New Zealand is looking at following in Australia’s footsteps and making all codeine-containing products prescription only. I don’t think this is the right solution.
The Medicines Classification Committee, which makes recommendations to the Minister of Health, will consider whether all codeine-containing products should become prescription only.
The Committee is reviewing a range of options, from maintaining the status quo to making all codeine-containing medicines available only via prescription.
I recognise that opioid medications have a high rate of dependence, and that codeine-containing products can be misused. But, as is so often the case in these instances, a blanket ban would disproportionately effect vulnerable people and minorities. People with chronic pain or illnesses, women with chronic period pain, people already battling addiction – all would suffer if the Ministry of Health decides to succumb to pressure.
Opiate addiction is a hot topic globally. But New Zealand is its own case, and banning codeine-based products doesn’t address the problem. What that will do is increase demand and make it more difficult – and possibly dangerous – to access codeine itself. Or people will turn to more unsafe replacements.
According to the NZ Drug Foundation, alcohol and tobacco are the drugs that cause the most harm in New Zealand. Illicit drug use overall is lower than people think, and cannabis is the most commonly used, not opiates.
A lot of people can’t afford to go to the doctor for a prescription, and they shouldn’t have to, for what is, in reality, a small amount of the drug. Over the counter medicines like Paracode or Panadeine only contain 8mg codeine per pill. If you wanted to take a recreational dose of codeine using OTCs, you’d put yourself at risk of overdosing on paracetamol, which it’s usually mixed with. To put that 8mg in perspective, I have a prescription for up to 90mg pure codeine a day, not that I tend to ever take that much. The lethal dose (LD50) is 800mg – so for half the population, they’d have to take 100 Paracode, by which point the panadol is going to be as much if not more of a problem.
I spoke to another person who has chronic pain and has trialed a range of opioid medication, from codeine through to morphine.
“The reality is that codiene is not all that strong, but it is useful for those who need it.
Pain affects and can control people’s lives in many ways, and sometimes access to weaker, temporary pain management is all someone needs. Sometimes people have increased pain, maybe it’s dental, maybe they’re having a particularly bad period. Maybe they have a chronic pain condition and are having a flare.
Access to over the counter pain management is not something we should consider revoking lightly.
The implications can be far reaching and the net positive effects are really no more than a limited sense of moral victory. Some people are always going to abuse drugs, and no amount of prohibition is going to stop someone who wants said drugs from getting them.
The exceptionally absurd part of this whole discussion is that New Zealand already has a system for managing the purchase of codeine based OTC medications. I was refused Panadeine by a pharmacist when I tried to buy a second box. It’s standard practice to keep a record of these purchases. They informed me I should seek medical advice before continuing to take codeine. That is a system functioning as it should. I was able to access the tools to manage my pain during onset, and when the pain didn’t get under control I was encouraged to see professional help. Removing the access to the pain management just creates a further strain on our medical system, invariably this trickles down to affect the most vulnerable the most.”
Writing this piece, I read a lot about the damage to people’s lives, particularly in the US, and more recently in Australia, and I understand the reasons for rising concerns about the availability of opioids. I’m definitely not saying the concern is unfounded. I’m just not convinced that removing OTC codeine is the best or only way to address the problem.
This, of course, bleeds into the argument for the availability of medicinal marijuana. I’ve had more than one doctor wish they could prescribe me cannabis rather than opiates. Its pain-relieving qualities are well-documented, it could be regulated and used more safely – since it’s already being widely used anyway – and doctors would have oversight of patient use.
(As it is, one doctor who jumped through all the hoops to get a patient access to medicinal marijuana told me in despair that the patient ended up being unable to fill the script because it would cost $1200 a month. The Ministry for Health might be trying to say they are reducing barriers to access by streamlining the application process – but what use is that if the product is too expensive?)
My original argument stands. People in pain need access to painkillers. If you make that access more difficult, the need doesn’t go away. If the person in need is addicted, that’s a health issue that deserves help. If they’re not, as most people aren’t, and they don’t have the money for a prescription, you’re either leaving them suffering – or pushing them into use of other drugs that might be far more harmful as well as illegal.
Don’t force people to choose between pain and crime. That’s not going to turn out well for anyone.