I’ve previously made the case that all codeine-containing pharmaceutical products be sold with prescriptions. In summary, there is mounting evidence that over-the-counter, codeine-containing medications provide modest analgesic benefits at an unacceptable cost.
Further support for this point of view was published in the MJA, where data from the 2010–2013 period showed an increase in codeine-related deaths, from 3.5 per million to 8.7 per million.
Many of the deaths were attributed to accidental overdose, and many occurred as multi-drug overdoses.
Would we tolerate a doubling in road deaths over a four-year period? Would a doubling of cancer deaths be acceptable? We ban unsafe products which cause harm without being useful all the time.
The main groups who stand to lose from making these products prescription-only are retail pharmacies and drug companies, at whose lobbying the measure was previously halted in 2010.
Codeine-containing products were moved behind the counter in pharmacies to ensure that pharmacy staff, and preferably the pharmacist in charge, would be involved to provide advice. This measure has quite patently been inadequate in stopping misuse of over-the-counter codeine products. Seemingly it may have gotten worse.
As someone who uses the occasional over-the-counter codeine product myself, I will be annoyed at having to get a script if I want something containing codeine. But I won’t mind too much, as I will know that, like seatbelts, vaccines, and not taking dangerous items onto planes, it will make the community safer as a whole.
There are simply too many people using over-the-counter codeine in a harmful way, and too many copping pointless side effects for poor quality relief, to make the status quo a responsible proposition.
There will be reassurances from the over-the-counter medicines industry about these measures being unnecessary, but if you read this statement from 2011, it is apparent they are being too optimistic in light of new figures about harm.
Codeine has not gotten any more effective since 2011, but we have ongoing and mounting evidence of it causing severe harms.
There is urgent need for more appropriate availability of up-to-date treatment for pain conditions.
Way too many Australians take opioids for migraines, for example. I challenge any interested reader to find advice from a reputable neurological society or pain society anywhere that recommends opioids as first-line community treatment for migraines.
To provide these medications without medical supervision and a proper diagnosis is almost unethically poor by current, developed-world standards.
There are countries overseas who have done this with codeine and not one of them has regretted it.
We will miss over-the-counter codeine for a while, but my prediction is that in five years, we will wonder why so many people were upset about losing it.
Michael Vagg is a clinical senior lecturer at Deakin University School of Medicine and pain specialist at Barwon Health, Australia. This article was previously published on TheConversation.com
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