G. Boone, Tony Antoniou, David N. Juurlink, Teagan Rolf von den Baumen, Sophie A. Kitchen, Georgia C. Richards, Mina Tadrous, Tara Gomes
Oct 2021, 9 (4) E1181-E1186; DOI: 10.9778/cmajo.20210173
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