Since this post was first published, the Department of Health has given notice that it intends to change federal law to make all codeine products prescription only in Canada. This is a positive change that means risky low-dose codeine products will not be available to our friends and family members. What it also means is that individuals, society, and health care professionals need to better focus on treating pain with non-opioid medications and non-drug options. Of course, codeine and other opioids are still very useful drugs, and need to be used more appropriately and safely to avoid unintentional harm to patients. A health care team is essential to good pain management. This can include professionals such as physicians, pharmacists, nurses, and nurse practitioners, who are experienced using pain medicines and providing psychological and social support so that patients can successfully achieve their health goals.
People love Canada. We’ve got stunning national parks, decent public health care, and we are known as polite people. But did you know that you can walk into almost any pharmacy in Canada and legally purchase a risky and addictive opioid called codeine?
Yes, for some this is another lovable dirty little Canadian (pharmacy) secret.
It’s time for our love affair with easily accessible codeine to stop. Pharmacists and governments need to admit that we’ve got a problem.
There is a little known section in our federal Controlled Drug and Substances Act that permits pharmacists to sell small amounts of medications containing codeine without a prescription. So long as these medications contain uselessly low doses of no more than 8 mg of codeine for tablets or 20 mg of codeine per 30 mL for liquid medications. The other stipulation is that the codeine is combined with at least two other non-narcotic medicinal ingredients.
The apparent rationale for this approach is that patients will experience side effects from the other medicinal ingredients if they attempt to take too much of the medicine in order to abuse the codeine.
This thinking is problematic for at least two reasons.
Often people addicted to opioids will do almost anything to get more opioid and avoid the pain and extreme discomfort of opioid withdrawal. The most recent example of this in the minds of many pharmacists include blatant pharmacy robberies to obtain Oxycontin® (oxycodone).
The second reason is that the side effects of the other ingredients can be deadly.
Let’s look at one of Canada’s most popular non-prescription codeine products called Tylenol® No.1. The brand name and generic forms of this medicine contain a drug called acetaminophen. You’ve heard of acetaminophen which also goes by its brand name of Tylenol®.
What you probably don’t know is that acetaminophen is the leading cause of acute liver failure in Canada. Patients with acute liver failure from acetaminophen require hospitalization and sometimes intensive care unit stays. The most severe patients need urgent liver transplantation and some will die from acetaminophen overdose.
In my years in the ICU I’ve seen all of these scenarios occur because of acetaminophen.
That’s why I’m working with several Canadian health professionals to get all non-prescription codeine products changed to prescription only status.
You can help us by signing this online petition. Your support will encourage the federal Minister of Health to make this overdue change to our drug laws.
Admittedly non-prescription codeine is only one part of Canada’s complex opioid problem.
We require further systemic changes and cannot view this solution in isolation. I expect more patients to visit doctors for codeine prescriptions. This means we need governments and physician colleges to step-up and provide unbiased and evidence-based training on the proper assessment of pain and selection of opioid pain medications, when appropriate.
We also need better access to addiction treatments for those patients who are currently hooked on non-prescription codeine as they may be driven to seek other sources of opioids such as heroin or fentanyl.
I want patients to get the best access to the most appropriate pain medications rather risky medications containing uselessly low doses of codeine. A step in that direction is eliminating access to non-prescription codeine.