Ahead of the regulatory decision to remove low-dose codeine medicines from sale over the counter (OTC) as of February 2018, 1 NPS MedicineWise—an independent and not-for-profit organisation enabling safe and effective use of medicines—has compiled and provided answers to the five most commonly asked questions by Australians about this change.

NPS MedicineWise spokesman Sarah Spagnardi said it was understandable some people, particularly those managing chronic pain, were concerned about all codeine-containing medicines moving to prescription only. 

“Some people may be unaware that extended use of codeine or increasing their doses could harm them, and there are too many cases of everyday Australians finding themselves in difficulty,” she said.

“When codeine is restricted to prescription-only — requiring a visit to the doctor — people who’ve been relying on these medicines to treat ongoing pain can work with their doctor or health professional to develop more effective pain management plans and follow-up.”

Australians’ most commonly asked questions about the codeine changes and advice from NPS MedicineWise:

1. Why is access to low-dose codeine-containing medicines changing?

Codeine is an opioid drug, similar to morphine, and can cause opioid tolerance, dependence, addiction, poisoning and in high doses, death. Regular and inappropriate use of these medicines, for example to manage chronic pain, has led to many everyday Australians becoming codeine dependent without even realising it. The risks associated with codeine medicines are high and often outweigh the benefits of their use.

2. What about the people who can’t afford the time or money to see a doctor to treat their pain?

For short-term pain, such as a headache or a sports injury, a pharmacist can advise about suitable OTC treatments that can be just as effective as those containing low-dose codeine. However, for pain that is more severe or longer-lasting, a doctor or allied health professional (e.g. physiotherapist) is better placed to develop a more effective approach to managing severe or chronic pain than OTC codeine-containing medicines. In the long run, this approach should save the patient paying for ineffective or harmful dosages of codeine. 

3. Why is everyone being penalised for a small minority who abuse these drugs?

The Therapeutic Goods Administration (TGA) made the decision because of the potential risks and harms associated with codeine-containing medicines. Other countries, including the UK and France, have successfully implemented this change. By making codeine prescription-only, it reduces people self-medicating with codeine and protects others from future harm.

4. If codeine is so dangerous, why is it still available on prescription? 

With codeine restricted to prescription-only, and requiring a visit to the doctor, patients and doctors can agree on pain management plans and follow-up. This has the potential to reduce the chance of people developing problems that can arise from self-medicating with codeine-based medicines, such as dependence and other serious side effects. 

5. People suffering stomach issues can’t take Nonsteroidal Anti-inflammatory Drugs (NSAIDs), meaning the only option for these will be paracetamol – are there any other alternatives?

Paracetamol (e.g. Panadol, Panamax) is an effective pain reliever for mild to moderate pain. In fact, studies have found that the low dose of codeine in OTC pain relievers may not offer any benefit over paracetamol alone. Sometimes, the best way to manage your pain may not be a tablet at all. Your pharmacist or allied health professional will be able to advise about other treatments, such as heat or cold packs or, when appropriate, NSAID ointments, which may be used as an alternative or in addition to paracetamol, to help you manage your pain.