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

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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.

Table 1:

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

Province	Units of codeine^*			Codeine sales		Acetaminophen sales

	No. of units	Rate, units per resident	% of total codeine sold as OTC^†	Codeine, kg	Rate, mg per resident	Acetaminophen, kg	Rate, mg per resident
Alberta	17 688 955	4.0	6.9	142	32.4	5375	1229.6

British Columbia	89 681 975	17.7	38.0	718	141.5	26 500	5225.3

Manitoba	2 175 128	11.6	3.3	17	12.7	753	549.7

New Brunswick	5 836 590	7.5	21.5	47	60.1	1788	2301.4

Nova Scotia	14 369 659	14.8	40.5	115	118.3	4462	4593.8

Ontario	225 685 892	15.5	44.6	1806	123.9	69 698	4784.8

Prince Edward Island, Newfoundland and Labrador	3 853 873	5.7	11.9	31	45.4	1443	2127.0

Quebec	13 570 422	1.6	19.3	109	12.8	3730	439.6

Saskatchewan	2 984 521	2.5	9.3	24	20.3	954	812.6

All provinces	375 847 016^‡	10.0	21.7	3007^§	80.3	114 703	2451.5

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.