Where to get codeine over the counter

As the majority of these studies are quantitative in nature this study aimed to explore in more depth some of the perceptions and experiences of Pharmacists in Victoria and South Australia. Using both quantitative and qualitative data from pre and post the up-schedule it was identified that pharmacists had varying perceptions about the changes, what they did to prepare and the impacts they felt it had or would have on their practice. Some pharmacists in this study expressed a negative perception towards the up-schedule as they believed it would limit their patients' ability to access effective pain relief.

They suggested it may be difficult for patients to visit their doctor to obtain a prescription. Disadvantages similar to this were identified by Mishriky et al.

However, evidence from an overview of Cochrane reviews of non-prescription over-the-counter oral analgesics for acute pain disputes the notion low dose codeine provides more effective pain relief than other readily available alternatives. Paracetamol plus aspirin at various doses worked in 1 out of to 4 out of 10 people and they found no information on many of the commonly available combinations containing low doses of codeine.

Most of these alternative medicines are available in a pharmacy without a prescription. Although there were concerns that pharmacists would not be able to provide options for managing pain without access to codeine containing analgesics over-the-counter, there were mixed views both within this study and from other research about the perceived efficacy of analgesics containing codeine thus their benefit as an analgesic option.

Prior to the up-schedule the quantitative questionnaire used in this study identified that a significant proportion of pharmacists rated the perceived efficacy of over-the-counter combination products containing codeine as high.

This was re-iterated by Mishriky et al. Many pharmacists in this study understood the reasons behind the up-scheduling of codeine containing analgesics, in particular the increasing rates of misuse and related harm from these products. However, they did not believe this was the most effective way to address codeine misuse, this has also been identified as a theme by other studies. The data showed decreasing trends for codeine and most other Schedule 8 prescription opioids, with no increase in any prescribed opioids associated with codeine up scheduling.

As at the time of writing RTPM is only mandatory in Victoria, it therefore would be interesting to compare the thoughts of Victorian and South Australian pharmacists at this point in time and whether the introduction of real time prescription monitoring has had an impact on the practice of pharmacists in this post up-scheduling era.

Regardless of the lack of success from the first codeine up-scheduling in , there appears to have been some success with the further measure in A study by Cairns et al. That is, putting the onus back on the government which took the blame and responsibility from the pharmacist allowing an opening for conservations about alternative options.

This was surprising, as media hype, prior to the up-schedule suggested that pharmacists were likely to receive a lot of backlash from the community regarding the up-schedule. There appears to be a mixed response in all studies to date investigating the impact of the codeine changes on the practice of Pharmacists in Australia.

These included removal of opportunities for pharmacists to help people using their professional judgment such as the ability to identify misuse and the opportunity to intervene. Despite this, pharmacists have the opportunity to intervene if they suspect misuse when they are presented with prescriptions for codeine containing products or other opioids and there is opportunity for improved collaboration with prescribers of these medications.

There is also opportunity for pharmacists to undertake chronic pain interventions and improve chronic pain health outcomes as discussed in the narrative from Mishriky et al. International studies investigating the effectiveness of pharmacist-driven interventions have demonstrated that there are benefits of pharmacists going beyond standard primary care practice for chronic pain management but further work is still required in the Australian context where research around the application of pharmacist-driven chronic pain interventions is lacking.

There was an indication by some pharmacists that the impact of up-scheduling on the pharmacy business was of concern. This could be influenced by bias towards self-preservation. Further work should be done analyzing actual figures to see if there was a loss in sales overall or if sales transferred to other products such as alternative analgesics or pain management options including rubs, heat or ice packs.

As mentioned above, data show these sales have not been transferred to prescription opioid medications, but researchers have not investigated other prescription medications such as pregabalin, non-steroidal anti-inflammatory drugs and paracetamol which potentially still contribute business to the pharmacy. Some pharmacists interviewed for this study were relieved to have the pressure of having to determine if supply was warranted taken from them.

This was identified as an issue by Hamer et al. There were also concerns regarding the lack of time to have detailed consultations with people about their use of these products. Since the up-schedule came into effect, pharmacists reported that recommending pain management alternatives had become easier and was generally useful in encouraging patients to visit their GP and discuss how to effectively manage their pain.

A strength of this study was its mixed-methods approach to gain insights into the perceptions of pharmacists post the up-scheduling of OTC codeine containing analgesics in Australia. However, this is limited by the fact that the participants in the qualitative phase were only practicing in South Australia and Victoria therefore the results may not be generalisable to all Australian pharmacists. A further limitation was the timing of the study.

As the study was conducted just after implementation it may not be a true reflection of the longer-term impacts. Additionally, further information around whether participants were pharmacy owners or employees within the pharmacy would have been beneficial to determine if the perceived impacts, from a business perspective, were different and this could be the focus of future research.

Overall pharmacists expressed diverse perceptions, preparedness and impact on practice regarding the up-scheduling of low dose codeine products. Many pharmacists indicated that the up-schedule had not affected their practice to a great degree. This study was completed during , just post the up-schedule. As a number of the perceptions expressed have proven not to be backed by the emerging evidence, further research should be conducted to gauge if and how these perceptions have changed over time.

Further research could also be conducted to identify whether pain is being managed more effectively post codeine up-scheduling and if so how and why. A strength of this study was the ability to explore more in depth the perceptions of the up-schedule and reasoning behind these perceptions. The researchers would like to acknowledge all the pharmacists who gave up time during work hours to be interviewed as part of this study.

Regulatory responses to over-the-counter codeine analgesic misuse in Australia, New Zealand and the United Kingdom. Serious morbidity associated with misuse of over-the-counter codeine-ibuprofen analgesics: a series of 27 cases. Med J Aust. Curr Top Behav Neurosci. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States.

Ann Intern Med. Counting the cost of over-the-counter codeine containing analgesic misuse: A retrospective review of hospital admissions over a 5 year period. Drug Alcohol Rev. Identifying and treating codeine dependence: a systematic review. A Comparative exploration of community pharmacists' views on the nature and management of over-the-counter OTC and prescription codeine misuse in three regulatory regimes: Ireland, South Africa and the United Kingdom. That way, you won't accidentally take a double dose of the same type of medicine in 2 different products.

If your healthcare provider gives you a prescription medicine for pain, understand what's in that medicine. Don't combine it with similar OTC medicines. This will put you at risk for overdosing. Always ask your healthcare provider or pharmacist if you are unsure.

Another problem is taking pain relievers for many days. Most of these medicines have a recommended maximum number of days that you should take them. Look for this information on the product label. Some medicines can be used safely in the long term for chronic pain such as arthritis. You should talk about this with your healthcare provider. Pain relievers can react harmfully with other medicines, especially blood thinners.

If you take any prescription medicines, ask your healthcare provider if you should avoid taking any OTC pain relievers. Also, some OTC pain relievers can make certain health conditions worse. So find out from your healthcare provider which ones are safe for you.

Talk with your provider or pharmacist before buying any OTC medicine. They can help you choose a medicine that's best for you based on your health history or condition. Tell your provider or pharmacist about any medicine or food allergies you have. Also tell them what prescription or OTC medicines you are taking.

Include any herbal supplements, vitamins, or other product you are using. This information will help your provider or pharmacist recommend an OTC medicine.

Alcohol is a concern with some OTC pain relievers, especially acetaminophen. Taking acetaminophen and drinking alcohol can lead to liver damage and failure. If you frequently have 3 or more drinks a day, talk with your healthcare provider before taking acetaminophen.

Alcohol should never be taken with an OTC pain reliever containing codeine. Doctors, pain specialists, and hospital pharmacists are overwhelmingly supportive of this move, possibly because we see first-hand the damage caused by these products being so freely available. But as is the way with most regulatory reforms, not everyone is going to agree. Groups like the Pharmacy Guild, which represent community pharmacy business owners, have been lobbying state and territory health ministers, claiming restricted access to codeine will inconvenience many consumers and they have made a case for exemptions to the plan to ensure people can continue to buy and use these drugs.

So why is the regulatory environment changing for codeine medicines? Codeine is closely linked to morphine and, like morphine, is derived from opium poppies.

It often results in opioid tolerance, addiction, poisoning and, in high doses, can contribute to both accidental and intentional death. There is a wide bank of evidence that documents the misuse, addiction, and secondary harm due to high dose exposure to the non-opioid analgesic medicines with which codeine is combined for example gastric ulcer with complications of haemorrhage or perforation, hypokalaemia, or renal tubular acidosis.

Pharmacies are permitted to dispense, on prescription, medicines containing codeine that are not labelled as prescription-only medicines until 5 May, , in order to use up existing stock. The details of the codeine-containing products that will become prescription-only medicines from November 5, , are provided in Table 1. The Codral range of cold and flu preparations has already been reformulated without codeine; the original products are listed in Table 1 as some pharmacies may still have stock of these formulations.

It is likely that some codeine-containing products that are currently available OTC may be withdrawn from the New Zealand market due to a lack of demand once a prescription is required. These products were included in the table as some pharmacies may have remaining stock of codeine-containing formulations. People often visit pharmacies to request medicines for the relief of mild to moderate acute pain associated with headache and migraine, dental issues, back injuries, menstruation and musculoskeletal conditions.

The reclassification of codeine will limit the number of products pharmacists are able to sell to people with pain, and other treatments will need to be recommended. People who are accustomed to purchasing analgesics containing codeine OTC will need to be informed of the change and advised to purchase a different medicine or to consult with their general practitioner.

The initial goal in the pharmacy is to distinguish between acute, self-limiting pain that the person can manage themselves with guidance, and long-term or more serious conditions that require consultation with a general practitioner or another health professional, e. Pain-related questions that may help in forming treatment recommendations include:. Additional factors that may influence pain management strategies include co-morbidities, any medicines or complementary and alternative treatments the person may be taking, and potential contraindications to medicines, e.

If self-management is appropriate, people should be advised to consult their general practitioner if their pain has not improved significantly in an agreed time frame or if their pain is increasing. It may be appropriate to consider the possibility of codeine misuse if a person becomes belligerent or distressed when informed that codeine is no longer available without prescription.

Paracetamol and a NSAID can also be taken concurrently or in a staggered dosing regimen if pain is not controlled with one medicine alone. It is important that people are made aware that paracetamol and NSAIDs may have different recommended dosing intervals, e. Topical NSAIDs may be appropriate for people with mild musculoskeletal pain that does not involve deep tissue.

A range of rubefacients are also available that increase blood circulation near the skin which may reduce discomfort, however, there is limited evidence supporting their use.

People may also apply heat or cooling packs to painful areas to either increase blood circulation or attempt to reduce inflammation. In general, people with musculoskeletal pain benefit from staying active, assuming this does not exacerbate an injury or the underlying condition.