As of Thursday, codeine-based pain relief will no longer be available over the counter.
To get your hands on painkillers like Panadeine and Nurofen Plus, you will first need to make a trip to your GP to get a script.
It’s part of a decision by the Therapeutic Goods Administration to move the drug from Schedule 2 and 3 to Schedule 4 (prescription only), in a bid to curb codeine addiction and misuse.
But the change doesn’t mean a doctor’s appointment will be necessary for every migraine, sports injury, or bout of period pain.
There are alternatives for effective pain management, and in most cases, codeine is not an appropriate first line of treatment.
If you use codeine medication for acute or chronic pain, here’s what you need to know.
Codeine use can be harmful
Codeine is an opioid pain medication that is converted into morphine once you swallow it.
“Traditionally, it’s been used for acute pain, chronic pain, and unfortunately for some patients who have irritable bowel syndrome and diarrhoea,” said Dr Bastian Seidel, president of the Royal Australian College of General Practitioners.
What doctors now know is that codeine is not an effective treatment for chronic pain, and when used over a long period of time or in a self-medicating way, can be harmful.
Research published in the Medical Journal of Australia found the rate of codeine-related deaths in Australia more than doubled between 2000 to 2009.
“Nationally, we are seeing 150 people die each year because of codeine overdoses,” Dr Seidel said.
“That is completely unacceptable in the 21st century, and it’s time for us to take action.”
Low-dose codeine isn’t that effective
Research has shown that over-the-counter pain medicines containing codeine offer very little additional benefit when compared with similar medicines without codeine.
For acute pain, alternatives include products containing paracetamol or ibuprofen (an anti-inflammatory), or a combination of both.
“If it’s dental pain, an acute headache, or you had a sports injury — and feel you need to take medication — then using paracetamol and ibuprofen in combination is certainly safer and more effective than a codeine-based product, and therefore preferable,” Dr Seidel said.
He noted that anti-inflammatories like ibuprofen are for short-term use only, and given the potential for long-term side effects, should not be used regularly without consultation from a GP.
“We can’t switch from one dangerous drug, which is codeine-based, to something else which is being used without any monitoring … So again, one has to be really careful,” he said.
If you find over-the-counter medicines do not provide adequate relief for your acute pain, it’s time to head to the doctor for further diagnosis and treatment.
“If your doctor believes codeine is appropriate for you, then codeine is still a viable treatment option. But you can’t self-medicate with it anymore, you’ve got to see your doctor first,” Dr Seidel said.
OK, but what if I have…
Cold and flu symptoms: There are numerous over-the-counter medicines available for treating cold and flu symptoms which don’t contain codeine. Ask your pharmacist for advice on the most appropriate medication for you.
A cough: Using codeine to treat a cough is “outright dangerous”, says Dr Seidel.
“We are extremely concerned that patients who have a cough for a little while, who have undiagnosed lung conditions such as asthma or COPD, are trying to self-medicate with a codeine – and unfortunately experience respiratory arrest, thanks to the use of codeine over a long period of time.”
While a bad cough may be the symptom, the underlying condition could be more serious, so it’s best to see your GP.
Period pain: For the vast majority of women, there are far better and far safer medicines for period pain than codeine, Dr Seidel says. Anti-inflammatories are safer and more effective, and should be among the treatment options considered first.
Migraines: If you experience ongoing migraines, codeine-based pain relief may be an option for you. But Dr Seidel says it’s important you speak with your GP to ensure all other treatment options have been explored.
“At least we know we’re putting some safeguards in place, where you will see your GP on a regular basis — at least once a year — to review whether your medications are appropriate, and whether it’s time to try something different.”
Managing chronic pain
If you use codeine on a regular basis to manage chronic pain, it’s a good idea to make an appointment with your GP to discuss alternative treatment plans.
“If you have a chronic medical condition, it certainly would be very reasonable to have a longer-term relationship with your doctor and see them on a regular basis, to review your medication needs and make sure you are otherwise well,” Dr Seidel said.
Chronic pain usually requires a multidisciplinary approach. Alternative pain management strategies include over-the-counter and prescription medicines, as well as non-medicine interventions, such as physiotherapy, acupuncture, lifestyle changes, and self-management tools like exercise and relaxation.
Your GP may also choose to refer you to a pain specialist or pain management clinic.
“Just giving out painkillers is certainly inappropriate and not something that’s going to help most patients. It’s got to be a more sophisticated approach of getting people pain relief,” Dr Seidel said.
If you think that you are unable to manage without codeine and experience some of the side effects of withdrawal, talk to your GP about getting help.