Is it unreasonable to think pure codeine should be sold otc?

[oganesson]

I live in Ireland but have visited the UK. As far as I know, codeine products are legal in both countries but pure codeine products have a higher schedule than combination products (codeine/paracetamol, codeine/ibuprofen).

There was a high profile case of a woman who died after Nurofen Plus. She died from a perforated bowel. I personally know a few others who did't die but suffered serious effects to their GI tract, and stomach.

The first thing someone would say is that they should be prescription only. I don't think so. As someone who suffers from migraines, Nurofen plus a few times a month is invaluable. It would be a waste of money to put in on prescription not to mention the greater burden on GP's on both sides.

A pharmacist I listened to on RTE said that even though she was addicted to the codeine, it was the ibuprofen that killed her. There are a few OTC codeine products but they are controlled.

My neurologist said codeine shouldn’t be taken for migraines as it can actually make them worse.

If you have migraine you shouldn't be taking codeine for it anyway - it's contraindicated for migraine due to it causing rebound headaches. It's also exponentially less effective than triptans which are a migraine-specific treatment.

Please see your GP to discuss triptans and whether preventative medication would be of use to you.

Migraleve should be banned IMO as a misleading brand.

If you must take codeine, buy non-branded from the pharmacy and save yourself an absolute fortune rather then Nurofen.

I don't understand your point. Opioids alone can cause perforated bowel.

Ibuprofen is the problem. Where I live
you get proton pump inhibitors with your ibuprofen to protect your intestinal tract.

Misunderstood message

yes to OTC. More OTC in general!

Codine is more effective for pain if taken with paracetamol though?

Codeine is highly addictive. Having it sold on its own would make it really easy for people to take just a bit extra, then a bit more, then have another one. Having it mixed with paracetamol etc makes that more immediately dangerous, so it is less likely to happen. Any boundaries we can have to stop people getting addicted to these substances are good.

The codeine would probably have eventually killed that woman, if she was able to take it in higher and higher doses. The only plausible answer to stop that happening again would be to make it prescription only, like you say.

I’m a doctor. This is nonsensical.

Codeine is addictive.
If you take ibuprofen as directed and with food you won’t die. Even if you get a stomach ulcer they very very rarely die.

Co-codamol over the counter is 8mg codeine per tablet. Prescription is 30mg.

Codeine is an opiate (same class of drug as morphine) and some clever people have made an evidence based decision that encouraging addiction in the general population is not a good idea. It’s prescription only for a very good reason, if you have uncontrolled pain then you need to see a doctor. You can’t skip the step of getting medical input before taking what is potentially a dangerous medication if unintentionally misused.

Prescription only, OTC should really only be for minor bumps and bruises that don't really require pain killers

I’m not understanding what you are asking…..it’s fairly simple that selling an addictive drug otc is going to cause problems isn’t it???

I don't think it should be available over the counter in any way shape or form given how addictive it is.

Anyway I thought using codeine containing products regularly for migraine was not advised as the benefit versus risk ratio is weighted on the risk side and you may end up with dependency/medication overuse headaches

I agree about the addiction issue. However, any of the GPs I have seen about spinal stenosis, sciatica, most recently pinched nerve in my neck that is making me struggle to work and preventing sleep - paracetamol is all they suggest. I did have Naproxen prescribed months ago but try to save that for the very worst days so take maybe one at the end of my working week because I am just not able for the fight to get prescribed more. Pain management is just severely lacking and it's making me fearful of being able to continue to work. I'm 48 so a long way off retiring yet.

I got such a grilling by a local pharmacist (I'm in Ireland) when I asked for Nurofen Plus that I left in tears.

OTC pure codeine - No but I do think GPs need to offer better pain management. It's affecting my mental health as well as physical. I've been 3 years on a waiting list for a pain management clinic and no sign of an appointment.