As of 1 February 2018, drugs containing codeine – including pain medications Nurofen Plus and Panadeine – are no longer available “over-the-counter”, and can only be accessed with a prescription due to codeine rescheduling. But why the need for change, if many people currently use codeine for pain?
First of all, what is codeine? Codeine is a very old drug, and like heroin, it is a derivative of the opium poppy. To work as a pain reliever codeine must first be converted to morphine in the body which then acts on the brain and central nervous system to reduce pain. Up until now, it has been available in formulations with paracetamol or ibuprofen, which are also pain medications of different classes. It’s also been used as a cough suppressant, as it directly acts on the part of the brain controlling the cough reflex, with brand names like Demazin or some Codral mixtures. Over-the-counter use exceeds 15 million packs in Australia per year.
There are several problems with codeine and its extensive use. First of all, when codeine is metabolised it depends on your liver’s enzymes to break down and activate the drug. 1 in 5 people do not effectively convert codeine to its active form and in those patients it has almost no pain relieving effect. Conversely some people metabolise the drug very quickly, which is a real worry for opioid toxicity. Toxicity can range from light sedation to respiratory depression and coma – meaning you can stop breathing. In a wide-scale review, codeine has been attributed to more than 100 deaths per year in Australia.
Codeine (like heroin) has also been shown to be very addictive.
Many people who take codeine for long periods of time experience tolerance and withdrawal symptoms – these include headache, insomnia and diarrhoea. In fact, some people who use codeine for headaches don’t realise that the headache they have when the drug wears off may be due to the withdrawal, and not the migraine!
So codeine can be dangerous, but does it actually work? For many the answer is no – large studies have shown that paracetamol or ibuprofen on their own are equally effective for acute pain including headaches, joint pain and period pain. Many people don’t realise that both these drugs can be used together for more serious pain – try alternating paracetamol and ibuprofen for continuous relief. But if you are having severe pain and it is not relieved by these medications then you should see your doctor. In some cases, proper codeine use will be the answer, but it’s essential that your doctor review you and make sure you are on the most appropriate medication for your pain
In chronic pain, codeine is rarely the answer. There have been significant developments in pain treatment over the past few decades – from physiotherapy, yoga, and even surgical procedures. If you do require long term pain medication there are newer options that are more effective, safer and with significantly less side effects than codeine. Your GP may refer you to a chronic pain specialist to be involved in your care so that you are receiving the most effective treatment for your particular type of pain.
The Therapeutic Goods Administration’s decision to limit codeine to prescription only is ultimately based on the safety and effectiveness of this drug. While it is an adjustment, this brings Australia in line with the US and many other countries who’ve realised that codeine is rarely the answer to acute or chronic pain. For more information on what treatments are most effective for your type of pain discuss with your GP for an individualised management plan.
By Rob Thomas