Sales of over-the-counter (OTC) codeine-containing products in the United Kingdom: a retrospective observational study

BackgroundCodeine is a widely available opioid medicine that is on the World Health Organisations list of essential medicines. However, widespread access to codeine has led to its misuse, abuse, dependence, and deaths. Some countries, including France and Australia, have successfully reclassified codeine to prescription only, which is encouraging other regulators, including the UK, to reconsider the status of codeine. However, little is known about how much codeine is sold in the UK. AimTo assess national trends in sales and expenditure of codeine-containing products sold over the counter (OTC) between 2013 and 2019. MethodsWe conducted a retrospective observational study using electronic point-of-sales data from the human data science company IQVIA and population statistics from the UKs Office of National Statistics (ONS). Descriptive statistics were used to examine the quantity, trends over time, and types of OTC codeine-containing products sold. Results4.75 billion dosage units of codeine were sold OTC in the UK between April 2013 and March 2019, an average of 72 dosage units per UK resident. Over time, sales of codeine fell by 8%, from 12.54 dosage units per resident in 2013 to 11.48 dosage units per resident in 2019. Codeine was often sold in combination with other analgesics, amounting to 1711 tonnes of paracetamol and 96 tonnes of ibuprofen. The public spent {pound}638 million on OTC codeine-containing products, which increased by 12% over the study period. There were 83 different types of codeine-containing products sold. ConclusionLarge volumes of codeine-containing products were purchased OTC in the UK in 2013-19. To improve the safety of opioids, OTC codeine sales data should be made accessible for public health surveillance. The trends presented in this study should inform policy for the future status of codeine availability in the UK. Principal Investigator statementThe authors confirm that the Principal Investigator for this paper is Dr Georgia Richards and that they had direct responsibility for the conduct of this study.