On a recent trip to Australia, I purchased some over-the-counter pain killers - each tablet contains Paracetamol 500mg and Codeine Phosphate 10mg.
Is this considered a prescription drug here in the States?
Yes. Codeine is a controlled drug.
I’m no expert, but my guess would be that it is, since it is marketed as a pain killer, and available in pill form(I’m guessing? You did say “tablet”). I was very recently made aware of an over the counter Codeine product that is available in the US, or in at least some states. It is Robitussin AC, which is marketed as a cough syrup, and while available OTC, it is kept behind the pharmacy counter, and you must go and ask for it specifically. It is also my understanding that the pharmacy staff keeps a log of people who purchase the medicine, and they will refuse to sell it to you, if it appears that it is being abused.
Not sure how helpful that is.
~V
Any particular reason why it’s OTC there and not here?
It isn’t OTC here because it’s an addictive narcotic, chemically related to morphine and heroin. I’m surprised to hear that you can get it OTC there.
Is 10mg of Codeine a large enough dose to become addicted?
And what’s Paracetamol?
Paracetamol is acetaminophen, aka Tylenol.
Codeine is addictive. Take it regularly and you will run the risk of addiction. Although it’s true that 10 mg is a rather modest amount, the danger lies in taking two, three or more tablets thus getting more codeine kick (and risking liver damage from too much acetaminophen).
In Canada, tablets containing 8 mg of codeine combined with 325 mg Tylenol and 15 mg caffeine are OTC (and also tabs with ASA substituted for the Tylenol). You can get them in bottles of 30, 100, or 200.
10mg taken sparingly probably won’t get you addicted, but most people looking to get high take much more than that in a sitting. It’s less than one tenth as potent as morphine gram for gram when taken orally, but take enough and the effect is the same.
Paracetamol is apparently just acetamenophin (Tylenol), probably not dangerous unless you drink a lot of alcohol.
(Note: IANAD)
Thanks for the info - I only bought one box of 48 pills.
Works wonders on cramps!
Robitussin AC is NOT an over-the-counter drug in the U.S.; it’s Schedule 5 under the Controlled Substances act. However, Schedule 5 drugs can be dispensed by pharmacists without a prescription if state law allows it.
about 10% of the adult population lacks a certain factor that
converts codeine into morphine, thus making codeine useless to
them.
Also, people looking for a cheap high sometimes crush the pills
and drop the powder in water (codeine is water soluble,
acetaminophen is not).
Grievar: Does this 10% condition generalize to other natcotics as well? When I’ve been prescribed narcotics in the past they do not provide pain relief, just terrible nausea. A real bummer if one has bad pain. Where can I read about this?
Grievar: Does this 10% condition generalize to other narcotics as well? When I’ve been prescribed narcotics in the past they do not provide pain relief, just terrible nausea. A real bummer if one has bad pain. Where can I read about this?
A product similar to that described by LolaCocaCola
can be purchased OTC in Canada, as I learned to my sorrow. I used it to augment codeine based prescription pain pills that I used for migraine headaches.
As a recovering codeine addict, I urge you not to fool around with it.
My bad. I guess it is obviously not classified as OTC, since you do have to get it from the pharmacist, himself. In my post, I used the term OTC in reference to the fact that, in some states, it is available without a prescription. I apologize for not being more specific.
~V
You can buy paracetamol-codeine pills in the UK as well, they’re great and very effective against pain (for me anyway).
Restricting them to prescription-only is an overreaction IMO, as there are so many more ways that someone determined to misuse chemical substances can do so. Banning just penalises the sensible law-abiding majority. Besides which, in terms of death, paracetamol alone is way more dangerous in terms of cry-for-help overdose.
I can’t seem to buy the codeine mix here in the UAE, so I bought a big box from Boots at Gatwick before coming over. They would only sell me one box though.
In the UK, you can also get this stuff called Veganin (OTC only with advice from pharmacist) which is aspirin, paracetamol and codeine, IIRC.
Lots of drug questions today.
First, the OP: Acetaminophen (APAP) and codeine is indeed prescription-only in the US. Most common - “Tylenol #3” APAP 325mg and Codeine 30mg. Schedule III (c-3) narcotic class.
(Inferred) “Is Robitussin-AC available without prescription in the US?” Legally, no. Robitussin-AC is a Schedule V (c-5) narcotic that is not exempt from prescription. Some c-5 drugs are exempt (Novahistine DH) and some are not (Robitussin AC, Lomotil). Exempt c-5s are legal to dispense, (in the absence of more stringent state law) in small amounts and over defined time periods, by the pharmacist in his professional judgment. A log is kept for inspection by the board and positive identification is necessary. There are pharmacists that either forget or ignore the fact that some c-5s are exempt and some are not and sell Robitussin AC without a prescription.
(Paraphrased) It seems so unfair/wrong that a drug that can do so much good is so restricted. Why?
The problem with c-5s are that you can go to multiple pharmacies and buy c-5s and no one knows you’re doing it until the board comes around with the list of druggies abusing the c-5s. Very few pharmacists dispense c-5 codeine any more because of the abuse. My old boss would (he was a real softie) and the first thing the board inspector would grab when he came was the c-5 book. He’d take a highlighter pen and mark the people who went from pharmacy to pharmacy and bought all the Novahistine DH. When he was done, the whole book would be yellow. Eventually, my old boss would only sell the codeine if he knew the patient really well. Even then, he still got bitched out by the board inspector. One day, a patient came in, talked old boss into a bottle of DH, paid for it, asked where the bathroom was, and then came out empty-handed and left. Sure enough, in the trash in the bathroom was the empty bottle of DH he had just bought and just drank. I saw this happening - and to this day I won’t sell the DH even if I do know you very well. In pharmacies where I was in charge, I wouldn’t allow DH to be stocked. IMNSHO, codeine should require a prescription. And, at least from me, that’s the only way you get it. Donnagel PG was the other c-5 that was the real problem, but thankfully it was pulled off the market several years ago.
No one says the system is perfect. It most certainly isn’t. You can get codeine and get addicted even with a prescription and under a doctor’s and pharmacist’s eyes. It is more difficult, though.
miatachris, R.Ph.
No, it’s specific to codeine. 5% of caucasian population has altered 2D6 isozyme of cytochrome P450, its absence dissallows conversion of the prodrug of codiene to its active form, generally morphine and codeine-6-glucuronide (C6G), morphine-3-glucuronide (M3G), and morphine-6-glucuronide. http://www.jatox.com/abstracts/1996/nov-dec/541-beck.htm
Hydrocodone is generally effective in those individuals who don’t metabolize codeine.
I am reliably informed by one of the foremost emergency specialists in Australia that paracetamol is most definitely dangerous when taken in large quantities.
Although there is an antidote available, he tells me that the damage to the liver is quite horrendous, and the effects are permanent even when dealt with early.
Panadol (the trade name for the most popular brand of paracetamol in Australia) is sold in supermarkets in packets of 24. I am told that taking all of these at once is sufficient to produce a long, slow, painful death.
I am reliably informed by one of the foremost emergency specialists in Australia that paracetamol is most definitely dangerous when taken in large quantities.
Although there is an antidote available, he tells me that the damage to the liver is quite horrendous, and the effects are permanent even when dealt with early.
Panadol (the trade name for the most popular brand of paracetamol in Australia) is sold in supermarkets in packets of 24. I am told that taking all of these at once is sufficient to produce a long, slow, painful death.