Community toolkit

It’s time to get candid about codeine

From February 2018, medications containing codeine such as Panadeine, Nurofen Plus and some cold and flu tablets will only be available by prescription from a GP.

Many Australians do not know the risks associated with using over-the-counter codeine medications, despite the devastating harm it’s been causing in families and communities. The risks of using codeine-based medications are too high without a doctor’s involvement.

You can view the full list of codeine-containing products which have been made prescription-only on the Therapeutic Goods Administration’s codeine information hub here.

Three reasons codeine is being rescheduled

1. Long-term regular use of codeine can cause serious harm: you can become dependent on codeine-containing medications and find that you need more and more of the medication to obtain the same effects. This can lead to toxicity, and sometimes even death.

2. It is not a very effective pain reliever in some people: medical and scientific evidence has shown that the low doses of codeine in over-the-counter medications do not provide any more pain relief than medications that don’t contain codeine.

3. There are safer and better alternatives to use: there are both pharmaceutical and non-pharmaceutical options for pain management which can be discussed with pharmacists, GPs and allied health professionals.

You can find out more about the Therapeutic Goods Administration’s decision to reschedule codeine on their codeine information hub website.

Start the conversation

What is codeine?

Codeine is an opioid pain medication that is converted into morphine in the body.

Products such as Nurofen Plus, Panadeine Forte and some cold and flu tablets are often used to relieve moderate to severe pain, and are usually safe in low doses or if taken for short periods.

Each body is unique and breaks down codeine at different rates. This means that people can have very different responses. Some get good pain relief from using it (and potentially are very susceptible to the risks associated with it), or get no pain relief at all.

What are the side-effects?

20-30 percent of people experience side-effects associated with using opioid medications such as:

+ Constipation

+ Nausea

+ Dizziness

+ Dry mouth

+ Sleepiness

+ Headaches, and

+ Difficulties breathing

Over-the-counter codeine medications in pharmacies are usually combined with paracetamol, ibuprofen or aspirin. Long-term use can lead to:

+ stomach ulcers

+ internal bleeding

+ kidney disease, and

+ heart disease

Higher doses of these medications can be very dangerous and cause:

+ liver disease, and

+ kidney failure

Codeine can cause dependence

Like morphine and other opioid drugs, codeine can be highly addictive. If taken regularly codeine can lead to:

+ tolerance

+ dependence

+ addiction

+ toxicity, and in high doses

+ death

It is possible to become dependent on codeine-based products without realising it. The body can develop a tolerance which lessens the medication’s effectiveness and means more and more is needed to get the same pain relief. When use stops suddenly, withdrawal symptoms can occur such as:

+ head and muscle aches

+ mood swings

+ insomnia

+ nausea

+ diarrhoea

This is why it’s important to speak with your pharmacist or GP about alternatives to codeine-based medications to avoid these risks and help manage your pain.

Types of pain

Although there are many different types of pain, the two most common types of pain over-the-counter codeine products are used for are acute pain and chronic pain.

Acute pain

Characteristics of acute pain:

+ Generally lasts for a short time (usually less than three months)

+ Usually happens after an injury of some kind

+ Often goes away on its own

Chronic pain (or persistent pain)

Characteristics of chronic pain:

+ Generally lasts for longer than three months

+ Chronic pain is complex and can happen when there’s no clear injury

+ Can cause changes in the central nervous system

NPS MedicineWise has a comprehensive explanation of chronic pain and its treatment which you can access here.

Understanding pain

Pain management is a complex issue.

Although we often think of pain as something that is purely physical, it often has other components that are social, psychological, behavioural and financial.

We know, based on scientific evidence, that pain (and particularly long-term or chronic pain) usually requires a multidisciplinary approach to help individuals go on with their daily lives.

It’s important to remember that effective pain management may not always just involve using medications, and there are many different non-pharmaceutical therapies available which you can discuss with your pharmacist, doctor or other health professionals such as physiotherapists or psychologists.

Getting Help for our Pain

Your pharmacist is a great person to speak to if you have been in pain for less than three months. They can work with you to suggest many alternative treatments to help manage your pain.

If you’ve had pain for longer than three months, it’s really important to speak to your GP about a treatment plan. This may involve a referral to an allied health professional (e.g. a physiotherapist) or pain specialist or working together with your GP to find the best ways to treat your pain.

Start the conversation with your pharmacist or GP around better alternatives to pain management.

Getting to know dependence and addiction

Codeine dependence is a common consequence of being prescribed or buying codeine over an extended period of time.

Anyone can be affected by or experience dependence and/or addiction. Dependence and addiction are medical conditions, and like other health conditions such as diabetes or asthma, they do not discriminate.

It is possible to become dependent on codeine-containing medications without realising it. This is a common consequence of using these medications for longer periods of time and doesn’t say anything negative about a person’s character or moral fibre.

Listen to Jessica’s Story

Treatment options

There are many effective treatments available to address and manage codeine dependency. Seeking help from your GP, and speaking to your family and friends if you think they may need help, are important first steps.

Call a helpline

There are also a number of help lines you can call if you are concerned about your codeine use. These services are free (from a landline), anonymous and confidential and you’ll be talking to a professional counsellor experienced in drug and alcohol-related issues.

DirectLine (VIC): 1800 888 236

Alcohol and Drug Information Service

(NSW): 1800 422 599

(TAS): 1800 811 994

(NT): 1800 629 683

(WA): 1800 198 024 and for parents 1800 653 203

(QLD): 1800 177 833

(ACT): 02 6205 4545

(SA): 1300 131 340

You can also contact CounsellingOnline 24 hours, 7 days a week, anywhere in Australia for free online advice about alcohol and drug-related issues: www.counsellingonline.org.au

If you, a friend or family member want to talk to someone about medication use you can also contact the Medication Support Service on 1800 931 101 to talk about your options or make an appointment. The Medication Support Service is free and offers confidential counselling, family support, peer support groups and withdrawal services for people in the East and North East regions of Melbourne.

For Victorians who have been affected by a friend or family member’s drug use, there is also information on finding support and treatment services in Victoria at The First Stop.

Learn how to recognise codeine dependence and addiction

Given the risks associated with using codeine, it’s important to be able to recognise warning signs of codeine dependence.

Potential warning signs of codeine dependence

Here are some of the warning signs that you, or someone you know, may be experiencing dependence and/or addiction:

+ Using more and more codeine to get the same pain relief

+ Being unable to stop taking or take less codeine

+ Feeling sick when you try to stop taking the medication (e.g. being shaky, anxious, sweaty or experiencing stomach pain)

+ Making excuses to get the medication

+ Negative life experiences in general (e.g. being late/absent from work, relationship problems, losing interest in everyday activities)

If you answer yes to any of the following questions, you may be at risk of dependence and it’s important to speak with your GP.

– Do you find that you’re taking more than the prescribed dose of codeine-based medication to treat your pain?
– Do you feel that you’re having to go to more than one chemist frequently to get the amount of codeine you need?
– Do you feel that your pain and your mood actually get worse if you don’t take codeine?
– Do you feel judged or ashamed when a pharmacist wants to discuss how much codeine you have been buying?
– Do you begin to feel highly anxious about not being able to buy codeine over the counter and that you need it to function in daily life?

Codeine dependence is a medical condition that can happen to anyone, and there is no shame in seeking treatment for it.

If you answered yes to any of the questions above, ask your GP about the many very effective treatments available.

Recognising the symptoms of withdrawal from codeine

Withdrawal symptoms can sometimes be difficult to distinguish from the original pain the medication was taken for, and can lead people to believe that they ‘need’ the codeine to cope, instead of seeking help or trying to cut down.

These are some of the symptoms of withdrawal:

+ Headaches

+ Muscle, bone and joint aches

+ Mood swings

+ Insomnia

+ Nausea

+ Diarrhoea

Remember to speak to your GP or visit the ‘Next steps’ tab if you’re concerned you may be experiencing withdrawal or are concerned about codeine rescheduling.

Talk to your pharmacist

Talk to your pharmacist about alternative options for effective pain management. These alternatives might include non-pharmaceutical options such as:

+ Heat and inflammatory rubs

+ Heat packs or ice packs

+ TENS machines

+ Exercise

+ Relaxation

Your pharmacist will also be able to help you identify pain relief medicines without codeine (and therefore without the associated risks). These products include:

+ Ibuprofen (e.g. Nurofen)

+ Paracetamol (e.g. Panadol)

+ A combination of ibuprofen and paracetamol (e.g. Maxigesic)

Talk to your GP

Talk to your GP if you think you need to create a long-term pain management plan or if you are concerned about tolerance or codeine dependency.

Remember to ask your GP about a Chronic Disease Management Plan. Long-term pain management often requires a holistic approach which may involve allied health professionals such as physiotherapists. You can find out more about the Plan here.

If you think you might need some help remembering the questions you’d like to ask your doctor, you can use this nifty ‘Question Builder’ from healthdirect and print or email the questions you’d like take with you to your appointment.

Talk to Allied Health Professionals

Effective pain management often requires a more holistic approach in which different health professionals work together with you to better manage your pain. It’s also important to remember that good pain management often doesn’t involve medication.

Allied health professionals who might help with management include:

+ Physiotherapists

+ Osteopaths

+ Psychologists

Call a helpline

There are also a number of help lines you can call if you are concerned about your codeine use. These services are free (from a landline), anonymous and confidential and you’ll be talking to a professional counsellor experienced in drug and alcohol-related issues.

DirectLine (VIC): 1800 888 236

Alcohol and Drug Information Service

(NSW): 1800 422 599

(TAS): 1800 811 994

(NT): 1800 629 683

(WA): 1800 198 024 and for parents 1800 653 203

(QLD): 1800 177 833

(ACT): 02 6205 4545

(SA): 1300 131 340

You can also contact CounsellingOnline 24 hours, 7 days a week, anywhere in Australia for free online advice about alcohol and drug-related issues: www.counsellingonline.org.au

Community toolkit

It’s time to get candid about codeine

From February 2018, medications containing codeine such as Panadeine, Nurofen Plus and some cold and flu tablets will only be available by prescription from a GP.

Many Australians do not know the risks associated with using over-the-counter codeine medications, despite the devastating harm it’s been causing in families and communities. The risks of using codeine-based medications are too high without a doctor’s involvement.

You can view the full list of codeine-containing products which have been made prescription-only on the Therapeutic Goods Administration’s codeine information hub here.

Three reasons codeine is being rescheduled

1. Long-term regular use of codeine can cause serious harm: you can become dependent on codeine-containing medications and find that you need more and more of the medication to obtain the same effects. This can lead to toxicity, and sometimes even death.

2. It is not a very effective pain reliever in some people: medical and scientific evidence has shown that the low doses of codeine in over-the-counter medications do not provide any more pain relief than medications that don’t contain codeine.

3. There are safer and better alternatives to use: there are both pharmaceutical and non-pharmaceutical options for pain management which can be discussed with pharmacists, GPs and allied health professionals.

You can find out more about the Therapeutic Goods Administration’s decision to reschedule codeine on their codeine information hub website.

Start the conversation

What is codeine?

Codeine is an opioid pain medication that is converted into morphine in the body.

Products such as Nurofen Plus, Panadeine Forte and some cold and flu tablets are often used to relieve moderate to severe pain, and are usually safe in low doses or if taken for short periods.

Each body is unique and breaks down codeine at different rates. This means that people can have very different responses. Some get good pain relief from using it (and potentially are very susceptible to the risks associated with it), or get no pain relief at all.

What are the side-effects?

20-30 percent of people experience side-effects associated with using opioid medications such as:

+ Constipation

+ Nausea

+ Dizziness

+ Dry mouth

+ Sleepiness

+ Headaches, and

+ Difficulties breathing

Over-the-counter codeine medications in pharmacies are usually combined with paracetamol, ibuprofen or aspirin. Long-term use can lead to:

+ stomach ulcers

+ internal bleeding

+ kidney disease, and

+ heart disease

Higher doses of these medications can be very dangerous and cause:

+ liver disease, and

+ kidney failure

Codeine can cause dependence

Like morphine and other opioid drugs, codeine can be highly addictive. If taken regularly codeine can lead to:

+ tolerance

+ dependence

+ addiction

+ toxicity, and in high doses

+ death

It is possible to become dependent on codeine-based products without realising it. The body can develop a tolerance which lessens the medication’s effectiveness and means more and more is needed to get the same pain relief. When use stops suddenly, withdrawal symptoms can occur such as:

+ head and muscle aches

+ mood swings

+ insomnia

+ nausea

+ diarrhoea

This is why it’s important to speak with your pharmacist or GP about alternatives to codeine-based medications to avoid these risks and help manage your pain.

Types of pain

Although there are many different types of pain, the two most common types of pain over-the-counter codeine products are used for are acute pain and chronic pain.

Acute pain

Characteristics of acute pain:

+ Generally lasts for a short time (usually less than three months)

+ Usually happens after an injury of some kind

+ Often goes away on its own

Chronic pain (or persistent pain)

Characteristics of chronic pain:

+ Generally lasts for longer than three months

+ Chronic pain is complex and can happen when there’s no clear injury

+ Can cause changes in the central nervous system

NPS MedicineWise has a comprehensive explanation of chronic pain and its treatment which you can access here.

Understanding pain

Pain management is a complex issue.

Although we often think of pain as something that is purely physical, it often has other components that are social, psychological, behavioural and financial.

We know, based on scientific evidence, that pain (and particularly long-term or chronic pain) usually requires a multidisciplinary approach to help individuals go on with their daily lives.

It’s important to remember that effective pain management may not always just involve using medications, and there are many different non-pharmaceutical therapies available which you can discuss with your pharmacist, doctor or other health professionals such as physiotherapists or psychologists.

Getting Help for our Pain

Your pharmacist is a great person to speak to if you have been in pain for less than three months. They can work with you to suggest many alternative treatments to help manage your pain.

If you’ve had pain for longer than three months, it’s really important to speak to your GP about a treatment plan. This may involve a referral to an allied health professional (e.g. a physiotherapist) or pain specialist or working together with your GP to find the best ways to treat your pain.

Start the conversation with your pharmacist or GP around better alternatives to pain management.

Getting to know dependence and addiction

Codeine dependence is a common consequence of being prescribed or buying codeine over an extended period of time.

Anyone can be affected by or experience dependence and/or addiction. Dependence and addiction are medical conditions, and like other health conditions such as diabetes or asthma, they do not discriminate.

It is possible to become dependent on codeine-containing medications without realising it. This is a common consequence of using these medications for longer periods of time and doesn’t say anything negative about a person’s character or moral fibre.

Listen to Jessica’s Story

Treatment options

There are many effective treatments available to address and manage codeine dependency. Seeking help from your GP, and speaking to your family and friends if you think they may need help, are important first steps.

Call a helpline

There are also a number of help lines you can call if you are concerned about your codeine use. These services are free (from a landline), anonymous and confidential and you’ll be talking to a professional counsellor experienced in drug and alcohol-related issues.

DirectLine (VIC): 1800 888 236

Alcohol and Drug Information Service

(NSW): 1800 422 599