OTC codeine restriction: a painful step?

One in three adults use daily medicines that don’t require prescriptions. Most of these over the counter (OTC) medications are our first treatment for common problems such as pains, aches, sprains, colds and rashes. Non-prescribed use of pain killers comes in fourth in the list of most frequently used drugs: behind alcohol, tobacco and cannabis, and equal with ecstasy.

Recently our easy access to these drugs has become a lot harder. Combinations containing codeine and paracetamol provide effective pain relief and but now they are only available with a doctor’s prescription.

There is a fine line between addiction, treatment and prevention. Just looking at the addiction data doesn’t tell the whole story.

Addiction is the problem. Codeine has crossed the line into the dark side of opiates. It seems it is not alright to be using any opiate regularly – even a mild one such as codeine. Studies conducted in methadone maintenance treatment clinics found that nearly half the attenders were abusing codeine.

Just looking at the addiction data doesn’t tell the whole story. Ten percent of teenagers use addictive, legal painkillers ever year and they are the main attenders of addiction clinics.

There is a fine line between addiction, treatment and part of that has to do with age and the type of problem. In adults, chronic problems account for much of their codeine use. Adults who have more than two health problems are likely to receive a prescription for a painkiller at least once every six months.

Prescribing for pain relief is legitimate for adults with ongoing problems because addiction is not the major concern. However, for adolescents who use pain killers for recreational use, addiction is the major problem. Adolescents are known to raid home medicine chests for unused pain killers. Nearly three quarters of all adolescents have unsupervised access to medications that are potentially addictive. Twenty-seven million packs of codeine-containing painkillers are sold every year in the UK. That is a lot of unsupervised use.

Removing codeine products from the shelves of pharmacies and making codeine only available by prescription has been the governmental answer worldwide. Rather than addressing the problem, it just moves it to other locations and makes the problem of addiction the responsibility of doctors, patients and their families. Often these patients are incapacitated with pain and without the resources to carefully monitor these drugs in their homes.

More effective solutions need to be found. Drug take-back programs offer some hope. Pharmacies and GP surgeries in some countries are now able to monitor use and offer safe disposal of unused and especially dangerous drugs. Recycling of unused packets of medications could be the next way forward.

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