Parnell Palme McGuinness misses the availability of codeine in cold medications. I must say I always wondered that it was freely available. Codeine is an opiate and prodrug of morphine. But the regulators have caught up with it. As usual, the many are hit to protect the few. My bathroom cabinet still contains some of the "old" medications but I find that Ibuprofen and paracetamol get me by. Eucalyptus lozenges help too
It’s flu season and there’s at least one nasty virus going around. If the overregulation bug hasn’t bowled you over yet, it will as soon as you get sick.
In my lifetime, the incredible advances of Western medicine have delivered the perfect preparation to ameliorate the worst symptoms of a cold or flu: a combination of paracetamol, which reduces fever, pseudoephedrine, which clears stuffy noses, and codeine, which treats the aches and can help suppress the body-wracking dry cough that makes it hard to rest and recover.
Except you can’t buy it anymore. In 2018, the government made codeine a prescription-only substance. So while you’ll still need to hand over your driver’s licence to buy cold and flu medication with pseudoephedrine (just in case you’re a gangster buzzing your Harley from chemist to chemist to get enough Codral to cook a minuscule amount of methamphetamine), it won’t contain codeine. You’d need a GP script for that.
For which you can thank the same instincts that have brought us lethargic speed limits on roads built for more (does anyone else itch to check their phone as they crawl along at 40 kilometres per hour on a wide and empty road?), laws against drinking alcohol in parks or by the beach on a warm summer evening, and laws that shut down Sydney’s all-night district because some lunkheads got violent and tragically punched and killed two young men at 9pm.
It is the Australian prison-warden spirit that prohibits people from eating in a pub’s designated smoking area and the intolerant egotism of people who move in next door to a pub and then campaign to shut down the noise.
Oh, believe me, I know that each of these things can be justified with some sanctimonious appeal to the health of the citizenry, but so often this spirit is really about imposing minority obsessions on everyone else. They make for great announcables – post-pandemic we can be under no illusion that Australians love councillors, governments and regulators which “keep them safe” – but as often as not, they make for terrible policy. Sometimes they can even lead to a different type of harm.
Like the hobbled Codral.
This winter’s ubiquitous cold is a doozy. The aches are bad. So let’s look at the options. If you’ve got some on hand, you could take Panadeine or some other paracetamol and codeine combination alongside your cold and flu tablets. But then you’d be exceeding the safe dose of paracetamol – and we’ll get back to what that does later.
Alternatively, you could schlep your sorry sick body to the doctor and get some ibuprofen with codeine – haha, jokes, with GP waiting times blown out to weeks, there’s not much chance of getting any in time. So just take straight ibuprofen alongside your cold and flu meds – this helps a bit. And then – because the body ache persists – make yourself a hot toddy. The lemon and honey are good for your throat. And the free pour of rum or whiskey really hits back at the general misery.
Now, while I’m all about a well-crafted cocktail, I have an inkling that consumers making their own medicine-and-booze cocktails to replace a lab-calibrated formula is probably not ideal. In fact, it’s one of those policy outcomes which are generally considered perverse.
The champions of prescription-only codeine will say that “upscheduling” codeine has led to a drop in codeine poisonings. In the year after the new regulation was introduced, Sydney University researchers found there was a 51 per cent drop in codeine poisonings overall – mostly from “low-strength preparations” which had previously been available without a prescription. That’s what you and I would call Panadeine.
That left paracetamol, which is not addictive, for non-prescription pain management. But here’s the thing – even at the time of the codeine upscheduling, research covering the preceding decade showed that paracetamol was the drug Australians most frequently overdosed on. Too much causes severe liver damage. It’s not good.
In acknowledgement of this fact, the regulator is now planning to reduce the pack sizes that paracetamol is available in at supermarkets and convenience stores by 2025.
Personally, I’m not fussed about smaller packs. I don’t feel any pain relief from it (maybe it’s not addictive because it doesn’t work). But I still end up having to take it because it always comes packed up with medicines that are more effective – the pseudoephedrine in cold and flu medicine is only sold packed with paracetamol, for instance, and low-dose codeine is only available to most of us with paracetamol or ibuprofen accompanying it.
Of course, the ibuprofen has side effects too. It can irritate the stomach lining and combining it with alcohol can make that effect worse.
Oh, and paracetamol interacts badly with too much alcohol as well – it can exacerbate liver damage – there goes another consolation because the “safe” painkillers conflict with it. So better go easy on the hot toddies above.
In fact, if you’ve got the flu, it looks like the regulator reckons it’d be best you just wallow in wretchedness and herbal remedies. But I’m sure we’re much better off now there’s no chance of getting addicted to a few milligrams of codeine in your cold and flu medicine.
It’s a great feeling to be protected by regulation, isn’t it. With so much protection against low-dose codeine, the ways left to manage pain can be downright dangerous.
Sometimes it seems that our overzealous regulators leave us with nothing left to fear but regulation itself.