Cough syrups with codeine to become controlled medications

Nov 28, 2019

According to new regulations by Health Canada, codeine-containing cough syrups will soon require a special type of prescription and will also be locked in vaults at pharmacies. Currently, most Canadian pharmacies also sell codeine in eight-milligram pills, mixed with two other ingredients, which can be purchased without a prescription. However, due to the opioid crisis witnessed by the country in recent years, pharmacists have been calling on the federal government to restrict access to over-the-counter codeine.

The College of Pharmacists of B.C. had previously expressed growing concerns about forged prescriptions and pharmacy robberies which targeted codeine formulations. In addition, there have been cases of codeine-containing medications diverted by health professionals for personal use or for illicit sale.  

In January 2020, codeine-containing medications of higher potency will be classified as controlled medications and require special, duplicate prescriptions. However, preparations containing low concentrations of codeine will remain available for over-the-counter sale at pharmacies.  

In his interview with the Vancouver Sun, Chris Chiew, general manager of western Canadian pharmacy operations for London Drugs, said that “grab and go” shoplifters are less likely to steal from stores with vaults used for storing codeine-containing medication because they would not want to wait for the vault to be unlocked.

Earlier in 2019, Health Canada conducted a safety review of cough and cold products containing opioids, including codeine, hydrocodone or normethadone.  The agency had concluded there was “limited evidence” linking codeine-containing cough syrups to opioid disorders and other harms in children and adolescents. However, Health Canada, still advised Canadians against the use of these products among children and adolescents under 18 years of age as a precautionary measure.

Another 2018 review of non-prescription medications containing codeine conducted by the Canadian Agency for Drugs and Technologies in Health (CADTH) found evidence that low-dose codeine is effective for pain control or chronic cough when compared with placebo or non-opioid analgesics.

The registrar of the College of Physicians and Surgeons, Dr. Heidi Oetter, told the Vancouver Sun that in addition to being potentially dangerous, codeine-containing cough medications have also not been shown to be effective for anything other than some pain relief. “The risk is simply too high for something that has no demonstrated benefits,” she said.

Earlier in May 2019, Saskatchewan’s College of Pharmacy Professionals released details of 15 charges against Dewdney Drugs, a pharmacy store in Regina. According to the results of an earlier inspection, during the period between April 2017 and January 2018, the Dewdney Drugs had purchased 1.6 million Tylenol 1 tablets, with 1.1 million of  bottles left unaccounted for. Subsequently, the owner of the pharmacy, a Regina pharmacist, had his licence suspended after being found guilty of professional misconduct and incompetence.

The Canadian Pharmacists Association had supported the move to of codeine-containing products to prescription status. The association is also calling on Health Canada to review the use of low-dose codeine due to evidence showing availability of better alternatives for pain management.