It's time to phase out codeine

Oct 04, 2010

It is time to phase out the use of codeine as a pain reliever because of its significant risks and ineffectiveness as an analgesic, states an editorial in CMAJ (Canadian Medical Association Journal).

Although has been used for pain relief for more than 200 years, it has never been subjected to the rigorous regulatory and safety requirements applied to all new drugs and its pharmacokinetics are unpredictable. Genetic variations in patients can mean very different responses to codeine, some with serious consequences. Infants and children are particularly vulnerable, and there have been several deaths due to different genetic responses. Serious, life-threatening effects have also been reported in adults.

"Because the need for oral pain control is so pervasive, the potential risk associated with codeine must be mitigated," write pediatricians Drs. Noni MacDonald, Section Editor, Public Health, CMAJ and Dr. Stuart MacLeod, University of British Columbia.

While limiting use of codeine, with minimum ages for codeine-based treatment, is one option, it is not ideal. prior to codeine use is expensive and impractical.

"Perhaps a more direct approach is now needed: to stop using the prodrug codeine altogether and instead use its active metabolite, morphine. Not only is the metabolism of more predictable than that of codeine, but also it is cheaper," they write. They call for a warning to physicians and modifications to existing guidelines for codeine use and research to define safety parameters.

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User comments : 5

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dtxx
not rated yet Oct 04, 2010
It's not just codeine. Certain CYP2D6 genotypes will process codeine or any other opiate at different rates, meaning some will get very high and some can't get pain relief at all. Unless we get rid of all opiate pain meds, I don't see the benefit here.
dirk_bruere
not rated yet Oct 04, 2010
I find opiates extremely effective with virtually no side effects. I would be very unhappy to see such useful drugs replaced, no doubt with rather expensive patented alternatives. I can't help feeling that Big Pharma does not like such unprofitable un-patentable drugs.
FainAvis
not rated yet Oct 04, 2010
I take a small amount of mixture of codeine and ibuprofen every day. Ibuprofen alone in sufficient quantities to be effective makes the blood too thin and I bleed for the tiniest scratch. Paracetamol causes severe liver pain. Codeine alone is constipating, easily fixed with a laxative. The mixture works.
Do not rule out a medicine for everyone just because some folk cannot manage it correctly.
Bonkers
not rated yet Oct 05, 2010
Nothing hits the cough reflex quite like codeine - and by god you need it to actually get some deep sleep, without which the immune system will not function.
like Dirk above, i can't help but see the hand of Big Pharma guiding this smear campaign.
Bob_B
not rated yet Oct 05, 2010
Doesn't that article about oxygen and how it creatse free radicals in the body indicate oxygen should be discontinued?

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