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:

• George report: Review of the efficacy and safety of over-the-counter codeine containing analgesics for pain and codeine based antitussives
• Safety review: Codeine use in children and ultra-rapid metabolisers
• Codeine RIS

Additional information can be found on the NPS MedicineWise website: Codeine-related deaths: a cause for concern.

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:

• Information on living with and managing chronic pain
• Tips for talking to your health professional, including a communication tool
• Other Useful links and resources for managing pain
• Managing Chronic pain video Dr Malcolm Hogg, Head of Pain Management Services, Royal Melbourne Hospital
• FAQs about chronic pain

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

• Brainman

National support services

• NPS MedicineWise
• Alcohol and Drug Information Service (ADIS)
• Pain Australia
• Chronic Pain Australia
• painHEALTH
• Australian Pain Management Association
• Ask Your Pharmacist
• Pain Management Network
• Pain Link Helpline 1300 340 357
• Healthdirect Australia - 24 Hour Health Advice Line 1800 022 222

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.

• Codeine Industry Forum
• Sponsor fact sheet: Changes to advertising for medicines containing codeine
• Frequently asked questions - industry sponsors of codeine-containing products