Back in June last year, the National Drugs and Poisons Schedule Committee decided to change the rules relating to analgesic medications containing codeine. These are known by such brand names as Panadeine, Mersyndol, which contain Paracetamol as well as Codeine. There are also combinations of Codeine and Ibuprofen. Note that Codeine on its own is not available.

The changes were deferred until 1st May this year. Previously a customer could just pick these off the shelf, and they were available in large packages. As a result of the changes, a customer will have to ask a pharmacist for them, and packages will be limited to a 5 day supply. Inevitably, the cost will rise and convenience will fall.

So why the change? Well, the concern is that people will get hooked on the Codeine component of these drugs, and will then take them in excessive quantities, thus causing themselves harm. Note that it's not the Codeine that does the damage here, but the amount of Paracetamol or Ibuprofen consumed, and the solution of making just Codeine available is not going to happen.

So where's the data that supports this change? You can look in the statement of reasons -

http://www.tga.gov.au/ndpsc/record/rr200906.pdf

- skip down to PDF page 41. But you will search in vain for hard facts, or even, for the most part, references to hard facts. Both the extent of the supposed harm being caused to addicts, and the benefits to be obtained from the change, are based on little more than anecdotal evidence, supposition and speculation.

We expect more from our regulators.

It's ridiculous. What business is it of the pharmacist why you need them?. Doctors are suppose script packs of 24 pills?. I have NEVER come across anyone using codeine for some sort of stone, and I've known plenty of junkies and used various drugs recreationally years ago.

If they REALLY want to help, make alcohol by prescription and ban smoking.

As much as it annoys me that we will now have to pay more for smaller packs of medications containing codeine, I can understand why it is happening.

Sure, we have the problem of junkies using the codeine component for cheap 'highs', but the main problem is that Joe Blow off the street does not understand these medications.

Many people don't understand that you can only safely ingest 2 grams (8 tablets)of panadol (paracetamol)over 24 hours, before long term overdoses can severely affect the liver and or kidneys.

If people already have boxes of panandol at home, and then suffer severe pain somewhere and rush out and buy mersyndol, codral forte, panadeine, or panadeine forte (to name a few), they do not factor in the actual amount of panadol they are ingesting over 24 hours from all these medications.

Also, the codeine component of these medications is dreadful for causing severe constipation. Anyone who is asking to take these medications, especially over a long period of time, needs to be under medical supervision.

The pharmacist should be involved in discussions with clients about codeine medications just as much as Doctors should.

I agree with this change. Codeine is an addictive drug in the same family as heroin and opium. This should only be available on prescription and under a doctors supervision. The types of pain that need codeine to treat are all severe enough to warrant a visit to the doctor. This is not the drug to be taking for a headache or a sore throat.

Money is probably the most addictive so should we hand it out in smaller doses ? If drugs are being misused then so be it ! let the idiots sort themselves out, don't waste taxpayers' funding on them. Druggies at the end of the queue if you ask me !

As Sylvia Else said, where's the facts?.

Opinions are fine, but it's like a**eholes. Everyone's got one and they're full of ...

Where's the data to help form an educated opinion and allow debate?

Hmm, I noticed that I had to show my license about a year ago, to buy a packet of cold medicine. I really wanted the girl to make a note of my sneezing and sniffling, so the authorities dont decide I am cooking up a batch of drugs. Its a bit of a humiliating thing to have to do, but there is a reasonable intention behind the idea, that is to help stop people cooking up batches of speed.
From what I hear out there on the streets, all it has done is make speed more expensive than cocaine. There really hasnt been any hiccup in the availability of such substances, just created a more intense market place for ephedrine-containing medicine.
We actually make heaps of opium drugs in Tasmania, and do it very cheaply. I reckon just give the junkies what they want, the problem will sort itself out in time, and they dont have to rip people off or sell themselves any more.

Suzeonline, as I said, these changes are not about reducing the risk of accidental overdosing. The is a potential wider problem of people not realising that medication with different brand names have the same active components, but that wouldn't be a reason to target medications containing Codeine to exclusion of others.

Mikk, It's not enough to assert that Codeine is addictive. While anecdotal evidence is sufficient to show that some people have become addicted to Codeine, and have endangered themselves by taking excessive amounts of Paracetamol or Ibuprofen, that evidence does not tell us the extent of the problem, and thus doesn't tell us whether we're justified in restricting access to these medications. I'm somewhat sceptical of the existence of a significant level of abuse because of the constipation causing side effect. Further, without proper study, we don't know what the actual results of restrictions would be. The road to hell is paved with good intentions.

The idea that anyone with pain enough to seek these medications should see a doctor ignores that fact that the medical profession are frequently powerless to help. Certainly a person who experiences severe pain of a given type for the first time should seek medical attention, but when they've been examined, and nothing untoward found, they should not then be tied to the medical profession for ever more, when all they actually need is reasonable strength analgesia.

I think it's really annoying and I expect the company packaging and marketing these products will profit by the changes toward restriction by selling smaller amounts.

However I am wondering if there is any age restriction on purchasing. I didn't see any in the document posted by the OP.

One thing I have noticed is that there seems to me to have been an increase in young people taking some sort of analgesic cocktail in attempted suicide. Some of them don't really think it will work. None that I've met are aware that if they do survive the liver damage will probably still mean an early and painful death. I don't know all the implications of the conditions that arise if the results of LFTs aren't good. Suzie can probably enlighten me/us on that.

The point is that although I find it irritating to have these tiny packs - and I rarely use such products - I won't mind the inconvenience if it helps restrict access to lethal or damaging amounts by young people. Trouble is, I don't think it will stop it.
Also, the 5 day supply - that could still be a lethal or damaging dose if it's all taken at once couldn't it Suze?

Yes Pynchme, the amount of paracetamol needed to be a lethal dose to the liver is 30 tabs for a small adult- that's all!
5 days supply equals 40 tabs, so technically they could still destroy their liver if they took them all at once.

I have looked after a couple of failed panadol suicide patients in the liver disease unit several years ago.

They destroyed their liver's ability to function correctly- leaving them jaundiced, nauseous and vomiting until the day they died.

They were only in their 20's but they took a few months to die after their overdoses, plenty of time to reconsider their original reason for dying. It was a heartbreaking thing to watch.

I don't think they want to restrict the codeine meds for just the panadol problem though. As I said above, there are many other problems associated with codeine use.

This is rubbish- the ONLY reason people would by so much of this drug is because they're in a LOT of constant pain- especially considering those people are going to be providing some medical evidence to support this notion, you know, in case the chemist wasn't sure.

I mean, really?
So, here's a person deciding they're going to take drugs for pleasure.
"WEll let's see- I could just stroll down to kings cross, an industrial area where dealers hang, and purchase an unlimited quantity under total anonymity, OR I could walk into the chemist and keep buying it from them- who would need my identification and medical needs disclosed, and hope they don't get suspicious."

This should be the proof that nanny-state doesn't work- because the 'nanny' in question tends to be completely out of her league when trying to judge what actually IS best for us.

suzeonline,

Codeine has some other side effects, with constipation being the most noticeable. But that one aside, and at the doses available on OTC medication, none are as significant as the toxicity of the analgesics they're packaged with. It makes no sense to target medications containing Codeine, but to leave straight Paracetamol and Ibuprofen on sale not just in front of the counter at pharmacists, but in supermarkets (not sure about the latter in supermarkets). As far as I can see, having read the statement of reasons, the sole motive for restricting access to Codeine medications is the unquantified risk that people will become addicted to it and then abuse medications containing it.

Recently, a group of people in Nimbin or somewhere like that decided to have a codeine party to celebrate the winter solstace. It was all going fine until the hippy girl in the orange kaftan was sick, and everybody was either asleep or going through other peoples things looking for more codeine. It was great.