The unrestricted use of codeine as an over the counter medication is of considerable concern to health professionals and has led to a review which recommended its restriction to prescription only. However following lobbying by the pharmaceutical industry the final decision has been delayed to 2017 (1). The continued unrestricted use of these medications is also likely to continue to adversely affect organisations and the implementation of their drug and alcohol programmes.
Codeine is a painkiller in the opiate class of drugs and is found in common over the counter medications such as Nurofen Plus and Panadeine. However dramatic increases in its use and potential abuse over the last 10 years has caused considerable concern with deaths linked to codeine doubling from 2000 to 2009 (1) and reports of its abuse leading to more serious drug use such as heroin (2).
Its effectiveness in treating common conditions such as headaches is minimal but in high enough doses it can cause serious impairment (3). In 2016 the Advisory Committee on Medicines Scheduling produced an interim report recommending the restriction of codeine to Schedule 4, which requires a prescription from a medical practitioner. This would greatly reduce the use of the drug and has been opposed by the major pharmaceutical companies, leading to the announced delay in implementation.
This decision will continue to impact workplaces where a drug and alcohol programme is being conducted. These medications will often produce a positive result in an onsite test and require a worker to be stood down while awaiting a confirmation that it is codeine. In addition these laboratory results may show very high levels of the drug that can indicate impairment or abuse. DASA has developed a range of strategies to assist a workplace in managing the impacts of codeine including the use of medication cards, fact sheets and training packages. We also have our own CASA registered Medical Review Officer who can assist in the interpretation and potential management of codeine laboratory results.
(3) DASA Fact sheet - Painkillers and the Workplace