Pharmacists say it’s time for Canada to restrict access to over-the-counter codeine as the country grapples with an opioid crisis.
There have been renewed calls to limit access of low-dose codeine products, including Tylenol 1 and their generic counterparts, since a pharmacy in Saskatchewan was disciplined for failing to understand how the drug can be abused.
Codeine is an opiate used as a painkiller and to treat coughs but can be misused. In most of Canada, codeine comes in eight-milligram pills, mixed with two other ingredients, that can be purchased without a prescription.
Saskatchewan’s College of Pharmacy Professionals recently released details of 15 charges against Dewdney Drugs, a store in Regina’s North Central neighbourhood. The pharmacy has since closed.
An inspection revealed that between April 2017 and January 2018, the pharmacy purchased 1.6 million Tylenol 1 tablets.
There was no report of what happened to 1.1 million of them.
Matthew Manz manages a nearby pharmacy and complained about Dewdney Drugs after the store sold a patient he was treating for opioid dependency three bottles of tablets containing codeine in less than a month.
Saskatchewan’s pharmacy watchdog determined codeine was that patient’s drug of choice.
Manz and some other pharmacists choose not to stock Tylenol 1.
“We’re in the middle of this opioid epidemic,” said Manz. “We have to be more conscious of what’s going on.”
“You’re doing a harm reduction program within the pharmacy … You’re getting people off opioids, but then at the same time you’re offering over the counter opioids.
“In my head it didn’t make sense.”
The Canadian Pharmacists Association supports the move to prescription status. It’s also calling for Health Canada to review why low-dose codeine products are used in the first place, since evidence suggests there are better alternatives to manage pain.
The agency is reviewing whether low-dose codeine products should be restricted to prescriptions only. Manitoba made the move in 2016.
Saskatchewan’s pharmacy college, citing health risks and the drug’s effectiveness compared to non-opioid drugs, said last year that it was considering a ban on the sale of low-dose codeine,
The college’s registrar says no decision has been made yet.
Rand Teed, an addictions counsellor near Regina, said cough syrup containing codeine is mixed into drinks to induce euphoria, but with it comes a high risk of overdosing.
