What it is advisable know concerning the codeine crackdown


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If you are taking Panadeine Extra, Nurofen Plus or Mersyndol, put together for giant adjustments. On February 1, 2018 all codeine-containing medicines offered over-the-counter will grow to be prescription solely.

With about a million Australians taking medicines that include codeine, the results shall be far-reaching, with higher demand on GPs and ache specialists, and 1000’s of individuals rethinking their relationship with this highly effective drug.

Codeine entry is not a brand new concern in Australia: Over the previous decade there have been restrictions made, akin to smaller pack sizes, making customers converse to a pharmacist earlier than buy, and voluntary codeine monitoring in lots of pharmacies. Compared to these inconveniences, what’s about to occur is a serious disruption. But that is an excellent factor, in line with pharmacist and NPS MedicineWise spokesperson Aine Heaney.

“If codeine were to come on the market today and be assessed, it probably wouldn’t make the cut in its low-dose form,” Heaney says. “It’s not a good pain reliever, plus it carries a high risk of side effects and dependence.” She provides that Australia is now “catching up with the rest of the world” with these adjustments – the US, most of Europe, Hong Kong and Japan have already got codeine as prescription-only.

Here’s what the adjustments imply for you.

What’s off the shelf

Codeine is an opioid, a sort of narcotic. Over-the-counter medicines include a “low dose” of between 5mg and 20mg per pill.

The medicines fall into 2 classes:

  1. Painkillers with codeine, together with Panadeine, Panadeine Extra, Nurofen Plus, Mersyndol and generic pharmacy variations. All of those additionally include one other analgesic akin to paracetamol or ibuprofen.
  2. Codeine-containing cough, chilly and flu merchandise (tablets and syrup), akin to Codral and Demazin, and generic variations. Codeine is commonly mixed with an analgesic and antihistamine and/or decongestant.

From February 1, these would require a prescription with attainable circumstances for sure teams of the group. Some low-dose merchandise might be reformulated with out the codeine to stay over-the counter, whereas others could disappear (Healthcare firm GSK says its complete over-the-counter codeine vary, together with Panadeine and Panadeine Extra, will exit the market).

Some individuals could not even know product they take accommodates codeine, and Dr Bastian Seidel, president of the Royal Australian College of General Practitioners, says that is why pharmacists have began speaking to prospects: “They’re explaining that a prescription will be needed soon, so GPs are already getting patients wanting to talk about codeine and their conditions.”

The downside with codeine

Recovered codeine addict Paula Ellis, 49, believes these adjustments will make a giant distinction. “I stopped using codeine medicine two years ago after I had kidney failure, but I would have done it earlier if codeine were harder to get,” she says.

Ellis’s story is not unusual: She started taking her mum’s painkillers when she was simply 13, for dangerous migraines and interval ache.” That’s what was around, and it seemed to work,” she says. Over the following 34 years, she mixed prescription and over-the-counter medication in more and more harmful methods. “I felt like I couldn’t function without it – at my worst I was taking 40 tablets a day.” Kidney failure 2 years in the past (attributable to long-term codeine misuse) was a turning level.

Ellis spent many years as an addict and now has long-term well being points, however she’s one of many fortunate ones. Codeine-related deaths doubled between 2000 and 2009, and there are actually as many as 150 codeine-related overdose deaths a 12 months. Of these, 40 per cent are from over-the-counter merchandise.

Why is codeine so addictive?

Because it turns into morphine as soon as it is metabolised by your physique, Heaney explains, and a few our bodies metabolise it sooner than others. “It gives a small euphoric effect and can also reduce anxiety,” she says. “Ultra-metabolisers get a quick hit, putting them at higher risk of dependence.” For all of the dangers of habit that codeine poses, many consultants say it would not even do its supposed job of easing critical ache.

“In low doses, it’s no better than analgesics,” Heaney says, including that in increased doses it helps acute episodic ache, like after surgical procedure, however not power ache – a current 12-month research introduced at a serious US medical convention discovered that even higher-dose opioids do not deal with decrease again ache higher than ibuprofen or paracetamol.

What to do now

A pharmacist can speak you thru the choices. The extra details about the ache (what it looks like, the place it’s, when it is worse), the extra enable you’ll get. GPs need to give you safer plans round codeine use, for instance a affected person who takes codeine for rare migraines would solely have a 48-hour provide.

For power points, a GP will ask concerning the ache and the way it impacts your life, and take a look at methods to handle it. “We’re guiding away from medicines and more to manual therapies, exercise and relaxation techniques,” says Seidel.

There’s no disgrace in telling a health care provider how a lot codeine you are taking, Seidel says, including that an important factor is getting the best therapy. If you are taking over-the-counter codeine usually, it is not really helpful that you simply give up all of a sudden. “It will be different for everyone, but generally we don’t recommend cold-turkey.”

Codeine: the lowdown

NPS MedicineWise solutions probably the most generally requested questions on codeine and the adjustments forward.

Q. “Why is codeine access changing? I don’t misuse it.”

A. Codeine is an opioid drug and may trigger dependence, habit, poisoning and, in excessive doses, dying. Many Australians grow to be codeine dependent with out even realising it. By making codeine prescription-only, it reduces individuals self-medicating and protects others from future hurt.

Q. “What if I don’t have the time or money to see a GP?”

A. For short-term ache, akin to a headache or a sports activities damage, a pharmacist can advise about appropriate over-the-counter therapies that may be simply as efficient. However, for power ache, a health care provider or allied well being skilled (e.g. physiotherapist) is best positioned to develop the best method.

Q. “I can’t take anti-inflammatories like ibuprofen due to stomach problems. Is paracetamol my only option?”

A. Your pharmacist can advise about different over-the-counter therapies, akin to warmth/chilly packs or non-steroidal anti-inflammatory ointments, which can be used as a substitute or along with paracetamol, that will help you handle your ache going ahead.


If you are taking over-the-counter codeine every day, do not give up with out medical recommendation.


Medicines Line 1300 633 424 For info on negative effects, substances and secure use.

Pain Link Helpline 1300 340 357 For help by and for victims of power ache.

(Editor references)

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