Identifying and treating codeine dependence: a systematic review

Area of Science:

• Pharmacology and Addiction Medicine
• Public Health
• Clinical Psychology

Background:

• Codeine dependence presents a significant public health challenge.
• Recent rescheduling of codeine in Australia highlights the need for effective clinical strategies.
• Understanding identification and treatment is crucial for managing codeine dependence.

Purpose of the Study:

• To systematically review existing literature on identifying and treating codeine dependence.
• To inform clinical responses to the growing problem of codeine dependence.
• To synthesize evidence on characteristics and management of codeine dependence.

Main Methods:

• Systematic review of English-language articles on codeine dependence and its treatment.
• Inclusion of studies with empirical data, excluding those without.
• Screening of abstracts and full-text articles by independent researchers, with quality assessment and data extraction.

Main Results:

• Codeine dependence is associated with mental health comorbidities and escalating use due to psychiatric issues.
• Delayed detection is common, often masked by complications from analgesic overuse.
• Effective treatments include behavioral therapy, opioid agonist therapy, and medicated inpatient withdrawal.

Conclusions:

• Improved strategies are needed for identifying problematic codeine use and dependence in clinical settings.
• Commonly described management approaches include opioid taper, opioid agonist treatment, and psychological therapies.
• These approaches align with established treatments for pharmaceutical opioid dependence.