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Why Australia got it right with reclassifying codeine to prescription-only

Australia’s medicines regulator made a smart decision when it recently decided that codeine products will no longer be sold over the counter (OTC) (The Pharmaceutical Journal online, 23 December 2016).

Addiction and death have been linked to these products in many countries. This is highlighted in my recent article in the Canadian Pharmacists Journal[1]. Here in Ontario, Canada, a pair of chart review studies concluded that patients who entered opioid detoxification programmes had been misusing OTC codeine — as many as 35% in one study[2],[3]. Other data shows that between 2011 and 2014, 514 people in Ontario began methadone treatment for addictions to OTC codeine[4]. There is a convincing argument that these products should be prescription only. The harms from OTC codeine outweigh the minimal (if any) benefit of these products.

The Pharmaceutical Society of Australia says there should have been a push for real-time monitoring of OTC codeine. But this is not the answer to curbing misuse and is not worth the money and effort. A monitoring system could tell pharmacists that, for example, a patient had purchased a pack of codeine OTC 60 days ago. But under what clinical circumstances, if any, would it be appropriate for a pharmacist to sell this patient another pack? Even with a monitoring system, community pharmacists would still not have access to full medical and medication histories in most cases. Pharmacists are still left making clinical decisions about these narcotics with an incomplete clinical picture. Indeed, patients using opioid medicines should be assessed and monitored by a physician.

In Canada, codeine products are still available for purchase OTC. But there is hope: Jane Philpott, the Canadian health minister stated in 2016 that all codeine products will be available by prescription only in the future[5]. This will be a logical step in fighting Canada’s opioid crisis and other countries including the UK should follow suit.

Jesse MacKinnon

Ontario,

Canada

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2017.20202259

Readers' comments (1)

  • The only problem is that "an addict needs his fix". Those who crave codeine will need instead to visit their GP. The GP, already overworked, and therefore only too willing to prescribe pain killers to treat symptoms rather than address the cause of the pain (which is often the pain killer: opioid-induced hyperalgesia; paracetamol withdrawal headache; interference with wound healing), will simply provide those who crave codeine-containing painkillers with a prescription. So, all that may happen is that the NHS / taxpayer will pay for the codeine-containing painkillers instead of the patients themselves. Given that, in my estimation, about 80% of the almost non-stop OTC sales on a Sunday in the supermarket pharmacies in which I occasionally work are for codeine-containing painkillers, I'm not sure that GPs in the UK will be looking forward to the day on which codeine is taken off OTC sale.

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