Addictive potential Tek Image/Science Photo Library/Getty

Australia has become the latest country to ban over-the-counter sales of medications containing the opioid painkiller codeine. The new regulation, which will come into effect on 1 February 2018, is hoped to halt the rise in codeine-related deaths, which have more than doubled in Australia since 2000.

Codeine is used to treat pain and suppress coughing, and can currently be purchased in Australia and the UK without a prescription; low doses are found in some painkillers, cough syrups, and cold and flu tablets.

However, even in small doses, codeine has the potential to become addictive. Inside the body, it is partially metabolised to morphine, which can produce feelings of relaxation and euphoria. As a result, some people increase their use of codeine-containing medications. The US, Germany and Japan have already banned over-the-counter sales of the drug.


Pain but no gain

Since banning such sales, these countries have seen a fall in codeine-related deaths, says Michael Vagg, a pain specialist in Geelong, Australia. “But that’s not even the most compelling argument for doing this,” he says. “It’s also a pretty rubbish drug that doesn’t actually help people as much as they think it does.”

In its decision to make codeine prescription-only, Australia’s Therapeutic Goods Administration noted that codeine doesn’t provide effective pain relief at the low doses used in over-the-counter medications.

Long-term codeine use has even been shown to have a pain-sensitising effect in people who take it regularly for headaches, ultimately making their pain worse.

Double whammy

When people start taking high doses, codeine can cause severe breathing difficulties. But there is another harmful effect for people who become addicted. Over-the-counter drugs that contain codeine also often contain other drugs like paracetamol (acetaminophen) or ibuprofen, and as a person increases their use of these, they can experience liver, gut or kidney damage.

A recent study found that paracetamol or ibuprofen was involved in 55 per cent of the 1200 codeine-related deaths recorded in Australia between 2000 and 2013.

Every hospital in Australia will tell you stories of addiction to such combined drugs, says Vagg. “You often see it in young women. Some have to be tube-fed because their guts are so damaged,” he says. “Others have to go on dialysis because their kidneys are wrecked.”

However, George Tambassis, president of the Pharmacy Guild of Australia, says that making codeine prescription-only will unfairly affect people who genuinely need it and use it safely. The issue of misuse would be better managed by a real-time monitoring system that identified people at risk of misusing codeine at the point of sale, he says.

In April 2015, the UK’s Medicines and Healthcare products Regulatory Agency recommended that children under 12 shouldn’t be given over-the-counter codeine. However, no plans have been announced yet to make codeine prescription-only in the UK.