Codeine information hub

Changes to patient access for medicines containing codeine

21 September 2017

No therapeutic product is ever completely risk free. Some risks may be known when a medicine or medical device is first entered on the Australian Register of Therapeutic Goods (ARTG). However, some information only comes to light after more people use the products.

Explore this page to find out more about the TGA's recent decision regarding medicines which contain codeine.

What's changing?

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

Your pharmacist will be able to help you choose from a range of effective products that do not require a prescription. 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.

Further information on the reasons for the change can be found on the TGA website: Scheduling delegate's final decision: codeine, December 2016

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.

Further information on the health risks of low-dose codeine medicines can be found on the TGA website:

Additional information can be found on:

NPS medicinewise logo
ScriptWise logo logo

Pharmacists have an important role to play in minimising harm from codeine

The current range of codeine-containing over-the-counter medicines will continue to be available without a prescription in pharmacies until 31 January 2018. Pharmacists will continue to be an important source of information and advice for consumers both before and after this date.

Most people should be able to manage acute pain or cough and cold symptoms with safer alternative medicines. For acute pain, this may include products containing paracetamol or ibuprofen, or the two products in combination. Your pharmacist will be able to provide advice on the most appropriate medicines for you. Speaking with your pharmacist is particularly important if you have any other medical conditions, such as stomach, kidney, liver or heart problems.

Talk to your doctor

People with ongoing pain should talk to their doctor or healthcare provider to determine better alternative treatment options. These may include: alternative over-the-counter or prescription medicines; non-medicine therapies from an allied health professional such as a physiotherapist; self-management tools such as exercise or relaxation; or referral to a pain specialist or pain management clinic.

Ask your doctor about a Medicare-funded care plan which will allow you access to a rebate for treatment from an allied health professional. Medicare provides a rebate for the preparation of a Chronic Disease Management (CDM) Plan and a Team Care Arrangement (TCA).

For more information see www.health.gov.au/internet/main/publishing.nsf/content/mbsprimarycare-chronicdisease-pdf-infosheet.


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Chronic Pain management

Further resources and information for individuals experiencing chronic pain are available on the NPS MedicineWise website:

If you think that you are unable to manage without codeine and experience some of the side effects of withdrawal talk to your doctor about getting help.

Chronic pain management video resources

National support services

Contact information for state and territory drugs & poisons units

State/Territory Website Contact details
Australian Capital Territory (ACT)

ACT Health

Pharmaceutical Services

Email: hps@act.gov.au

Phone: 02 6205 1700 or 02 6205 0998

New South Wales (NSW)

NSW Ministry of Health

Pharmaceutical Services

Email: pharmserv@doh.health.nsw.gov.au

Phone: 02 9391 9944

Northern Territory (NT)

NT Department of Health

Environmental Health - Medicines & Poisons Control
Phone: 08 8922 7341
Queensland (QLD)

QLD Health

Medicines:

Medicines Regulation & Quality

Poisons:

Poisons Management

Medicines:

Email: mrq@health.qld.gov.au

Phone: 07 3328 9890

Poisons:

Email: environmentalhazards@health.qld.gov.au

Phone: 07 3328 9310

South Australia (SA)

SA Health

Medicines and Technology Policy and Programs

Phone: 08 8204 1942 or 08 8226 7100

Tasmania (TAS)

TAS Department of Health & Human Services

Pharmaceutical Services
Phone: 03 6166 0400
Western Australia (WA)

WA Health

Pharmaceutical Services
Phone: 08 9222 6883
Victoria (VIC)

VIC Department of Health & Human Services

Drugs and Poisons Regulation
Phone: 1300 364 545

A Nationally Coordinated Codeine Implementation Working Group (NCCIWG) has been established with representatives from state and territory health departments and peak professional bodies representing consumers, pharmacists and medical professionals. The purpose of this working group is to assist with the implementation of a communication and engagement strategy to help inform the community of the upcoming changes to the availability of low-dose codeine containing medicines from 1 February 2018.

Advice for pharmacists and medical professionals regarding the changes to codeine access and to help them provide the best advice to their patients will be made available on the Department's website.

The following organisations have contributed to the work of the Nationally Coordinated Codeine Implementation Working Group (NCCIWG):

  • ACT Health
  • Asthma Foundation, NT
  • Australian College of Nurse Practitioners
  • Australian College of Pharmacy
  • Australian College of Rural & Remote Medicine
  • Australian Medical Association
  • Australian Nursing & Midwifery Federation
  • Australian Pain Management Association
  • Australian Pain Society
  • Australian Physiotherapy Association
  • Australian Self Medication Industry
  • Consumer Health Forum of Australia
  • Department of Health, Western Australia
  • Faculty of Pain Medicine, Australian and New Zealand College of Anaesthetists
  • NPS MedicineWise
  • NSW Health
  • NSW Nurses & Midwives' Association
  • Painaustralia
  • Pharmaceutical Society of Australia
  • Pharmacy Guild of Australia
  • Queensland Health
  • Royal Australian and New Zealand College of Psychiatrists
  • Royal Australian College of General Practitioners
  • Royal Australian College of Physicians
  • ScriptWise
  • Society of Hospital Pharmacists of Australia
  • Tasmanian Health Service, Tasmanian Government
  • University of New South Wales, National Drug & Alcohol Research Centre
  • University of Sydney, Pain Management and Research Institute

Prominent professional organisations are supportive of the national codeine communication strategy being implemented through NCCIWG. Their views are articulated in these letters of support.

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