Common painkiller codeine, and medicines containing codeine, will no longer be available over the counter after it was deemed too harmful to use without a doctor’s prescription.

Low doses of codeine are found in commonly used medicines such as Panadeine, Nurofen Plus and Codral. The change comes into effect on Thursday February 1, 2018. Here’s what you need to know.

Why is codeine no longer available without prescription?

Codeine is an opioid drug closely related to morphine and is derived from opium poppies.

According to the Therapeutic Goods Administration, the agency responsible for the decision, current over-the-counter (OTC) medicines containing low doses of codeine for pain relief offer very little additional benefit when compared with similar medicines that do not contain codeine. The use of such medicines, however, is associated with high health risks.

Codeine can lead to opioid tolerance, dependence, addiction, poisoning and in high doses, even death. A study published in the Medical Journal of Australia found that codeine-related deaths more than doubled between 2000 and 2009, from 3.5 deaths per million to 8.7 per million. Regular use of medicines containing codeine, for example for chronic pain, has led to some consumers becoming addicted to codeine without realising it.

Codeine can also lead to withdrawal symptoms such as head and muscle aches, mood swings, insomnia, nausea and diarrhoea when a person stops taking the medicine. Confused by these symptoms, the person might then think they need to take more codeine-containing medicine for longer, or in higher doses.

Which medicines are affected?

• Codeine-containing combination analgesics (painkillers) — available under brand names such as Panadeine, Nurofen Plus and Mersyndol, as well as pharmacy generic pain relief products.
• Codeine-containing cough, cold and flu products — available under brand ranges such as Codral and Demazin, as well as pharmacy generic cough, cold and flu medicines.
• Over-the-counter cold and flu medicines that are changing their ingredients. From 1 February 2018, no cough, cold and flu medicine available over the counter will contain codeine.

Check healthdirect’s list of active ingredients that contain codeine or the NPS Medicinewise Medicine Finder for a list of more drugs containing codeine, and talk to your doctor if you currently take codeine medication.

Trusted information about a wide range of medicines, including specific brands and active ingredients, is available on healthdirect's Medicines pages.

If codeine is so dangerous, why is it available at all?

According to NPS Medicinewise, when used at the higher doses found in prescription-only medicines, codeine can provide effective relief for short-term pain.

If codeine is prescription-only, requiring a visit to the doctor, patients and doctors can agree on pain management plans and follow-up. This will reduce the chance of people developing problems with the medicine, such as dependence and other side effects.

What to do if you suffer from chronic pain

Talk to your doctor or healthcare provider about alternative treatment options if you live with chronic pain, advises NPS Medicinewise. These may include:

• alternative over-the-counter or prescription medicines
• non-drug therapies from an allied health professional such as a physiotherapist or psychologist
• self-management tools such as exercise or relaxation
• referral to a pain specialist or pain management clinic

Ask your doctor about a Medicare-funded care plan, which will allow you access to a rebate for treatment from an allied health professional. For more information, see the Australian Government Department of Health’s Chronic Disease Management Patient Information: Planning your health care, Patient Information Sheet.

For more information about changes to the supply of codeine medications, check out NPS Medicinewise.