Can you buy codeine over counter?

The Medicines and Healthcare Products Regulatory Agency (MHRA) has allowed some codeine-containing combination analgesics to be sold over the counter for better health management.

To reduce the risk of drug overuse and toxicity, most drugs need a doctor's prescription. Such drugs are known as prescription-only drugs (POMs). However, some safer drugs can be sold over the counter. These drugs are known as pharmacy medicines.

The pharmacist is allowed to recommend these drugs after some questions. The common over-the-counter drugs are contraceptives, some painkillers etc. What about codeine? Can you buy it from a local pharmacy without a prescription? Let's first have an overview of the codeine.

Codeine, a powerful narcotic analgesic?

Codeine is an analgesic drug which is used to relieve chronic pain. It belongs to the opiate group and is used to treat pain, diarrhoea, coughing etc. Its use as an analgesic is second only to morphine, another popular narcotic analgesic. It is also a common recreational drug, i.e., it is used to alter consciousness and induce pleasure.

It is one of the alkaloids obtained from the poppy plant. It is, however, a weak opiate painkiller and needs to be combined with other anti-inflammatory painkillers for better effects.

It directly influences the opiate receptors in the nervous system and reduces pain by interrupting the flow of impulses between the body and the brain.

So is it available over the counter? What issues are associated with over-the-counter use, and how can these issues be handled?

Is codeine available over the counter?

The medicines containing codeine are available both on prescription and over the counter. The term over the counter is used for the drugs sold behind the counter under the supervision of a pharmacist. The pharmacist will review the need by questioning and will also decide on the dose.

According to a report published in the Pharmacy in 2020, 26 million units of codeine-containing products were sold in 2020 in the UK, which is 7.8% of the total oral painkiller market in the country. So, the importance of community education about the usage, dosage, side effects and potential complications of codeine can hardly be over-emphasized.

MHRA approved the over-the-counter sale of codeine-containing products due to the following reasons:

• The OTC availability improves codeine availability, increasing public access to the drugs. It will also allow people to combine them easily with various flu medicines.

• The OTC availability of drugs makes consumers more responsible for their health and also offers more choice and convenience.

• It lowers the burden on the national health services whose costs rest upon the taxpayers. It allows the healthcare agency to shift its burden on the consumers.

• The OTC availability of drugs improves the public perception of the drug's safety, although the data related to public awareness related to the misuse of OTC drugs is conflicting.

• Multiple sources of information about the drug are available, which can help the individual in case of issues related to drug misuse. The sources include the pharmacists at the local Pharmacy, patent leaflets and the internet.

Despite these arguments, the OTC availability of drugs is not free from some issues, and you need to be aware of them. Let's see what issues you may face if you use codeine over the counter.

Read more: What is codeine phosphate?

What are the issues associated with OTC codeine-containing combination analgesics?

The OTC availability of codeine and codeine-containing products is, however, not free from concerns. Some of these issues are so severe that the public health authorities are still determining whether its OTC availability should be continued. The main possible issues are;

High risk of misuse

There is a high risk of unintentional drug misuse despite all possible measures to avert it. The individuals can take more than the daily recommended dose of 240mg, exposing them to possible toxicities. Many people can get codeine tablets of questionable quality from unauthorized sources, further complicating the issues.

Poor public awareness

The information about drug safety is provided on the patent leaflet. The pharmacist is also expected to convey important information to the users. Although multiple sources of information are available, people seldom pay attention to them, and it has been noted that most people discard the patent leaflet without reading it.

Sometimes, the information in the leaflet about codeine and other medicines is complicated and useless for the reader. All these factors severely compromise the quality of public health.

Poor health literacy of people

The OTC availability of drugs is highly dependent on the individuals' health literacy, and poor health literacy is very common, even in very advanced societies. A study published by the BMC Public Health in 2020 noted that 19.4% of correspondents face some difficulty reading and comprehending written information related to health, while 23% of people face some difficulty explaining their issues to the doctor.

Possible risk of adverse health outcomes

The presence of codeine in lower doses in various other OTC combination drugs, the development of drug tolerance and codeine dependence are the contributing factors towards severe health outcomes, e.g., liver and kidney damage and death.

A higher risk of side effects

The intentional or accidental overdosing of codeine increases the risk of side effects, e.g., weak and fast pulse, warmth feeling, pounding, decreased libido, dental pain, irregular, fast and racing pulse or heartbeat, sexual dysfunction, darkening of urine, fatigue, troubled and difficult breathing, anxiety and depression, cold and darkened skin, agitation etc.

You are at risk of incorrect self-diagnosis.

The drug should be used after consulting the pharmacist. However, the inability to do so can expose you to another common issue associated with OTC drugs, the incorrect self-diagnosis of the condition. It can expose you to serious illness and dangerous drug-drug interactions.

Read more: What is co-codamol?

How can the issues associated with OTC codeine be handled?

Avoiding the risks associated with over-the-counter painkillers needs a sincere effort on the part of users and drug regulatory and health agencies. The issue becomes more complicated with the narcotics like codeine. Should codeine be reclassified as a prescription medicine?

Reclassifying codeine remains controversial and is perhaps not a practical option as it will increase the burden on the regulatory agencies (NHS) and goes against the NHS policy of promoting self-care among the people. It will also not be welcomed by the drug manufacturers and will likely promote illicit drug sourcing.

According to the experts, the appropriate and strong intervention at the levels of community pharmacy is perhaps the only best alternative. The following measures can be helpful for users;

Pharmacists need to be proactive

Pharmacists are always at the front line in handling drug-related issues. Pharmacists' professional duty is to support individuals in their health-related decisions. They should be more proactive in tackling the issue of drug misuse. They should support the consumers in making decisions related to medication and provide useful advice to select the most effective and safe product.

All these things will improve the community's health and will positively impact the quality of life. There is evidence that, in many cases, the advice is either unavailable or of questionable quality, as noted by a review published in the Research in Social and Administrative Pharmacy in 2017.

Consumer education should be expanded

Consumers should be guided to change their attitudes towards drug use and safety. Consumers should be educated about how the dangerous consequences of a potential use can outweigh the current analgesic effects. According to a report published in 2009, behavioural therapy should be focused on the consumers who focus more on the current benefits and are less concerned about the long-term costs and consequences.

Susan Michie and his colleagues designed a specialized "patient safety card" in 2011. It was based on the assumption that capability, motivation and opportunity greatly impact behaviour. The card was given to the community pharmacy staff so they could issue them to the OTC codeine purchasers to encourage and reinforce its appropriate and safe use.

Community education about the drug interactions

Codeine interacts with other drugs, particularly other painkillers. These interactions become very important as codeine is often combined with other painkillers. For better safety, you need to inform the pharmacist if you are taking any drugs. The interactions of codeine with other painkillers, the drugs used for hypertension and depression, steroids and blood thinners etc., are very important from a safety point of view.

Moreover, don't use alcohol or any sedative drugs if you use codeine or codeine-containing medicines, as the additive effect can influence consciousness and breathing. Such information is also written on the patent leaflet, so the users should read them carefully and consult the doctor or pharmacist in case of any issues.

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Read more: What are the risks of paracetamol?

Summary

Codeine is an opiate drug used for pain killing alone or in combination with other drugs. It is also used with cold and flu products for better results. However, unlike other cold medicines and painkillers, it can cause addiction and other issues.

It is a prescription drug, but the MHRA has allowed some codeine-containing medicines to be available over the counter to promote health consciousness among the people. However, the misuse of these OTC medicines is common and is a cause of concern for health authorities in the United Kingdom.

The overuse of drugs is associated with a higher risk of side effects. For your safety, you need to use codeine according to the guidelines provided by the doctor or pharmacist and consult them about any possible drug interactions.

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