Flu tablets and painkillers that include codeine should be prescription-only from January 2020, Medsafe’s Medicines Classification Committee has recommended.

The committee’s decision that codeine-containing cold, flu and painkiller medicines –currently available over-the-counter in pharmacies – should become prescription only medicines was made public this week with the release of its November meeting minutes.

In Australia from next month medicines containing codeine will no longer be available with a prescription, which prompted New Zealand to review whether it should do the same

Following public consultations and considering advice on the issue the Committee, chaired by Dr Stewart Jessamine, has decided there is not a need for a cough and cold medicine containing codeine because of the “evidence of toxicity and the risk of abuse associated with combination medicines”.

But to fill the ‘pain-relief’ gap – created by making codeine-combination medicines prescription-only –  the committee also recommended that from 2020 onwards that limited supplies of codeine-only medicines be available from pharmacists for the emergency management of acute pain. (See full recommendations below).

The committee’s recommendations have been described as “disappointing and unnecessary” by the New Zealand Self-Medication Industry Association – the body representing pharmaceutical and other companies that produce non-prescription medicines, like the affected flu remedies and codeine-combination painkillers.

Scott Milne, the association’s executive director said it was disappointed that the committee had not taken the opportunity to encourage better recording of over-the-counter sales of codeine-products.  But instead had pushed for all codeine-in-combination productions to become prescription-only which “anecdotal evidence and earlier research” suggested was how the bulk of abused codeine was currently procured.

He said the decision also meant meant “a valuable opportunity to develop a real-time recording system for codeine purchases” proposed by the association and the Pharmacy Guild might have been lost.

“We are concerned that further restricting access to these medicines will have unintended consequences for consumers, who will be required to visit a GP or emergency department to access medicines for minor, self-limiting conditions instead of being able to get them from a pharmacy. He said it would increase the workload of doctors and create greater inefficiencies and additional cost in an already over-strained primary health system.

But Dr Hartley Atkinson, the managing director of AFT Pharmaceuticals which produces a non-codeine based painkiller, welcomed the decision saying it was “sensible given the risk of misuse or addiction that comes with codeine-based medicines”.

Committee Recommendations:

  • That Medsafe should write to the professional bodies (ie, New Zealand Medical Association, Royal New Zealand College of General Practitioners, Pharmaceutical Society of New Zealand, Pharmacy Council of New Zealand, Pharmacy Guild of New Zealand, New Zealand Nurses Organisation, Chairs of the District Health Boards, Dental Council and the New Zealand Dental Association) regarding the importance of better education and professional development for health professionals regarding acute and chronic pain management, analgesics with the potential for abuse and a reminder of section 24(1) of the Misuse of Drugs Act 1975.
  • That the Committee should advocate the national monitoring of all codeine-containing medicines which would include restricted and prescription, subsidised and unsubsidised medicines. Medsafe alongside the Ministry of Health should explore how the Committee could advocate a monitoring system.
  • That, from 31 January 2020, all codeine in combination medicines, both analgesics and those used for cough and colds, should be reclassified to prescription medicines.
  • That, from 31 January 2020, medicines containing codeine as the only active ingredient should be reclassified from prescription to restricted medicine; for oral use in adults and children over 12 years of age in medicines containing not more than 15 mg per solid dosage unit with a maximum daily dose not exceeding 90 mg of codeine for use as an analgesic and when sold in a pack of not more three days’ supply.
  • That Medsafe should liaise with the sector regarding the required labelling to be included on codeine when sold as a restricted medicine.

The full committee decision and recommendations by the Medsafe’s Medicines Classification Committee can be read here

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