Health & Lifestyle

Over-the-counter cough syrups containing codeine could become prescription-only under major shake-up

Powerful cough syrups could become prescription-only in the UK over fears people are becoming addicted.

Five over-the-counter codeine products will be restricted if the move goes ahead. 

Drug watchdogs are concerned about rising cases of serious, and sometimes fatal, side effects.

Health chiefs are also worried by reports that the drug is being used recreationally for its powerful opioid effects.

Now the Medicines and Healthcare products Regulatory Agency (MHRA) has started a public consultation on making the syrups prescription only.

These are the five codeine cough syrups the UK regulator wants to make prescription-only

These are the five codeine cough syrups the UK regulator wants to make prescription-only

If given the go-ahead, it would mean Britons wanting codeine linctus —  one specific kind of codeine medication — would be grilled by a GP before they are allowed to purchase it.  

The MHRA said the move would only affect five products: Codeine Linctus BP, Bells healthcare codeine linctus, Care codeine, Galcodine Linctus, Pulmo Bailly.

These are sold for as little as £3.20. 

Other over-the-counter codeine products, like tablets containing the painkiller, would not be affected.   

MHRA officials said that since 2018 they have received 116 reports of recreational drug abuse and addiction to codeine medicines, including cough syrups.

HOW MUCH CODEINE CAN A PERSON TAKE AND STILL BE ABLE TO DRIVE?

Drug-drive laws state that people with more than 80 micrograms of codeine per litre of blood in their systems are eligible for a penalty. 

How much codeine is in popular painkiller brands? 

  • Nurofen Plus – 12.8mg
  • Solpadeine – 12.8mg 
  • Boots own brand – 12.8mg 
  • Migraleve – 8mg
  • Syndol – 8mg

The amount of each medication people can take before breaking drug-drive legislations varies according to the individual.

This is due to laws working on a codeine per litre of blood basis.

Drug levels per litre of blood vary according to factors such as an individual’s tolerance, gender, weight and muscle amount, as well as if they are taking any other treatments.

Manufacturers therefore advise people follow the instructions on medications’ labels and do not drive if they feel dizzy, sleepy, or unable to concentrate or make decisions.  

Data from the MHRA also show reports of serious and fatal side effects have skyrocketed in recent years, with a record 35 fatalities in 2022, the most recent full year available. 

Codeine is an opioid — a class of painkillers in the same family as morphine, heroin and fentanyl.

Like with other opioids, people can become addicted. 

Dr Alison Cave, the MHRA’s chief safety officer said: ‘Codeine linctus is an effective medicine.

‘But as it is an opioid, its misuse and abuse can have major health consequences.’ 

In total, the MHRA received 243 reports of serious and fatal adverse reactions to codeine medicines in 2022, and 277 in 2021.

There have been 95 such reports in 2023 so far.  

These reports, made to the Yellow Card reporting scheme, are not direct confirmation that a drug was responsible or contributed to a medical problem, and could just be a coincidence. 

Professor Claire Anderson, president of the Royal Pharmaceutical Society welcomed the move. 

‘Medicines should maximise benefits to patient health with minimum risk,’ she said. 

‘We believe there is insufficient robust evidence for the benefits of codeine linctus in treating coughs safely and appropriately. 

‘We also have significant concerns about its misuse and addictive potential, as well as the risk of overdose.’

She added that considering there were many other, non-codeine, products capable of alleviating a dry cough, the benefits of keeping codeine linctus as an over-the-counter option were limited.

This chart show the serious and fatal events regarding codeine reported to the Medicines and Healthcare products Regulatory Agency (MHRA) per year. Dark green portions of the bars represent fatal reports only while light green are serious but non-fatal events

This chart show the serious and fatal events regarding codeine reported to the Medicines and Healthcare products Regulatory Agency (MHRA) per year. Dark green portions of the bars represent fatal reports only while light green are serious but non-fatal events

Pharmacist say that with many non-codeine based cough syrups available the easy availability of products containing the potentially addictive opioid were 'questionable'

Pharmacist say that with many non-codeine based cough syrups available the easy availability of products containing the potentially addictive opioid were ‘questionable’ 

‘With studies showing up to 60 per cent of people are genetically predisposed to opioid dependence, the role of codeine linctus in treating what is ultimately a self-limiting condition is questionable,’ she said.

Opioid addiction has become a rising concern in both the UK and the US with people becoming addicted by stealth after taking the painkillers as part of a medical treatment. 

The US in particular has seen devastating ‘Zombieland’ scenes of opioid addiction in some cities. 

The MHRA’s public consultation will run until August 15.  

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