Several news sources have today reported that codeine-based pain killers sold over the counter can “cause addiction within three days”, and that new rules will change the way they will be made available. These changes include adding addiction warnings to packaging, and changing the conditions for which they can be recommended.
These current reports are based on a press release issued by the Medicines and Healthcare products Regulatory Agency (MHRA), the government agency responsible for ensuring that medicines and medical devices are effective and safe. The press release highlights upcoming changes to the way that certain prescription and over-the-counter medications can be made available to the public. These changes are based on the policy of the government and the MHRA.
The MHRA has announced that manufacturers and dispensers of some common painkillers containing codeine (a weak opioid drug) will need to change their practices in order to minimise the risk of over-use and addiction. These measures include improved labelling, changing quantities that can be purchased, and making certain medicines available only on prescription.
The MHRA has announced a package of measures in line with the government’s change of policy. These include:
Codeine is a weak opioid painkiller (analgesic). Opioids are a group of drugs used to treat moderate and severe pain that cannot be relieved by more simple analgesics, such as paracetamol. Other stronger opioids are used in hospital practice for various types of pain relief, including morphine, diamorphine (heroin), pethidine and tramadol.
A range of over-the-counter painkillers contain codeine, including Nurofen Plus and Co-codamol. Usually, these drug preparations will contain codeine combined with other analgesics, such as paracetamol, aspirin or ibuprofen, and possibly other drugs, such as caffeine, decongestants or anti-sickness drugs (depending on the branded medication’s indicated use).
Although effective for reducing pain, opioids have a range of side effects that vary in severity, depending on the strength and dose of the drug. The most common side-effect experienced with a mild opioid such as codeine would be constipation. There are also several medical conditions and population groups in which opioids should be used with caution, such as the elderly, debilitated people, and people with certain types of kidney, lung or bowel diseases.
While codeine is sometimes used to treat mild pain, the new recommendations call for it to be used only for acute, moderate pain that cannot be relieved by either paracetamol, aspirin or ibuprofen alone.
The evidence on codeine drug dependency has been discussed by an All-Party Parliamentary Drugs Misuse Group, which conducted a year-long inquiry into physical dependence and addiction to prescription and over-the-counter medication that concluded in January 2009. It gathered evidence from a wide range of stakeholders including the general public, medical and addiction specialists, pharmaceutical companies, regulatory bodies and charities. The review has been discussed in Parliament, and the recommendations reflected in the government’s review are also in line with those of the MHRA.
The new recommendations and changes will not affect people taking prescription pain killers. People who purchase over-the-counter pain killers containing codeine will notice changes to their medication’s labelling and specified indications from next year, when manufacturers and dispensers will implement the new policies.
Codeine-based drugs can be effective if used appropriately, but there are risks associated with using them for longer than three days. It is important that people who buy pain killers over-the-counter follow the new advice, which is based on the available evidence on potential dependency.
People are advised to always read drug labelling, noting in particular what drug preparations are contained within the branded medication, and following recommendations for use. Those who have concerns about their use of painkillers should speak to the pharmacist or doctor. Those who experience ongoing pain and feel the need to take analgesics on a regular basis should also seek medical advice.