Safe and effective pain relief

From 1 February 2018, codeine will no longer be available over the counter. This means you will need to get a prescription from your doctor to buy codeine. For people with ongoing chronic pain, there are other treatments in addition to or instead of medication that can be very helpful.

What are some other ways you can manage your pain?
Watch the video
           

How will these changes affect you?

Take this simple questionnaire to see how these changes will affect you. All your answers are confidential and your identity protected.

Do you take codeine for short term (fewer than 3 days at a time) or long term (more than 3 days at a time) pain relief?

Short term Long term

After 1 Feb 2018 you can still obtain codeine on prescription or ask your pharmacist for an alternative. Ibuprofen and paracetamol combinations are more effective than codeine for short term pain relief.

Codeine is not recommended for more than 3 days and is ineffective for treating ongoing chronic pain. Visit your GP

Have you had a diagnosis for the cause of your pain?

Yes No

Codeine is not recommended for more than 3 days and is ineffective for treating ongoing chronic pain. Visit your GP.

Pain medications such as codeine could be masking an underlying health condition. Visit your GP for a thorough health check.

Have you spoken to your doctor about alternatives to codeine for pain relief?

Yes No

Self-managing pain on a daily basis is the best way to reduce pain-related disability and improve quality of life.

Visit your GP, who may consider a referral to someone trained in pain management or a pain clinic.

Have you experienced any of the following symptoms in your use of codeine:


  • Loss of appetite and weight loss

  • Constipation (too much) or diarrhoea (on withdrawal)

  • Nausea and vomiting

  • Cold sweats, clammy hands and feet

  • Needing to use more codeine to get the same effect

  • Unable to stop or cut down the use of codeine

  • Confusion

  • Mood swings

  • Changes in sleeping patterns

  • Loss of interest in normal activities

Yes No

From what you've described, you may be experiencing the symptoms of codeine dependence. Speak to your GP about what this means and how you can access safe and effective pain relief.

Continued used of codeine can lead to dependence, tolerance and addiction. Speak to your GP about your use of codeine and alternative methods of pain management.

Would you like to hear more about codeine or other approaches to pain relief?

Yes No

Hear more about safe and effective pain relief

Anyone can be affected by codeine

"I started using pain medication after I had an accident that left me with a neuromuscular condition. Codeine was quick and easy and I could buy it anywhere. It surprises me that I was addicted without knowing it."

Leah

"I thought if you have pain, then you need to take pain medication. Codeine was ruining my life but I didn’t know it. I’m now managing my pain in other ways – with physiotherapy, walking, baths and prescribed low-dose pain relief."

Alena

"For four years I took the over-the-counter codeine. If I didn’t have enough medication in the house, I would panic at the thought of running out and not being able to control the pain. Now I don’t take opiates, which is the hard road but it’s a better quality of life."

Mary-Lynne

Hidden harms of codeine

Because codeine has been sold as an over-the-counter medication, it’s easy to assume that it is a safe substance. But like all medicines, there are risks that you should know about:

Codeine is not effective for ongoing chronic pain

Codeine is recommended for a maximum of three days for acute short-term pain. It is not effective for chronic long-term pain. However, Australians are misusing it, especially people with pain. 75% of Australians who misused over-the-counter painkillers in the last 12 months misused codeine. People with chronic back pain or headaches commonly use on average five times the recommended daily dose over two years.

Codeine can be deadly

More than 100 Australians die from codeine overdoses every year, and thousands of others are hospitalised from overdose symptoms. Deaths from codeine are increasing, and people with pain are at high risk of harm. People with ongoing chronic pain make up to 35.8% of total codeine-related deaths in Australia.


Codeine is addictive

Many people don’t know that codeine is in the opioid drug class, like morphine and heroin. This makes it highly addictive and can lead to tolerance and physical dependency. If tolerance occurs, your body will need higher and higher doses to feel the same relief from your symptoms.

International consensus

Australia is not the first country to introduce stronger safety standards for using codeine,

The following countries already require a prescription to buy codeine: the United States, Japan, Germany, France, Italy, Spain, Sweden, Austria, Belgium, Hong Kong, Iceland, India, the Maldives, Romania, Russia, the United Arab Emirates, Croatia, Czech Republic, Finland, Greece, Hungary, Luxembourg, Netherlands, Portugal and Slovakia.

These changes are supported by key medical and consumer groups

Frequently asked questions

  • Alternatives

    There are many different ways that people can manage their pain without using codeine. Research shows low-dose codeine is not superior to over-the-counter alternatives such as a combination of paracetamol and ibuprofen for pain relief.

    If pain is ongoing the best way to manage it is with a combination of strategies that suit your condition and personal situation. Medication alone is not effective.

    Multidisciplinary pain management will address all of the factors associated with pain – including emotions, mental health, social relationships and work – to help you get the best results.

    One of the best ways to manage pain is to take control of it. With access to the right education and strategies, most people with chronic pain can successfully regain quality of life without the need for opioids, surgery or other invasive treatments.

    You can learn more about multidisciplinary pain management through your GP who can refer you to your nearest pain service.

  • Access

    It is important to remember codeine will still be available at pharmacies. However, you will need a prescription from your doctor to access codeine-based medicines.

    Codeine-containing pain medication is available under brand names such as Panadeine, Nurofen Plus, Mersyndol and generic pharmacy-branded pain relief products.

    Codeine-containing cough, cold and flu products are available under brand ranges such as Codral, Demazin and generic pharmacy-branded cough, cold and flu medicines.

    A full list of products that have been upscheduled is available on the Therapeutic Goods Administration website.

    Changes in accessing codeine-containing products will improve the health and safety of Australians.

    When visiting your doctor, talk to them about alternatives to codeine that will suit your personal circumstances

  • Dependence

    Codeine is closely related to morphine and like morphine, is derived from opium poppies. Its use often results in opioid tolerance, addiction, poisoning and in high doses, can cause death.

    There is widespread evidence documenting tolerance, misuse, addiction and other harms from codeine-containing medicines.

    Addiction to codeine takes the form of physical dependence after prolonged use. Symptoms of dependence include:
    • Loss of appetite and weight loss
    • Constipation (too much) or diarrhoea (on withdrawal)
    • Nausea and vomiting
    • Cold sweats, clammy hands and feet
    • Needing to use more codeine to get the same effect
    • Unable to stop or cut down on the use of codeine
    • Confusion
    • Mood swings
    • Changes in sleeping patterns
    • Loss of interest in normal activities

  • Getting help

    If you think that you are unable to manage without codeine or are experiencing side effects of withdrawal, speak with your doctor. They can provide you with treatment options that will assist you to reduce your dependence on codeine and discuss other ways to manage your condition.

    Doctors support the change to codeine access as they recognise codeine and opioid dependence is a significant public health issue. They will be only too happy to help you.

    In some cases people may need specific addiction treatment and support.

    There are many support groups and helplines available to people suffering the effects of codeine.

  • Find out more

    The Therapeutic Goods Administration hosted a national series of workshops to help health professionals dealing with chronic and acute pain management have alternative strategies to use in preparation for 1 February.

    Presentations from the workshops include:
    • Background to the decision to change to prescription only
    • Alternative options to codeine in the pharmacy
    • Rethinking our approach to pain
    • Delivering pain management in a rural setting
    • Over the counter, down the hatch: OTC codeine use

    Visit the Painaustralia website to watch the presentations.

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