Changes to
CODEINE
Availability
From February 2018 over the counter (OTC) medications containing codeine will require a prescription in Australia. This change brings us into line with similar countries overseas. This article discusses the backstory …
- OTC codeine-containing products offer little additional pain relief compared to similar medicines without codeine and carry greater health risks to users
- Codeine is a highly addictive drug and unintended tolerance, dependence and addiction may develop quickly
- There is limited evidence to support the use of codeine-containing medications in chronic (non-cancer) pain conditions
Which medications are affected?
Medications affected by these changes include codeine-containing combination analgesics (eg Panadeine, Nurofen Plus, Mersyndol) and codeine-containing cough, cold and flu products (eg Codral, Demazin), which could previously be purchased without a prescription.
Was codeine really that bad?
Codeine is an opioid medication, meaning it is in the same family of drugs as morphine and oxycodone and therefore has the same risks and benefits as other opioid drugs (second dot point above). As with any opioid, people taking codeine may experience problems with tolerance (a situation where increasingly higher doses are needed to achieve the same level of symptom relief) and/or withdrawal symptoms (eg headache, mood swings, insomnia, nausea) when stopping its use.
Codeine preparations contain other active medications such as paracetamol and ibuprofen. Accidental poisoning or overdose can result from taking more than the recommended dose of the other active ingredients leading to a range of drug related side effects (eg liver damage is associated with high dose or long-term paracetamol use; gastrointestinal bleeding, heart attack and kidney problems are some of the possible side effects of long term ibuprofen use).
What can I use instead of codeine?
Common problems such as headache, period pain, or dental pain can be managed successfully using OTC medications without codeine, which are safer and more effective at providing pain relief. It’s also important to remember that codeine containing products have never been recommend for use as first line agents (the drugs we use first) for managing common pain conditions. Lastly, some types of pain also respond well to use of heat packs or cold packs.
Any final words?
If you have been affected by the changes to OTC codeine availability, do not despair! Talk to your pharmacist or GP about any concerns you may have and for assistance with selecting suitable alternatives for managing your pain.
Further Reading
Consumer Fact Sheet (Source: TGA)
https://www.tga.gov.au/sites/default/files/consumer-fact-sheet-codeine-containing-medicines-harms-changes-patient-access.pdf
Over-the-counter codeine: changes to supply. Information and resources for health professionals and consumers
https://www.nps.org.au/medical-info/clinical-topics/over-the-counter-codeine-changes-to-supply
Treating pain with heat and cold
https://www.healthline.com/health/chronic-pain/treating-pain-with-heat-and-cold