Right:If codeine is ingested at high enough levels, the the resulting respiratory depression can lead to an unpleasant death.
 Found a word you're not familiar with? Double-click that word to bring up a dictionary reference to it. The dictionary page includes an audio sound file with which to actually hear the word said. |
background information
Withdrawal and dependence
As with other opiate-based pain killers, chronic use of codeine can cause physical dependence. When physical dependence has developed, withdrawal symptoms may occur if a person suddenly stops the medication. Withdrawal symptoms include: drug craving, runny nose, yawning, sweating, insomnia, weakness, stomach cramps, nausea, vomiting, diarrhoea, muscle spasms, chills, irritability, and pain. To minimize withdrawal symptoms, long-term users should gradually reduce their codeine medication under the supervision of a healthcare professional.
Legal status
Australia
In Australia, codeine preparations must be sold only at a pharmacy. Preparations will often be a combination of paracetamol (500 mg), ibuprofen (200 mg) and doxylamine succinate (5 mg), and the codeine content may range from 5 mg to 15 mg; preparations with in excess of 15 mg per tablet are S4 (Schedule 4, or "Prescription Only") medications. The item is given over the counter, no prescriptions, at the discretion of the pharmacist. Most preparations are considered S3 (schedule 3, or "Pharmacist Only") medications, meaning that they must be sold with the direct involvement of a pharmacist. It must be labelled and usage history monitored by the pharmacist to help deter misuse and dependence. The exception to this rule is cold and flu preparations such as "Codral". These preparations contain phenylephrine (5 mg), paracetamol (500 mg) and codeine (9.5 mg) or phenylephrine (5 mg), paracetamol (500 mg), chlorpheniramine (2 mg) and codeine (9.5 mg).
Preparations containing pure codeine (e.g., codeine phosphate tablets or codeine phosphate linctus) are available on prescription and are considered S8 (Schedule 8, or "Controlled Drug Possession without authority illegal"). Schedule 8 preparations are subject to the strictest regulation of all medications available to consumers.
From February 1, 2018, preparations containing codeine will not be available without a prescription.
Canada
In Canada tablets containing 8 mg of codeine combined with 15 mg of caffeine and 300 mg of paracetamol are sold as T1s (Tylenol Number 1) without a prescription. A similar tablet called an AC&C which contains 325 mg of acetylsalicylic acid (Aspirin) instead of paracetamol is also available without a prescription. Both tablets are kept behind the counter and must be dispensed by a pharmacist who may limit quantities. Names of many codeine and dihydrocodeine products in Canada tend to follow the narcotic content number system (Tylenol With Codeine No. 1, 2, 3, 4 &c) which came to be in its current form with the Pure Food & Drug Act of 1906.
Codeine became a prescription-only medication in the province of Manitoba on February 1, 2016. A pharmacist may issue a prescription, and all purchases are logged to a central database to prevent overprescribing.
France
In France, before 2017, most preparations containing codeine did not require a doctor's prescription. For example, products containing codeine include Nocodion (codeine and camphor), Tussipax (ethylmorphine and codeine), Paderyl (codeine alone), Codoliprane (codeine with paracetamol), Prontalgine and Migralgine (codeine, paracetamol and caffeine) could be purchased over-the-counter.
In 2017 the law was changed making mandatory a prescription for all codeine products along with ethylmorphine and dextromethorphan.
United Kingdom
In the United Kingdom, the sale and possession of codeine are restricted separately under law.
Neat codeine and higher-strength codeine formulations are generally prescription-only medicines (POM) meaning that the sale of such products is restricted under the Medicines Act 1968. Lower-strength products containing combinations of up to 12.8 mg of codeine per dosage unit, combined with paracetamol, ibuprofen or aspirin are available over the counter at pharmacies. Codeine linctus of 15 mg per 5 ml is also available at some pharmacies, although a purchaser would have to request it specifically from the pharmacist.
United States
In the United States, codeine is regulated by the Controlled Substances Act. Federal law dictates that codeine be a Schedule II controlled substance when used in products for pain-relief that contain codeine alone or more than 90 mg per dosage unit. Tablets of codeine in combination with aspirin or paracetamol (paracetamol/Tylenol) made for pain relief are listed as Schedule III (allowing for electronic fills and refills without a physical paper-copy of the physician ordered prescription); and cough syrups are Schedule III or V, depending on formula. The paracetamol/codeine pain-relief elixir (trade name Tylenol Elixir with Codeine) is a Schedule IV controlled substance.