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Experts raise concerns over sales of OTC codeine ahead of NICE chronic pain guideline


By Emma Wilkinson
Reporter

17 Feb 2020

Experts advising NICE on its first-ever guideline on chronic pain have raised concerns about over-the-counter codeine.

NICE is due to publish draft guidance on the assessment and management of chronic pain in the coming weeks, with the final guideline planned for August of this year.

Some experts on the committee have called for a ban on OTC codeine sales, whilst others have raised concern that a ban could lead to increased workload for GPs.

Dr Jens Foell, a GP and honorary senior clinical lecturer at Imperial College London, who is on the guidelines committee said: ‘I don’t like OTC codeine because it builds a culture of pill- popping and I’m aware of people who are really dependent and addicted to codeine. 

‘But I don’t know how many people use it and I also don’t know what it would mean to take it away in terms of increased demand on GP practices so there may be a price to pay.

‘Personally I think a public health campaign would be better.’ 

He also cautioned against the use of stringent targets for GP practices to reduce prescribing as it could harm patients not ready to stop taking them.

‘It would need to be about doing reviews and doing them properly and not just as a tick box exercise,’ he told The Pharmacist’s sister publication, Pulse.

The NICE guidance is part of a raft of recent reports looking at the prescription drug addiction and the dangers of opioids.

Professor Jamie Coleman who is part of a working group looking at the use of opioid medication for the government in England, said that he was in favour of ending the over-the-counter sale of codeine in pharmacies, to combat prescription drug addiction.

Prof Coleman told the BBC that making the drug prescription-only alongside a change in culture towards painkillers overall, was key to tackling its misuse.

A Public Health England review published in October last year pointed to significant issues with some medicines including opioid painkillers.

The Medicines and Healthcare products Regulatory Agency has also set up an Expert Working Group to review the benefits and risks of opioid medicines with the aim of cutting overprescribing and drug misuse.

It comes after data released last year showed a 60% rise in prescriptions for opioid drugs in England and Wales within 10 years.

In England and Wales, the number of codeine-related deaths also increased to over 150 in 2018 – more than double the figure in 2008.


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