These factors contribute to why Health Canada is considering banning all non-prescription codeine1. Health Canada is most concerned about the addictive potential of codeine, as they’ve noticed a significant number of patients entering rehab programs for non-prescription codeine substance abuse alone1. From a pharmacist perspective, there are two predominant viewpoints:
- Schedule 2 codeine products have an important role in therapy and with the appropriate tools, they can be effectively monitored for abuse.
- Schedule 2 codeine products are too unsafe, due to their abuse potential, to be sold without a prescription.
Whether
pharmacists can effectively monitor non-prescription codeine depends on the
electronic tools available to them in each province. For example, Alberta pharmacists have access
to the patient’s electronic medical record (EMR) called NETCARE. They can use
the software to identify when the patient last picked up codeine. In this situation, schedule 2 codeine
products can have an effective role in therapy and may not need to be
prescription, since pharmacists are capable of monitoring for abuse.
However,
Ontario pharmacists do not have access to an EMR and thus are unable to assess
if the medication is being abused. This
can be dangerous since it is impossible to know how much codeine the patient is
using. In this instance, banning the
sale of the non-prescription codeine products may be appropriate.
Health Canada should encourage
provinces to make the appropriate regulatory changes based on their pharmacy
infrastructure. If the appropriate
mechanisms are in place to monitor for abuse, the provinces should trust
pharmacists to make the correct judgement to dispense codeine.
In either case, pharmacists must be
competent to counsel patients on effective pain management strategies. RxBriefCase offers an excellent program
discussing mild to moderate pain management in primary care:
It will be interesting to see how Health Canada
decides to regulate non-prescription codeine and how changes to the legislation
will impact patients.
- Ajay Chahal
References
- Beeby, D. (2017, September 11). Health Canada aims for prescription-only codeine pills, syrups. Retrieved September 15, 2017, from http://www.cbc.ca/news/politics/codeine-opiate-prescription-health-canada-juurlink-pharmacists-ban-sales-1.4284013