Changes to patient access for medicines containing codeine
Medicines that contain low-does codeine are no longer available without prescription in pharmacies. This has received wide attention in the media and reactions within the community have been mixed.
If you have strong or chronic (long-lasting) pain you will now need to consult your doctor, an if codeine-containing medicines are part of your treatment a prescription may be needed.
Why has access to codeine-containing medicines changed?
Some Australians don’t realise how much harm codeine can cause.
Codeine is an opioid drug closely related to morphine and, like morphine, is derived from opium poppies. Codeine can cause opioid tolerance, dependence, addiction, poisoning and in high doses, death.
Regular use of medicines containing codeine, for example for chronic pain, has led to some consumers becoming addicted to codeine without realising it. The risks associated with codeine use are too high without oversight from a doctor.
Codeine use can be harmful
Most Australians are unaware that over-the-counter medicines containing codeine for pain relief offer very little additional benefit when compared with medicines without codeine. The use of such medicines however, is associated with high health risks, such as developing tolerance or physical dependence on codeine.
Repeated dosing can cause tolerance, which means that increasing doses are required to achieve the same level of pain relief. Severe withdrawal symptoms can result when the medicine is stopped; these include head and muscle aches, mood swings, insomnia, nausea and diarrhoea.
Some of these withdrawal symptoms, such as head or muscle aches, mimic the symptoms that low-dose codeine products are often used to treat, leading people incorrectly to take the medicine longer or in higher doses.
Codeine poisoning contributes to both accidental and intentional deaths in Australia. The codeine- containing medicines that are currently available over-the-counter are usually combined with either paracetamol or ibuprofen. Long term use of high doses of paracetamol can also result in liver damage and the most severe adverse effects of long term ibuprofen use include serious internal bleeding, kidney failure and heart attacks.
Codeine is also sometimes used in medicines to relieve the symptoms of cough and cold, however there are safer and more effective medicines available that can help provide relief from these conditions. Talk to your pharmacist or doctor for advice on what may be best for you.
What can you do?
It is important to remember that not all pain requires medication. The management of pain is diverse. Some pain requires no treatment and will resolve spontaneously. Non-pharmaceutical treatments such as heat packs, cold packs and TENS machines can all assist.
Allied health providers including physiotherapists, massage therapists and occupational therapists are important members of the treating team, each providing a different perspective and skill-set.
If medicines are required, analgesics such as aspirin, paracetamol, ibuprofen, or combinations of these, are still available over the counter. Please talk to your pharmacist about the best choice.
If stronger pain relief is required, or if you are using analgesics regularly, a consultation with your doctor is necessary. This will allow for better diagnosis and management of the underlying problem, as well as an appropriate choice of symptom relievers. In addition, the changes to scheduling of codeine will allow those who are currently dependent on codeine to access appropriate medical assistance.
If you need more information about the current changes or any aspect of your health care, please consult with your pharmacist, general practitioner, rheumatologist, Arthritis Queensland, or other health care provider.
Roxburgh A, Hall WD, Burns L, Pilgrim J, Saar E, Nielsen S, Degenhardt L. Trends and characteristics of accidental and intentional codeine overdose deaths in Australia. The Medical journal of Australia. 2015 Oct 5;203(7):299.
Gisev N, Nielsen S, Cama E, Larance B, Bruno R, Degenhardt L. An ecological study of the extent and factors associated with the use of prescription and over-the-counter codeine in Australia. European journal of clinical pharmacology. 2016 Apr 1;72(4):469-94.