Skip to main content
SpringerLink
Log in

Over-the-Counter Codeine—from Therapeutic Use to Dependence, and the Grey Areas in Between

  • Chapter
  • First Online:
Non-medical and illicit use of psychoactive drugs

Part of the book series: Current Topics in Behavioral Neurosciences ((CTBN,volume 34))

Abstract

Codeine is a widely used analgesic, that is available for sale in pharmacies over the counter (OTC) in a number of countries including the UK, South Africa, Ireland, France and Australia. In these countries with OTC codeine sales there has been emerging concerns about misuse of and dependence on codeine containing combination analgesics, with increasing numbers of people presenting for help with codeine dependence at primary care and addiction treatment services. This has led to many countries reviewing availability of codeine in OTC available preparations, and considering possible measures to reduce harms from misuse of OTC codeine containing combination analgesics.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Notes

  1. 1.

    http://selfcare247.co.za/247-codeine-care-initiative/.

References

  • Agyapong VIO, Singh K, Savage M, Thekiso TB, Finn M, Farren CK et al (2013) Use of codeine-containing medicines by Irish psychiatric inpatients before and after regulatory limitations on their supply. Ir J Psychol Med 30(01):7–12

    Article  Google Scholar 

  • Allotey P, Reidpath DD, Elisha D (2004) “Social medication” and the control of children: a qualitative study of over-the-counter medication among Australian children. Pediatrics 114(3):e378–e383

    Article  PubMed  Google Scholar 

  • Armstrong DJ (1992) The use of over-the-counter preparations by drug users attending an addiction treatment unit. Br J Addict 87(1):125–127

    Article  CAS  PubMed  Google Scholar 

  • Arora S, Roxburgh A, Bruno R, Nielsen S, Burns L (2013) A cross-sectional analysis of over the counter codeine use amongst an Australian sample of people who regularly inject drugs. Drug Alcohol Rev 32(6):574–581

    Article  PubMed  Google Scholar 

  • Babalonis S, Lofwall MR, Nuzzo PA, Siegel AJ, Walsh SL (2013) Abuse liability and reinforcing efficacy of oral tramadol in humans. Drug Alcohol Depend 129(1–2):116–124

    Article  CAS  PubMed  Google Scholar 

  • Baratta JL, Gandhi K, Viscusi ER (2014) Limited evidence that single-dose oral ibuprofen plus codeine is more effective for postoperative pain than either drug alone. Evid Based Nurs 17(2):51–52

    Article  PubMed  Google Scholar 

  • Bateman C (2013) Is your prescribing serving a hidden addiction? S Afr Med J 103(6):359–361

    Article  PubMed  Google Scholar 

  • Boyd CJ, McCabe SE (2008) Coming to terms with the nonmedical use of prescription medications. Subst Abuse Treat Prev Policy 3(1):22

    Article  PubMed  PubMed Central  Google Scholar 

  • Butler R, Sheridan J (2010a) Innocent parties or devious drug users: the views of primary healthcare practitioners with respect to those who misuse prescription drugs. Harm Reduction J 7(1):21

    Google Scholar 

  • Butler R, Sheridan J (2010b) Innocent parties or devious drug users: the views of primary healthcare practitioners with respect to those who misuse prescription drugs. Harm Reduction J 7:21

    Google Scholar 

  • Casati A, Sedefov R, Pfeiffer-Gerschel T (2012) Misuse of medicines in the European union: a systematic review of the literature. Eur Addict Res 18(5):228–245

    Article  PubMed  Google Scholar 

  • Chee E, Schneberger S (2003) British Colombia’s pharmanet project. University of Western Ontario, London

    Google Scholar 

  • Chetty R, Baoku Y, Mildner R, Banerjee A, Vallance D, Haddon A et al (2003) Severe hypokalaemia and weakness due to Nurofen(R) misuse. Ann Clin Biochem 40(4):422–423

    Google Scholar 

  • Cooper RJ (2011) Over-the-counter medicine abuse—a review of the literature. J Subst Use 18(2):1–26

    Google Scholar 

  • Cooper RJ (2011) ‘Respectable addiction’—a qualitative study of over the counter medicine abuse in the UK

    Google Scholar 

  • Cooper RJ (2013a) ‘I can’t be an addict. I am.’ Over-the-counter medicine abuse: a qualitative study. BMJ Open 3(6):e002913

    Google Scholar 

  • Cooper R (2013b) Surveillance and uncertainty: community pharmacy responses to over the counter medicine abuse. Health Soc Care Community 21(3):254–262

    Article  PubMed  Google Scholar 

  • Dayer P, Desmeules J, Leemann T, Striberni R (1988) Bioactivation of the narcotic drug codeine in human liver is mediated by the polymorphic monooxygenase catalyzing debrisoquine 4-hydroxylation (cytochrome P-450 dbl/bufI). Biochem Biophys Res Commun 152(1):411–416

    Google Scholar 

  • Dhital R, Whittlesea CM, Norman IJ, Milligan P (2010) Community pharmacy service users’ views and perceptions of alcohol screening and brief intervention. Drug Alcohol Rev 29(6):596–602

    Article  PubMed  Google Scholar 

  • Dutch MJ (2008) Nurofen plus misuse: an emerging cause of perforated gastric ulcer. Med J Aust 188(1):56–57

    PubMed  Google Scholar 

  • Dyer BT, Martin JL, Mitchell JL, Sauven NC, Gazzard B (2004) Hypokalaemia in ibuprofen and codeine phosphate abuse. Int J Clin Pract 58(11):1061–1062

    Article  CAS  PubMed  Google Scholar 

  • Ernest D, Chia M, Corallo CE (2010) Profound hypokalaemia due to nurofen plus and red bull misuse. Crit Care Resusc 12(2):109–110

    PubMed  Google Scholar 

  • Evans C, Chalmers-Watson TA, Gearry RB (2010) Combination NSAID-codeine preparations and gastrointestinal toxicity. NZ Med J 23(1324):92–93

    Google Scholar 

  • Ferner RE, Beard K (2008) Over the counter medicines: proceed with caution. BMJ 336(7646):7694–7696

    Article  Google Scholar 

  • Fleming GF, McElnay MJ, Hughes CM (2004) Development of a community pharmacy-based model to identify and treat OTC drug abuse/misuse: a pilot study. Pharm World Sci 26(5):282–288

    Google Scholar 

  • Frei M, Nielsen S, Tobin C, Dobbin M (2010) Serious morbidity associated with misuse of over-the-counter codeine-ibuprofen analgesics: a series of 27 cases. Med J Aust 193(5):294–296

    PubMed  Google Scholar 

  • French DP, James DH (2008) Reasons for the use of mild analgesics among English students. Pharm World Sci 30(1):79–85

    Article  CAS  PubMed  Google Scholar 

  • Gourlay DL, Heit HA, Almahrezi A (2005) Universal precautions in pain medicine: a rational approach to the treatment of chronic pain. Pain Med 6(2):107–112

    Article  PubMed  Google Scholar 

  • Hamer AM, Spark MJ, Wood PJ, Roberts E (2014) The upscheduling of combination analgesics containing codeine: the impact on the practice of pharmacists. Res Soc Adm Pharm 10(4):669–678

    Google Scholar 

  • Heather N, Bowie A, Ashton H, McAvoy B, Spencer I, Brodie J et al (2004) Randomised controlled trial of two brief interventions against long-term benzodiazepine use: outcome of intervention. Addict Res Theory 12(2):141–154

    Article  Google Scholar 

  • Horsfield E, Sheridan J, Anderson C (2011) What do community pharmacists think about undertaking screening and brief interventions with problem drinkers? Results of a qualitative study in New Zealand and England. Int J Pharm Pract 19(3):192–200

    Article  PubMed  Google Scholar 

  • Hughes GF, McElnay JC, Hughes CM, McKenna P (1999) Abuse/misuse of non prescription drugs. Pharm World Sci 21(6):251–255

    Article  CAS  PubMed  Google Scholar 

  • International Narcotics Control Board (2012) Narcotic drugs estimated world requirements for 2012. Comments on the reported statistics on narcotic drugs

    Google Scholar 

  • Kahan M, Wilson L, Wenghofer EF, Srivastava A, Resnick A, Janecek E et al (2011) Pharmacists’ experiences with dispensing opioids: provincial survey. Can Fam Phys 57(11):e448–e454

    Google Scholar 

  • Khan N, Norman I, Dhital R, McCrone P, Milligan P, Whittlesea C (2013) Alcohol brief intervention in community pharmacies: a feasibility study of outcomes and customer experiences. Int J Clin Pharm 35(6):1178–1187

    Article  PubMed  Google Scholar 

  • Kitabayashi Y, Ueda H, Narumoto J, Kita H, Nakamura K, Tsuchida H et al (2000) A case study of BRON (cough suppressant) tablet dependence–its social psychiatric and biological aspects. Japan J Alcohol Stud Drug Depend 35(5):295–305

    Google Scholar 

  • Kolodny A (2013) Better late than never: time to up-schedule hydrocodone combination products. Pain Med 14(11):1627–1628

    Article  PubMed  Google Scholar 

  • Kypri K, Langley JD, Saunders JB, Cashell-Smith ML, Herbison P (2008) Randomized controlled trial of web-based alcohol screening and brief intervention in primary care. Arch Intern Med 168(5):530–536

    Article  PubMed  Google Scholar 

  • LA Gudin J (2013) The downside of upscheduling. Pain Med 14(11):1628–1629

    Article  PubMed  Google Scholar 

  • Le Roux K (2013) Marketing of CPS. S Afr Pharm J 80(5):43–47

    Google Scholar 

  • Leppert W (2011) CYP2D6 in the metabolism of opioids for mild to moderate pain. Pharmacology 87(5–6):274–285

    Article  CAS  PubMed  Google Scholar 

  • Lessenger JE, Feinberg SD (2008) Abuse of prescription and over-the-counter medications. J Am Board Fam Med 21(1):45–54

    Google Scholar 

  • MacFadyen LED, McGowan T (2001) Community pharmacists’ experience of over-the-counter medicine misuse in Scotland. J R Soc Promot Health 121(3):185–192

    Article  CAS  PubMed  Google Scholar 

  • Madadi P, Amstutz U, Rieder M, Ito S, Fung V, Hwang S et al (2013) Clinical practice guideline: CYP2D6 genotyping for safe and efficacious codeine therapy. J Popul Ther Clin 20(3):e369–e396

    Google Scholar 

  • Manchia M, Alda M, Calkin CV (2013) Repeated erythromycin/codeine-induced psychotic mania. Clin Neuropharmacol 36(5):177–178

    Google Scholar 

  • Matheson C, Bond C, Pitcairn J (2002) Misuse of over-the-counter medicines from community pharmacies: a population survey of Scottish pharmacists. Pharm J 269:66–68

    Google Scholar 

  • Maxwell JC (2011) The prescription drug epidemic in the United States: a perfect storm. Drug Alcohol Rev 30(3):264–270

    Article  PubMed  Google Scholar 

  • McAvoy BR, Tobin CL (2014) Fatal misuse of codeine-ibuprofen analgesics in Victoria, Australia. Med J Aust 200(3):150–151

    Article  PubMed  Google Scholar 

  • McAvoy BR, Dobbin MD, Tobin CL (2011) Over-the-counter codeine analgesic misuse and harm: characteristics of cases in Australia and New Zealand. NZ Med J 124(1346):29–33

    Google Scholar 

  • McBride AJ, Pates R, Ramadan R, McGowan C (2003) Delphi survey of experts’ opinions on strategies used by community pharmacists to reduce over-the-counter drug misuse. Addiction 98(4):487–497

    Article  PubMed  Google Scholar 

  • McCabe SE, Boyd CJ (2005) Sources of prescription drugs for illicit use. Addict Behav 30(7):1342–1350

    Article  PubMed  PubMed Central  Google Scholar 

  • McDonough MA (2011) Misuse of codeine-containing combination analgesics. Med J Aust 194(9):486

    PubMed  Google Scholar 

  • Medani S, Short S, Wall C (2010) Nurofen plus toxicity—what should nephrologists be alert to? Rare complications of an increasingly misused medication. NDT Plus. 2010 May 11

    Google Scholar 

  • Medicines and Health Care Products Regulatory Agency (MHRA) (2009) Public assessment report. Codeine and dihydrocodeine-containing medicines: minimising the risk of addiction. MHRA, London (UK). Available from http://www.mhra.gov.uk/. Accessed 6 Oct 2013

  • Murnion B (2010) Combination analgesics in adults. Austr Prescriber 33:113–115

    Article  Google Scholar 

  • Myers B, Siegfried N, Parry CD (2003) Over-the-counter and prescription medicine misuse in Cape Town–findings from specialist treatment centres. S Afr Med J 93(5):367–370

    PubMed  Google Scholar 

  • Ng JL, Morgan DJ, Loh NK, Gan SK, Coleman PL, Ong GS et al (2011) Life-threatening hypokalaemia associated with ibuprofen-induced renal tubular acidosis. Med J Aust 194(6):313–316

    PubMed  Google Scholar 

  • Nielsen S, Cameron J, Pahoki S (2010) Over the counter codeine dependence. Turning point alcohol and drug centre, Melbourne July 2010. Report No

    Google Scholar 

  • Nielsen S, Cameron J, Lee N (2011) Characteristics of a non-treatment seeking sample of over-the-counter codeine users: implications for intervention and prevention. J Opioid Manag 7(5):363–370

    PubMed  Google Scholar 

  • Nielsen S, Tobin C, Dobbin M (2012) Over the counter codeine: examining the evidence for and against. Austr Pharmacist 31(3):236–240

    Google Scholar 

  • Nielsen S, Cameron J, Pahoki S (2013) Opportunities and challenges: over the counter codeine supply from the codeine consumer perspective. Int J Pharm Pract 21(3):161–168

    Article  PubMed  Google Scholar 

  • Nielsen S, Murnion B, Dunlop A, Degenhardt L, Demirkol A, Muhleisen P et al (2014) Comparing treatment-seeking codeine users and strong opioid users: findings from a novel case series. Drug Alcohol Rev 34(3):304–311

    Google Scholar 

  • Nielsen S, Roxburgh A, Bruno R, Lintzeris N, Jefferson A, Degenhardt L (2015) Changes in non-opioid substitution treatment episodes for pharmaceutical opioids and heroin from 2002 to 2011. Drug Alcohol Depend 149:212–219

    Google Scholar 

  • Nordmann S, Pradel V, Lapeyre-Mestre M, Frauger E, Pauly V, Thirion X et al (2013) Doctor shopping reveals geographical variations in opioid abuse. Pain Phys 16(1):89–100

    Google Scholar 

  • Nuesch E, Rutjes AW, Husni E, Welch V, Juni P (2009) Oral or transdermal opioids for osteoarthritis of the knee or hip. Cochrane Database Syst Rev (4):CD003115

    Google Scholar 

  • O’Donnell A, Anderson P, Newbury-Birch D, Schulte B, Schmidt C, Reimer J et al (2013) The impact of brief alcohol interventions in primary healthcare: a systematic review of reviews. Alcohol Alcohol 13:2013

    Google Scholar 

  • Orriols L, Gaillard J, Lapeyre-Mestre M, Roussin A (2009) Evaluation of abuse and dependence on drugs used for self-medication: a pharmacoepidemiological pilot study based on community pharmacies in France. Drug Saf 32(10):859–873

    Article  CAS  PubMed  Google Scholar 

  • Otto CCB, Lohrmann I, Zahradnik A, Bischof G, John U et al (2009) Brief intervention in general hospital for problematic prescription drug use: 12-month outcome. Drug Alcohol Depend 105(3):221–226

    Article  PubMed  Google Scholar 

  • Pates R, McBride A, Li S, Ramadan R (2002) Misuse of over-the-counter medicines: a survey of community pharmacies in a South Wales health authority. Pharm J 268:179–182

    Google Scholar 

  • Phokeo V, Sproule B, Raman-Wilms L (2004) Community pharmacists’ attitudes toward and professional interactions with users of psychiatric medication. Psychiatr Serv 55(12):1434–1436

    Article  PubMed  Google Scholar 

  • Pilgrim JL, Dobbin M, Drummer OH (2014) Fatal misuse of codeine-ibuprofen analgesics in Victoria, Australia. Med J Aust 199(5):329–331

    Article  PubMed  Google Scholar 

  • Reed K, Bond A, Witton J, Cornish R, Hickman M, Strang J (2011) The changing use of prescribed benzodiazepines and z-drugs and of over-the-counter codeine-containing products in England: a structured review of published English and international evidence and available data to inform consideration of the extent of dependence and harm. London: National Addiction Centre, King’s College London, and School of Social and Community Medicine, University of Bristol

    Google Scholar 

  • Robinson GM, Robinson S, McCarthy P, Camero C (2010) Misuse of over-the-counter codeine-containing analgesics: dependence and other adverse effects. NZ Med J 123(1317):59–64

    Google Scholar 

  • Roumie CLGM (2004) Over-the-counter analgesics in older adults, a call for improved labelling and consumer education. Drugs Aging 21(8):485–498

    Article  PubMed  Google Scholar 

  • Roussin A, Bouyssi A, Pouche L, Pourcel L, Lapeyre-Mestre M (2013) Misuse and dependence on non-prescription codeine analgesics or sedative H1 antihistamines by adults: a cross-sectional investigation in France. PLoS ONE 8(10):e76499

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Schatman ME, Darnall BD (2013) A practical and ethical solution to the opioid scheduling conundrum. J Pain Res 7:1–3

    Article  PubMed  PubMed Central  Google Scholar 

  • Shand F, Campbell G, Hall W, Lintzeris N, Cohen M, Degenhardt L (2013) Real-time monitoring of Schedule 8 medicines in Australia: evaluation is essential. Med J Aust 198(2):80–81

    Article  PubMed  Google Scholar 

  • Sheridan J, Wheeler A, Ju-Hsing Chen L, Chen-Yun Huang A, Nga-Yee Leung I, Yow-Chyi Tien K (2008) Screening and brief interventions for alcohol: attitudes, knowledge and experience of community pharmacists in Auckland, New Zealand. Drug Alcohol Rev 27(4):380–387

    Google Scholar 

  • Skurtveit S, Furu K, Borchgrevink P, Handal M, Fredheim O (2011) To what extent does a cohort of new users of weak opioids develop persistent or probable problematic opioid use? Pain 152(7):1555–1561

    Article  PubMed  Google Scholar 

  • Sproule BA, Busto UE, Somer G, Romach MK, Sellers EM (1999) Characteristics of dependent and nondependent regular users of codeine. J Clin Psychopharmacol 19(4):367–372

    Article  CAS  PubMed  Google Scholar 

  • Strobbe S (2014) Prevention and screening, brief intervention, and referral to treatment for substance use in primary care. Prim Care Clin Off Pract 41(2):185–213

    Google Scholar 

  • Toms L, Derry S, Moore RA, McQuay HJ (2009) Single dose oral paracetamol (acetaminophen) with codeine for postoperative pain in adults. Cochrane Database Syst Rev (1):CD001547

    Google Scholar 

  • UVUN (2011) The non medicinal use of prescription drugs. Discussion paper. Vienna

    Google Scholar 

  • Vallejo RBR, Wang VC (2011) Pharmacology of opioids in the treatment of chronic pain syndromes. Pain Phys 14(4):E343–E360

    Google Scholar 

  • Van Hout MC (2015) Nod and wave: an internet study of the codeine intoxication phenomenon. Int J Drug Policy 26(1):67–77

    Article  PubMed  Google Scholar 

  • Van Hout MC, Bergin M, Foley M, Rich E, Rapca AI, Harris R et al (2014) A scoping review of codeine use, misuse and dependence, final report. Brussels: CODEMISUSED Project European Commission 7th Framework Programme

    Google Scholar 

  • Vargas-Schaffer G (2010) Is the WHO analgesic ladder still valid? Twenty-four years of experience. Can Fam Physician 56(6):514–517

    Google Scholar 

  • Wawruch MKM, Foltanova T, Ondriasova E, Luha J, Dukat A et al (2013) Characteristics of elderly patients who consider over-the-counter medications as safe. Int J Clin Pharm 35(1):121–128

    Article  PubMed  Google Scholar 

  • Wazaify M, Shields E, Hughes CM, McElnay JC (2005) Societal perspectives on over-the-counter (OTC) medicines. Fam Pract 22(2):170–176

    Article  PubMed  Google Scholar 

  • Wazaify M, Hughes CM, McElnay JC (2006) The implementation of a harm minimisation model for the identification and treatment of over-the-counter drug misuse and abuse in community pharmacies in Northern Ireland. Patient Educ Couns 64(1–3):136–141

    Article  PubMed  Google Scholar 

  • Wilk AI, Jensen NM, Havighurst TC (1997) Meta-analysis of randomized control trials addressing brief interventions in heavy alcohol drinkers. J Gen Intern Med 12(5):274–283

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Wilsey B, Prasad H (2012) Real-time access to prescription drug monitoring databases. CMAJ 184(16):1767–1768

    Article  PubMed  PubMed Central  Google Scholar 

  • Wrobel JP (2003) Are we ready for the better medication management system? Med J Aust 178(9):448–450

    PubMed  Google Scholar 

  • Zahradnik A, Otto C, Crackau B, Löhrmann I, Bischof G, John U et al (2009) Randomized controlled trial of a brief intervention for problematic prescription drug use in non-treatment-seeking patients. Addiction 104(1):109–117

    Article  PubMed  Google Scholar 

  • Zhou SF (2009) Polymorphism of human cytochrome P450 2D6 and its clinical significance: part I. Clin Pharmacokinet 48(11):689–723

    Article  CAS  PubMed  Google Scholar 

Download references

Funding Acknowledgement

Suzanne Nielsen is supported by NHMRC fellowship (#1013803). The National Drug and Alcohol Research Centre at the University of NSW is supported by funding from the Australian Government under the Substance Misuse Prevention and Service Improvements Grant Fund. Research leading to these results has received funding from the European Community’s Seventh Framework Programme FP7/2007–2013 under Grant Agreement No 611736.

Author information

Authors and Affiliations

  1. National Drug and Alcohol Research Centre, UNSW, 22-32 King Street, Randwick, NSW, 2031, Australia

    Suzanne Nielsen

  2. South East Sydney Local Health District (SESLHD) Drug and Alcohol Services, 591-623 S Dowling Street, Surry Hills, NSW, 2010, Australia

    Suzanne Nielsen

  3. Department of Health, Sport and Exercise Science, School of Health Sciences, Waterford Institute of Technology, Waterford, Ireland

    Marie Claire Van Hout

Authors
  1. Suzanne Nielsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marie Claire Van Hout
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Suzanne Nielsen .

Editor information

Editors and Affiliations

  1. National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia

    Suzanne Nielsen

  2. University of Tasmania School of Psychology, Launceston, Tasmania, Australia

    Raimondo Bruno

  3. Victoria University of Wellington School of Psychology, Wellington, New Zealand

    Susan Schenk

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Nielsen, S., Van Hout, M.C. (2015). Over-the-Counter Codeine—from Therapeutic Use to Dependence, and the Grey Areas in Between. In: Nielsen, S., Bruno, R., Schenk, S. (eds) Non-medical and illicit use of psychoactive drugs. Current Topics in Behavioral Neurosciences, vol 34. Springer, Cham. https://doi.org/10.1007/7854_2015_422

Download citation

Publish with us

Policies and ethics

Search

Navigation