Why are some cough syrups and painkillers now sold in smaller package sizes?
Regulation of over-the-counter codeine-containing compounds help to protect the public
Tuesday, 23 October 2018, Over-the-counter medications containing codeine can provide effective short-term relief from pain and coughing, however this active ingredient can be habit-forming if it is not used responsibly and as directed by an appropriately qualified healthcare professional.
“It is important that South Africans are aware of the reasons behind the reduction in quantities of such medications that pharmacies can dispense, so that they can be empowered to make responsible choices when it comes to over-the-counter medications,” says pharmacist Marilise van Biljon, Operations Manager at Medipost Pharmacy.
“Codeine is an opiate and belongs to the same family of chemical compounds as the narcotics heroin and opium, and can be similarly addictive if used for an extended period,” explains Van Biljon.
Codeine is metabolised in the liver to form morphine, which is a very potent painkiller. In lower doses, such as in the medications available from pharmacies without a prescription, codeine can be highly effective in managing symptoms of mild to moderate pain and coughing.
“In 2015 the Medications Control Council, which is now The South African Health Products Regulatory Agency, proposed regulatory measures in an effort to help prevent members of the public from becoming dependant on codeine and developing addiction.”
Since the regulations came into effect the following year, a number of pharmaceutical manufacturers were obliged to reduce the size of packages of codeine-containing medications available for purchase over-the-counter. This is because the regulations limit the dispensing of such over-the-counter medications to a maximum of 80mg of the active ingredient per day, limited to a five-day course.
Implications for the public
“The public may have noticed, for example, that whereas it used to be possible to purchase a pack of 100 codeine-containing schedule two [S2] painkillers over-the-counter prior to the restrictions, these would now only be available in a 40-pack. Certain cough syrups that include this active ingredient are now sold in 100ml bottles, compared to the larger quantities that were previously available,” Van Biljon says.
“As such, dosages for medications in tablet form may, for example, comprise two tablets, each containing 10mg, four times per day. Pharmacists must record the identity number, address and telephone number of the person they dispense to, and may not sell the same person more codeine-containing medications within five days.”
Marilise van Biljon, Operations Manager at Medipost Pharmacy, warns that codeine containing medications must be used responsibly and as directed by an appropriately qualified healthcare professional
Dangers of codeine addiction
According to Van Biljon, the main reason for people wishing to purchase medications containing codeine is for pain relief.
“A person who is experiencing back pain may find that a short course of such over-the-counter painkillers brings them effective relief. The danger creeps in if the person then returns to their pharmacy time and again for more of these tablets, and over time becomes reliant on the medication.
“As the person’s body develops a tolerance to the medication, they may take higher doses to achieve the same level of pain relief – and before long they may begin to feel as though they need to keep taking the tablets simply to feel ‘normal’. This is a real concern, as when the person is no longer experiencing physical pain they may become so addicted to codeine that they can no longer function without it.”
Van Biljon points out that the family, friends or colleagues of a codeine addict may be entirely unaware of the substance abuse problem.
“The typical profile of a codeine addict is a person who is often well educated and gainfully employed, which does not tally with most people’s preconceived idea of a drug addict. This, coupled with the stigma of being labelled as an addict, means that people who are abusing codeine may not seek out or receive the support they need to break free of addiction.”
Prevention and intervention
Van Biljon explains that Medipost Pharmacy has a number of safeguards in place to help prevent people from becoming addicted to codeine.
“At Medipost, we have an advanced pharmacy management system with a profile allocated to each person we dispense medication to, which includes the patient information required by the South African Pharmacy Council as well as a record of the medications they have purchased. If a person requests more codeine-containing medication within a five-day timeframe, the system automatically alerts the pharmacist that there is potentially cause for concern.”
She explains that where pharmacists identify inappropriate use of codeine, they will discuss various options with the patient. “There are alternatives to codeine painkillers that we can recommend, including paracetamol or aspirin based painkillers. In other cases, the patient is advised to consult their doctor to investigate the root cause of their pain and find a more suitable and sustainable solution to their discomfort.”
Those who make use of Medipost Pharmacy’s service have access to telephonic clinical advice from pharmacists and pharmacist’s assistants in their preferred official South African language to discuss concerns relating to their medication. This service is available from Monday to Friday, 08h00 to 22h00, and Saturdays between 08h00 and 12h00.
“My advice to members of the public is to be aware of the potential dangers of codeine addiction, which can leave lasting health consequences. Be aware of which medications are potentially habit-forming and take the time to discuss appropriate alternatives with your pharmacist if you find that you are looking to buy a second or third package of codeine-containing medication,” she concludes.
More about Medipost Pharmacy
Medipost Pharmacy, which is the largest such service registered with the South African Pharmacy Council (SAPC), provides free delivery of chronic medication anywhere throughout the country to ensure patients have reliable, timeous access to chronic medications.
For the last 27 years, Medipost Pharmacy has been a trusted partner to medical schemes, private and public patients, providing free delivery to a customer’s home, their nearest approved delivery point, such as a doctor’s rooms, clinic or PEPcell counter, and by arrangement to the customer’s temporary address or holiday destination within South Africa.
The company claims, dispenses, dispatches and delivers chronic medication to beneficiaries, to medical schemes, and other clients such as the employer groups and the Department of Health. Some 400 000 members of 82 medical schemes across South Africa are among those currently benefitting from Medipost’s courier pharmacy service.
Issued by: Martina Nicholson Associates (MNA) on behalf of Medipost Pharmacy
Contact: Martina Nicholson, Graeme Swinney, Meggan Saville and Estene Lotriet-Vorster
Telephone: (011) 469 3016