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    Over-The-Counter Codeine: Commonly Asked Questions

    Opioid painkiller dependence and recovery

     

    The new law changes to patient access of codeine will be taking effect this week, and the decision has sparked a nationwide conversation about medicines which contain the narcotic pain-reliever. Amid Australia’s growing codeine problem, both consumers and medical professionals have shared their experiences and concerns – but with the rising burden of the drug’s adverse side-effects, there’s no doubt these medicines are associated with some serious public health implications.

    Codeine isn’t as potent as other opioids, but dependence is a very real and far-reaching health issue in Australia. Over the past decade, opioid-related hospitalisations outnumbered heroin poisoning, with almost 1500 cases, costing the Australian government over $270 million. [1]

    Codeine is commonly found in things like cough syrup and cold and flu relief – but what makes this seemingly run-of-the-mill drug so addictive? Here are some answers to the most frequently asked questions about codeine, dependence and recovery:

     

    What kind of drug is codeine?

    Codeine is an opioid analgesic (or opiate) derived from morphine that is used to decrease the way you feel or react to pain.

    Codeine is often combined with paracetamol or ibuprofen, and can be found in drugs such as Nurofen Plus, Panadeine and Codral Cold & Flu.

     

    What is codeine used for?

    Codeine-containing medicines are most commonly used treat mild to moderate pain and relieve cough – but they are addictive and can lead to dependence.

    Patients with long-standing pain often use codeine to provide relief where everyday painkillers (like paracetamol, ibuprofen or aspirin) aren’t effective.

     

    Can you buy codeine over-the-counter?

    From February 1, 2018, codeine-containing medicines will be withdrawn from the market and will only be available with a prescription.

    The ready availability of over-the-counter products containing codeine (such as Nurofen Plus, Panadeine and Codral Cold & Flu) has raised concerns – largely due to the drug’s potential for misuse. In a bid to combat codeine overuse and abuse, the Therapeutic Goods Administration (TGA) has coordinated new laws to ban over-the-counter purchases of medicines containing codeine in Australia. [2]

    Critics of the the prescription-only scheme are worried that the majority of responsible users – as well as those in remote communities – will be unfairly penalised by the few who misuse those medications. Others have argued the move may even encourage “doctor-shopping” without an effective recording and monitoring system in place.

    Despite the backlash, research suggests there are more effective pain management treatments available that carry less risk. [3] There has also been increased reporting of harms associated with codeine dependence, mainly caused by the side effects of additional ingredients (including ibuprofen and paracetamol) which have led to deaths. [4]

    The decision follows years of consumer and industry research (not to mention a great deal of public debate), and all medicines containing low-dose codeine will only be available with a prescription in order to reduce the associated public harm.

     

     

    How addictive is codeine?

    Codeine has a high potential for misuse which can develop into a serious dependence.

    Codeine can be used safely to treat minor pain or suppress coughs, however, users sometimes abuse codeine combination medicines or build up a tolerance to their effects – mainly due to the feelings of euphoria and relaxation they produce. Many people begin using codeine under the advice of a medical professional without realising they are becoming dependant. Some individuals consider themselves ‘dependant’, but socially and economically different from illicit drug users.

    It’s important to remember that anyone can develop codeine dependence; however, factors like genetics, length of use, dosage and behaviour towards the drug can determine just how quickly you build up a tolerance. The more tolerant you become, the more likely you are to increase your dosage or take the drug on a regular basis – even after the pain has passed.

     

    What are the long-term side effects of codeine abuse?

    Using codeine combination medicines on a long-term basis can result in a number of physical, mental and social issues.

    Taking codeine-containing medicines more often, and in higher doses than recommended will not only increase your risk of dependence, but the long-term effects can be quite dangerous to other parts of the body, and even prove fatal. [5,6]

     

    Long-term codeine misuse may cause:

    - Bowel dysfunctions

    - Intestinal bleeding

    - Other stomach problems

    - Liver damage

    - Kidney damage

    - Seizures

    - Depression

    - Anxiety

    - Fatigue

    - Anemia

    - Constipation

    - Hypoventilation

    - Slowed heart rate

    - Pancreatitis

    - Sleep disorders

     

    What are the signs and symptoms of codeine withdrawal?

    The side-effects of codeine withdrawal can range from mild to severe, depending on the individual and how dependent they are on the drug.

    For those who have formed a habit or have used codeine long-term, getting used to functioning without the drug is both physically and mentally challenging. As the body requires a certain amount of time to repair and restore function, withdrawal symptoms will often take the opposite effects of the drug. For example; while codeine use causes constipation, coming off the drug may induce the reverse effect of diarrhea.

     

    Common withdrawal symptoms may include:

    - Nausea

    - Headaches

    - Stomach cramps

    - Muscle aches

    - Agitation

    - Irritability

    - Fever

    - Runny nose

    - Watery eyes

    - Diarrhea

    - Rapid heart rate

    - Vomiting

    - Chills or cold sweats

    - Loss of appetite

    - Confusion

     

    If you think you may have codeine dependence, it’s so important to seek the appropriate treatment and support. If you’re concerned about codeine withdrawal, ask a mental healthcare professional about safe detox options.

     

     

    What happens if you become codeine dependent?

    Continued misuse can bear significant consequences, so it’s important to acknowledge your dependence and seek immediate treatment and support.

    As many people who use codeine struggle to come to terms with their dependence, seeking treatment can be a difficult task – but recovery doesn’t have to be so daunting. It’s important for those who rely on these medicines to understand why they misuse. With the right treatment and support, sufferers of codeine dependence learn to change their behaviour in order to better manage pain and lead fulfilling lives.

    Speak to your doctor about mental health day programs and ongoing support, or reach out to Currumbin Clinic on 1800 119 118 where one of our compassionate and experienced staff members will best advise you on your options.

     

    References

    1. Blanch, B., Pearson, S.A. and Haber, P.S., 2014. An overview of the patterns of prescription opioid use, costs and related harms in Australia. British journal of clinical pharmacology, 78(5), pp.1159-1166.

    2. Health.qld.gov.au. (2018). Changes to patient access for medicines containing codeine | Queensland Health. [online] Available at: https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/medicines/medicines-containing-codeine/changes 

    3. Furlan, A.D., Sandoval, J.A., Mailis-Gagnon, A. and Tunks, E., 2006. Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects. Canadian Medical Association Journal, 174(11), pp.1589-1594.

    4. Cooper, R.J., 2013. Over-the-counter medicine abuse–a review of the literature. Journal of substance use, 18(2), pp.82-107.

    5. Tobin, C.L., Dobbin, M. and McAvoy, B., 2013. Regulatory responses to over?the?counter codeine analgesic misuse in Australia, New Zealand and the United Kingdom. Australian and New Zealand journal of public health, 37(5), pp.483-488.

    6. Frei, M.Y., Nielsen, S., Dobbin, M.D. and Tobin, C.L., 2010. Serious morbidity associated with misuse of over-the-counter codeine-ibuprofen analgesics: a series of 27 cases. Med J Aust, 193(5), pp.294-6.

    30 JAN 2018
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