Now Canada’s considering a codeine change


person picking out a bottle of pills

Yet another country is considering upscheduling low-dose codeine products to prescription-only status

Canada’s Department of Health is seeking feedback on its proposal to require all products containing codeine to be sold by prescription only; the Department says this feedback will be taken into consideration when making a decision on the future of these drugs.

In Canada, most codeine products are available by prescription only, though the Narcotic Control Regulations exempt products containing 8mg of codeine or less per pill, or 20mg or less per 30mL of liquid medications), providing certain conditions are met. Tighter controls are in force in the province of Manitoba.

“In 2015, over 600 million low-dose codeine tablets were sold in Canada, the equivalent of 20 tablets for every person living in Canada that year,” the Department says.

“When low-dose codeine products are used improperly, individuals may be exposed to higher doses of codeine, leading to an increased risk of dependence or addiction.

“For example, in Ontario alone, from 2007 to 2015, an average of 880 individuals per year (representing approximately 2% of total admissions per year) who were newly admitted into publicly funded addiction treatment centres indicated non-prescription codeine products as one of their five problem substances. 

“In that same nine-year period, over 500 individuals admitted to these treatment centres stated that non-prescription codeine was their only problem substance.”

The Department says that the potential change could mean people access the health care system for conditions they may have treated in the past with low-dose codeine, meaning the creation of an avenue for Canadians to take all relevant factors into consideration (such as other health conditions or other medications) when talking to their health care providers about what medication is right for them”.

It points out that some studies suggest that non-codeine analgesics may provide more effective pain relief.

However, it also warns that “reducing the availability of low-dose codeine products may lead to a shift from codeine to other, potentially more dangerous drugs, and/or a shift among current users to sourcing opioids from illicit markets, rather than from health care professionals”.

Canadian stakeholders have 60 days from publication of the notice to give feedback to the Department.

As pointed out by its Department of Health, which cited the upcoming Australian upschedule of low-dose codeine, Canada is only the latest country to consider tightening restrictions on the drug’s availability.

In July 2017, New Zealand’s Medicines Classification Committee decided not to make any changes yet following a MedSafe submission to upschedule the drug. However, it asked stakeholders three questions which it wants to see satisfactorily answered if codeine is to remain OTC, including about education for health professionals to minimise misuse, and how the sector planned to track codeine sales.

However Stuff.co.nz reports that the Waitemata District Health Board in North and West Auckland voted for tighter controls on codeine, including hiding the products from pharmacy customer view, reducing the amount available in one transaction and upscheduling the drug.

In the same month, French Health Minister Agnès Buzyn announced an effective-immediate upschedule of all codeine-containing preparations.

This followed concerns that young people were using codeine-containing cough syrup with alcohol in a potentially deadly cocktail called “purple drank”.

Meanwhile in Australia, efforts to retain access to codeine for patients in exceptional circumstances remain underway.

The Pharmacy Guild says its “prescription – except when” model is a top priority, and it hopes to secure an ability for pharmacists to dispense codeine without prescription under emergency circumstances, such as severe toothache when a patient cannot get in to see a dentist or doctor. It has also repeatedly highlighted that the upschedule will not address issues around doctor shopping.

Consumers have expressed concern and confusion over the 1 February 2018 upschedule, commenting on a News Corp story about the Guild’s efforts that the change will cause inconvenience, expense and pain.

The NSW Branch of the PSA remains hopeful that the upschedule can still be overturned.

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