Rescheduling of codeine products

From 1 February 2018, medicines that contain codeine will no longer be available without prescription. This decision was made by the Therapeutic Goods Administration (TGA), based on evidence that codeine is a commonly used medicine of abuse.

Low-dose codeine (less than 30 mg) is currently available in pharmacies over the counter, for consumers to self-administer. Low-dose codeine formulations include cough and cold preparations, and analgesic preparations combined with other pain relief medicines such as aspirin, paracetamol or ibuprofen.

These medicines are not intended to treat long-term conditions; however, that this is how they are often used. Codeine is an opioid drug closely related to morphine and like morphine, long-term use can lead to dependence. The development of codeine dependence can lead to severe adverse health outcomes, including liver damage and death.

In addition, some individuals, particularly children, can experience serious adverse reactions when given codeine, including breathing difficulty and death.

In 2015, an Australian study found codeine-related mortality more than doubled over the ten-year period from 2000 to 2009.

Given these issues, the TGA has decided the risks associated with codeine use are too high without oversight from a doctor.

The change has been introduced through amendments to The Standard for the Uniform Scheduling of Medicines and Poisons (the Poisons Standard), deleting codeine entries from Schedule 2 (Pharmacy Medicines) and Schedule 3 (Pharmacist Only Medicines), leaving only the codeine entries in Schedule 4 (Prescription Only Medicine) and Schedule 8 (Controlled Drug). The changes are enacted into law through local state and territory scheduling legislation which will come into effect early next year.

For further information please visit www.nps.org.au

S8 Prescriber Information Service (08) 9222 4424 (Drugs of Dependence Branch Department of Health)

It is illegal to prescribe S8 medications to a registered drug user. Prior to prescribing an S8 or controlled medicine to a patient who is not previously known to the GP or practice, it is recommended that practitioners:

Record the patient’s identity and where possible verify against an official source of photo identification (e.g. driver’s licence).

Contact the S8 Prescriber Information Service on (08) 9222 4424 for a prescription history and regulatory advice.

Note: This information is provided under the authority of the Medicines and Poisons Act 2014. Information will only be provided to an authorised health professional and only relating to a patient under the care of that practitioner. Any information provided may not be used for any other purpose than for assisting with the management of the patient.

What GPs can do to support patients

Let the patient know that you are willing to help them with any health problems.

Establish strong therapeutic boundaries that will help clarify treatment goals and minimise challenging behaviours.

Consider use of a Treatment Agreement.

Promote the Alcohol and Drug Support Line (08) 9442 5000 or Country 1800 198 024.

Have a practice policy on prescribing drugs of dependence and display a notice for patients to see. Further information www.racgp.org.au

Undertake GP training to manage drug and alcohol issues in primary care.

Promote local alcohol and other drug services in waiting rooms and on notice boards. Find local services www.greenbook.org.au

Register with the Prescription Shopping Information Service: 1800 631 181

Need clinical help?

Alcohol and Drug Support Line:
(08) 9442 5000 or Country 1800 198 024

After hours Clinical Advisory Service:
(08) 9442 5042