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Health Minister Stands by Statement

Health Canada is moving to make pain pills, cough syrups and other medications that contain low doses of codeine available only with a doctor’s prescription as Health Minister Jane Philpott warned last year she would tighten the rules on over-the-counter codeine.

“While a prescription may not be needed today, codeine can produce drug dependence and has the potential for being abused,

The regulatory notice says about 600 million low-dose codeine tablets, or about 20 for every person in the country, were sold in Canada alone. The report further notes that over the 2007-2015 period roughly 500 people came into rehab centres in Ontario due to codeine addiction.

These millions of dollars and doses obscure a crucial problem: there is a startling lack of evidence that these drugs work better than household painkillers like Tylenol or Advil. Yet it maintains the addictive aspects of codeine.

Easy Access

“Currently, Canadians can buy medications with low doses of codeine — for example, a maximum of 8 mg in a single pill — as long as two other medications are present, normally caffeine and a painkiller such as an acetaminophen.”

The regulator further states that although this will increase wait times for medication prescriptions it will be worthwhile by providing more information to patients and allowing a more careful tracking of sales.

Health Canada is aiming to increase tracking as the current system has largely failed, as although the drug is over the counter it is almost impossible for individual pharmacists to track usage.  For example, a Toronto Star article from 2015 found that:

“drive across the border to Niagara Falls, Ont., and you can buy as much codeine as you want. The Toronto Star purchased 1,000 tablets from five pharmacies with barely any questions asked — in little more than an hour.”

 International Problem

International research provides further insight into the problems with OTC codeine. In France, a study of 53 purchases of codeine at a community pharmacy found that 15% were using codeine for nonmedical reasons.

With 7.5% reported dependence and 7.5% reported abuse. New Zealand and Australia have published multiple case reports highlighting the harms of OTC codeine.

Many highlighting low dose Codeine’s lack of efficacy as the drugs largest problem. Published studies suggest other products without codeine provide similar pain relief as low-dose codeine products.

For example, a scientific review conducted in 2010 indicated that other commonly used comparable non-opioid based drugs provided more effective pain relief than 60 mg of codeine alone.

In these reports, many patients addicted to OTC codeine had gastrointestinal-related morbidities secondary to the nonsteroidal anti-inflammatory drugs (NSAIDs) in codeine combination pills.

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