Codeine and opioid painkiller dependence

Codeine is an opioid painkiller

In Australia, codeine is one of the most widely used prescription opioid painkillers. Also available directly from a pharmacy, misuse can lead to dependence – just as with other opioids, with similar signs, symptoms and risks.

Available with a prescription or in lower doses over-the-counter after consulting with a pharmacist, codeine has the same addictive qualities as other opioid painkillers such as tramadol, oxycodone, fentanyl and morphine. In fact, codeine actually converts to morphine in the body and people can process codeine at different rates, depending on their metabolism.

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“Any medicine containing
codeine can lead to opioid
painkiller dependence

when misused”

Pain or headache medicines, and even some cough suppressants that you can buy from your pharmacy, sometimes contain codeine in combination with other pain killing medicines such as paracetamol or ibuprofen. They may be sold under brand names or unbranded pharmacy names that are familiar and that you trust, however, any medicine containing codeine can lead to opioid painkiller dependence when misused.

Which medicines contain codeine?

Codeine comes in different forms such as:
  • Tablets
  • Capsules
  • Suppositories
  • Soluble powders and tablets
  • Liquids

It’s important to know if a medicine you have purchased from your pharmacy without a prescription contains codeine. The list below includes just a few of the more familiar brands, but don’t forget similar combinations can be sold under pharmacy-own brand names.

What’s in your codeine combination painkiller?
Medicine such as paracetamol, ibuprofen or aspirin

May provide relief from:
  • •  Mild-to-moderate pain
  • •  Cold & flu symptoms

Generally added for extra pain relief, but may also be added to help relieve:
  • •  Dry, irritating cough
  • •  Diarrhoea
Common over-the-counter codeine combinations
Aspalgin® (aspirin and codeine)
Nurofen® Plus (ibuprofen and codeine)
Panadeine®, Panamax Co® (paracetamol and codeine)
Codral® Cold & Flu (paracetamol, phenylephrine hydrochloride, codeine)
Mersyndol®, Panalgesic® (paracetamol, codeine and doxylamine)
Adapted from Alcohol and Drug Information Factsheet. Codeine facts. Australian Drug Foundation, May 2016.

If you are taking a codeine combination medicine, it’s very important to take it as directed, and to see your doctor for advice if your symptoms persist.

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Should I be concerned about codeine dependence?

Codeine may be readily available without a prescription, but it has the same effect on the brain’s chemistry as other opioid painkillers – so caution needs to be taken. Misuse can still lead to dependence.

Signs that you may be developing dependence include:
  • An icon of several pills stacked on top of each other.

    Using more codeine to get the same effect

  • An icon representing repeated taking of tablets.

    Unable to stop or cut down on the use of codeine

  • An icon of a person’s face viewed side on.

    It is affecting your life – you may be losing interest in regular activities, are often late or absent from work or school, or having relationship problems

What other health issues can result from misuse of codeine medicines?

Taking codeine combination medicines more frequently than recommended may not only lead to a risk of opioid painkiller dependence. Taken in high doses, other drugs in the combinations, such as paracetamol and ibuprofen can also cause harm. Regular or high doses of ibuprofen, for example, can cause serious harm to the stomach and kidneys, and high amounts of paracetamol can be toxic to the liver.

Serious side effects of misusing codeine combinations include:
  • Stomach and kidney damage
  • Liver toxicity
  • Bleeding in the stomach
  • Stomach ulcers
  • Anaemia

Why am I being asked more questions when I buy codeine products at the pharmacy?

A pharmacist handing a box of medicine to a customer and giving her advice.

You may have noticed your pharmacist is asking more questions and making it more difficult to buy medicines containing codeine. By asking questions, pharmacists are aiming to support you in managing your pain, while also helping prevent the misuse of codeine painkiller medicines. This is important as codeine dependence is growing in Australia. A scheme is currently in progress to help identify and manage people at risk of codeine dependence, by monitoring codeine purchases from pharmacies.

What should I do if I suspect I may be dependent on codeine?

It is important to understand that dependence on opioid painkillers, including codeine combinations can happen to anyone, and doesn’t deserve blame.

Want to find out if you may be at risk of opioid painkiller dependence?

Take the test

If you experience any side effects related to codeine that concern you, or you think you might have a dependence on codeine, it’s important to speak with a doctor.