Where Can I Buy Codeine
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Your baby may get used to having codeine and may have withdrawal symptoms when they're born. There is a slightly higher risk of your baby having breathing problems. These are usually temporary, but your baby may need extra monitoring.
Codeine belongs to a group of medicines called opiates. It affects pain receptors in the central nervous system and the brain to block pain signals to the rest of the body. When codeine blocks the pain receptors, there are other unwanted effects \\u2013 for example slow and shallow breathing. It can also slow down digestion, which is why codeine can cause constipation.
However, if you take high doses of co-codamol for a long time, there's a very small risk it can temporarily reduce fertility in men and women. It can cause a health problem called hypogonadism. Hypogonadism is where the body does not make enough sex hormones. This can make it more difficult for you to conceive.
If you take recreational drugs, such as cannabis, cocaine and heroin, while you're taking co-codamol, you're more likely to get the serious side effects of the codeine in co-codamol. These include breathing difficulties, heart problems, fits and even going into a coma.
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.
Codeine is a narcotic medication that is used to treat mild to moderate pain. It is also used to treat cough when combined with other medications. Codeine will help relieve symptoms but will not treat the cause of the symptoms or speed recovery. It is considered an opiate analgesic and can be classified as an antitussive. When Codeine is prescribed to treat pain, it works by changing the way the brain and nervous system respond to pain. It tells your brain that you are not in pain, whereas a medication such as ibuprofen goes to the site of injury and reduces pain by reducing inflammation. When Codeine is used to treat cough, it works by decreasing the activity in the part of the brain that causes coughing.
In the United States, drugs with codeine in them are available only by prescription because codeine is a controlled substance and very addictive. The regulations in the United States have gotten strict on medication that contains Codeine, due to the increase in addiction. However, in the United Kingdom and some other parts of Europe, Codeine can be purchased in low doses over the counter from a pharmacy. The codeine comes mixed with Paracetamol (Co-Codamol), with aspirin (Co-Codaprin), or with ibuprofen (Nurofen Plus). You can also buy Codeine from a pharmacy as a syrup (linctus) to treat dry cough.
Warning labels will tell you that Codeine is habit-forming. From our experience, Codeine is highly addictive and individuals dependent on the drug have a hard time putting it away for good on their own. If you or anyone in your family have ever had issues with alcohol or addiction, have used street drugs, have ever overused any prescription medications, or if you have ever suffered from depression or any other mental illness, especially untreated mental illness, there is a greater risk that you will misuse codeine.
If you are in the United Kingdom or anywhere that you can purchase Codeine over the counter, we highly advise that you speak with a pharmacist about the symptoms you are experiencing before purchasing Codeine or any related products.
If you have been prescribed or have purchased Codeine or any related products over the counter for pain or a cough, and you believe you may be dependent or addicted to it, you may experience some withdrawal symptoms. Withdrawal symptoms may come in two phases. The early phase occurs within a few hours of your last dose and other symptoms may occur later as your body readjusts to working without codeine.
Deaths involving codeine or codeine/paracetamol medicines in England and Wales have almost doubled in the last two decades and continue in an upward trend with 102 deaths reported in 2006 rising to 182 in 2016 . While the number of people in treatment for codeine addiction has increased in the last 5 years , many depend on alternative support, such as from the internet, to manage codeine misuse .
In Canada, The Controlled Drugs and Substances Act defines OTC (Schedule II) codeine preparations as those containing no more than 8 mg or its equivalent of codeine phosphate per unit of solid form, or no more than 20 mg codeine phosphate per 30 mL of liquid preparation.9 Additionally, these products must contain 2 or more additional medicinal ingredients of specified quantities.9 The most commonly sold OTC codeine preparations in Canada contain codeine, acetaminophen and caffeine. Although intended to prevent inappropriate use, the requirement for OTC codeine products to be combined with other medicinal ingredients places consumers at risk of toxicity from these drugs, in addition to opioid-related harm,8,10 particularly hepatotoxicity caused by acetaminophen.11,12
In Canada, the federal government is responsible for determining the conditions of sale of drug products, such as the requirement for a prescription. Provincial and territorial governments can specify additional conditions of sale, but those conditions must be more restrictive than federal legislation.13 On Feb. 1, 2016, the College of Pharmacists of Manitoba mandated that all low-dose codeine preparations previously considered OTC would require a prescription by a pharmacist or other prescriber.14 Similar regulations have been proposed on a provincial15 and national16 level, and are supported by professional pharmacy and medical associations.17,18
Purchasing of over-the-counter (low-dose), prescription-strength codeine products, and total codeine purchased, in units per resident per month (1 unit = 8 mg) in Manitoba from January 2014 to October 2019. Vertical bar indicates policy change on Feb. 1, 2016, which required a prescription for all codeine products, regardless of strength.
The decrease in codeine purchasing observed after the opening of a comment period suggests that the engagement of stakeholders in regulatory discussion influenced consumption trends. This may indicate that media coverage22 and communication to clinicians regarding the potential regulatory changes from their college23 increased public awareness of the potential risks of codeine, and may have influenced consumption trends and pharmacist counselling. The observed reduction in sales of low-dose codeine products is suggestive of a therapeutic area in which consumers and health care providers are willing to consider alternative therapies. Ongoing policy discussions should consider this as an indication of the ability for pharmacists and patients to adapt to changing regulation around these products, if introduced nationally.
This is further reinforced by our findings in Manitoba, which are consistent with a study that evaluated the 2018 rescheduling of low-dose codeine in Australia.24 In both of these studies, purchasing of low-dose codeine preparations declined immediately after the policy change, with no compensatory change in purchasing of high-dose formulations. The consistency of these findings suggests that rescheduling low-dose codeine preparations may reduce potentially unsafe use of these products without shifts in treatment toward higher-strength alternatives.
International research provides insight into the problems with OTC codeine. In France, a study of 53 purchasers of codeine at a community pharmacy found that 15% were using codeine for nonmedical reasons, 7.5% reported dependence and 7.5% reported abuse.6 New Zealand and Australia have published many case reports highlighting the harms of OTC codeine in their jurisdictions.7-10 In these reports, many patients addicted to OTC codeine had gastrointestinal-related morbidities (hemorrhage, anemia, hematemesis) secondary to the nonsteroidal anti-inflammatory drugs (NSAIDs) in codeine combination pills. OTC codeine is commonly sold in combination with acetylsalicylic acid (ASA) and acetaminophen in Canada, and both of these noncodeine drugs could cause similar collateral harms as a result of codeine misuse. Another study showed that of all codeine deaths recorded in Australia between 2000 and 2009, OTC codeine products were the primary codeine product consumed in 40% of cases.11 These data highlight some of the problems with OTC codeine and the need for stricter regulation of these products.
Pharmacists would benefit from tools to help them counsel on OTC codeine and to help separate those who misuse versus those who do not. One such tool would be a prescription monitoring program (PMP). A PMP would give pharmacists real-time alerts of potential misuse at the time of purchase.
Research exists on PMPs that monitor prescription drugs in Canada and the United States, showing that after these programs are implemented, double-doctoring and polypharmacy use decrease.12-14 This suggests that these programs can help to reduce inappropriate prescribing and dispensing of opioids and other controlled drugs. Whether this ultimately leads to a reduction in abuse and addiction is not clear, and further research is needed.14 If concepts (e.g., practitioner license number recording, flags for double-doctoring and polypharmacy) associated with these prescription-only PMPs were applied to an OTC codeine-monitoring program, then inappropriate OTC codeine use might be reduced as well.
Implementing a PMP is not the ultimate solution and may not be sufficient in curbing OTC codeine misuse. A PMP could tell pharmacists that, for example, a patient had purchased 200 pills of OTC codeine 60 days ago. But under what clinical circumstances, if any, would it be appropriate for a pharmacist to sell this patient another bottle Even with a PMP, pharmacists in many provinces would still not have access to medical and medication histories. Pharmacists are still left making clinical decisions about these narcotics with an incomplete clinical picture. 59ce067264