Guide Health: Should you take non-prescription codeine?

Codeine isn’t actually a good pain reliever. Non-drug therapies are often better

The majority of narcotic drugs can only be obtained by seeing your doctor and getting a prescription. However, one class of codeine-containing drugs can be purchased without a prescription.

These are known as exempted codeine products, and you need to ask your pharmacist for them because they are all kept behind the pharmacy counter in the dispensary. But there have been recent changes to how these products are supplied.

Federal legislation allows for products with no more than eight milligrams of codeine per tablet and 20 milligrams of codeine per 30 milli-litres of liquid to be sold without a prescription. However, there can be additional provincial regulations.

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In some provinces when you purchase one of these products, the transaction must be entered into the provincial electronic health network, and there can be limits on the quantity and size that you can purchase. The most recent change has occurred in Manitoba where all exempted codeine products now require a prescription. Your doctor can write this prescription, but so can your pharmacist, after an assessment and within limits on the quantity prescribed.

Two factors have led to these changes. First, exempted codeine products are not considered effective pain relievers, and second, misuse and abuse commonly occurs among users of these products. About 15 per cent of Canadians use narcotic drugs, and about two per cent admit to abusing them.

With only two per cent of people admitting abuse, you wonder why there is a problem, but these numbers do not include people who don’t admit abuse, and exempted codeine products are not usually included in the numbers.

Codeine is actually considered a poor pain reliever. Plain acetaminophen or non-steroidal anti-inflammatory drugs like ibuprofen or naproxen provide better relief for all kinds of pain ranging from muscle “pulls” and back injuries to dental pain. As well, non-drug approaches such as heat or cold therapy, physiotherapy, rest, massage, exercise, improved sleep, and yoga are often just as effective.

Besides dependency, exempted codeine products are associated with other problems. Codeine can cause constipation, dizziness, increased risk for falls, and even nausea and vomiting, and combination products can contain acetaminophen which causes liver damage.

If you use only plain acetaminophen, then it’s easy to track your limit, and of course you need to remember that alcohol can exacerbate this adverse effect.

Also remember that exempted codeine products are not recommended for pregnant women or nursing mothers, children, or the elderly. Health Canada does not recommend any cough syrups, including those containing codeine, for children six and under, and for children six to 12 years old, this labelling is quite specific.

Increasing the humidity and drinking plenty of fluids (yes, even chicken soup) are better options.

Dependency is one issue with overuse of exempted codeine products, and rebound headaches are another. You may find the headache returning after you finish your last tablet, and then you realize you need to take more tablets to have the same pain relief.

If you are using an exempted codeine product more than twice a week to manage your headache pain, you probably have a rebound headache.

If you do take an exempted codeine product, ask yourself what you are trying to treat, and whether you are self-medicating or following your doctor’s advice. Also ask if you have tried non-drug approaches. You may surprise yourself and realize that there are better options that will alleviate your pain and give you a better quality of life.

About the author


Marie Berry is a lawyer/pharmacist interested in health and education.



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