From 1 February 2018, medicines that contain low-dose codeine will no longer be available without prescription in pharmacies.

If you have strong or chronic (long-lasting) pain you will need to consult your doctor, and if medicines are part of your treatment, a prescription may be needed.

Why is access to low-dose codeine-containing medicines changing?

Some Australians don’t realise how much harm codeine can cause. Codeine is an opioid drug closely related to morphine and, like morphine, is derived from opium poppies. Codeine can cause opioid tolerance, dependence, addiction, poisoning and in high doses, death. Regular use of medicines containing codeine, for example for chronic pain, has led to some consumers becoming addicted to codeine without realising it. The risks associated with codeine use are too high without oversight from a doctor.

Codeine use can be harmful

Most Australians are unaware that over-the counter medicines containing codeine for pain relief offer very little additional benefit when compared with medicines without codeine. The use of such medicines however, is associated with high health risks, such as developing tolerance or physical dependence on codeine.

Tolerance occurs when codeine becomes less effective and so the body needs higher and higher doses to feel the same relief from your symptoms. Severe withdrawal symptoms can result when the medicine is stopped; these include head and muscle aches, mood swings, insomnia, nausea and diarrhoea. Some of these withdrawal symptoms, such as head or muscle aches mimic the symptoms that low-dose codeine products are often used to treat, leading to people incorrectly continuing to take the medicine longer or in higher doses.

Codeine poisoning contributes to both accidental and intentional deaths in Australia. The codeine-containing medicines that are currently available over-the-counter are usually combined with either paracetamol or ibuprofen. Long term use of high doses of paracetamol can also result in liver damage and the most severe adverse effects of long term ibuprofen use include serious internal bleeding, kidney failure and heart attack.

Codeine is also sometimes used in medicines to relieve the symptoms of cough and cold, however there are safer and more effective medicines available that may provide relief from these conditions. Talk to your pharmacist or doctor for advice on what may be best for you.

How and where to get advice

Most people should be able to manage acute pain or cough and cold symptoms with safer alternative medicines. Speaking with your pharmacist is particularly important if you have any other medical conditions, such as stomach, kidney, liver or heart problems.

People with ongoing pain should talk to their doctor or healthcare provider to determine better alternative treatment options.