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C+D readers want codeine linctus to switch from P to POM, poll shows

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MHRA: We are keeping the legal status of codeine linctus under review

Over two thirds of pharmacy professionals who responded to C+D’s snapshot poll believe that codeine linctus should be reclassified as a prescription-only medicine (POM).

Of the 150 respondents to the poll – which ran on the C+D website from March 11–22 – 105 (70%) said they think codeine linctus should be reclassified from a pharmacy (P) medicine to a POM, while only 15% of respondents thought it should not be reclassified.

Twenty-three (15%) respondents said they no longer stocked the product.

Result

Do you think codeine linctus should be reclassified from a P medicine to POM?
Yes
70%
No
15%
N/A, we don't really stock this product anymore
15%
Total votes: 150
Codeine products “under review”

These findings come as the Medicines and Healthcare products Regulatory Agency (MHRA) told C+D last month that it is keeping the supply of codeine-based products “under review”, following a rise in concerns of over-supply or of it falling into the wrong hands.

Following the results of C+D’s snapshot poll, a spokesperson for the medicines regulator said: “The MHRA continuously monitors the safety of all medicines and seeks advice from the Commission on Human Medicines and its expert working groups on whether regulatory action is required when there is significant new evidence of a safety concern.

“The MHRA is keeping the legal status of codeine, including codeine linctus, under review and will consider all sources of evidence and information relating to this issue,” the spokesperson said.

Addiction concerns

Helen Devoy, a community pharmacist at Reach Pharmacy in Glasgow, said while reclassifying codeine linctus could help to tackle codeine addiction, she is concerned about a lack of support available to deal with the issue.

“Switching codeine from P to POM might make some people actually realise they are addicted and spur them on to tackle the issue. But, where will they go? Who will help them?” she asked.

Chris Campbell, a locum pharmacist based in Scotland, said: “We have such a bad codeine problem, cutting legitimate supplies would lead to a significant number of ‘addicts’ turning to black markets for their needs.

“This would lead to them being exposed to drug dealers who would lead them along different addiction pathways,” he suggested.

“Without significant investment by the government, the switch from P to POM would be an utter disaster.”

Solution to harassment issues

Meanwhile, a dispenser, who asked to remain anonymous, told C+D that they had a recent negative experience of declining to sell codeine linctus: “We had a patient trying to buy it a few weeks ago who got quite aggressive because we refused the sale.”

This was echoed by another pharmacist, who said: “I am fed up of the conversations with addicted people who try and repeatedly buy!”

4 Comments
Question: 
Does your pharmacy provide addiction support services?

PARESH shah, Community pharmacist

our sales are quite small in number as we strictly control how we sell these products. however i think it is an inportant product for otc and should be kept otc. we have to control how we sell these products. because soon the next product will be phenergan, nytol, senna, dulcolax etc, etc. anyway what guarantee is it that doctors will prescribe less . i see lots of prescriptions for co-codamol 30/500 on repeats

Mr CAUSTIC, Community pharmacist

If you do not keep codeine linctus on display it is easy to say sorry it is out of stock .  No problem and no confrontation .  I  think it should remain P. 

Naresh Rallmil, Community pharmacist

Unfortunately removing display isnt enough either.  We are hearing that customers are phoning pharmacies before hand to ask if the pharmacy has codeine in stock as they have a prescription for it before coming in and then asking to buy it over the counter instead.

Getting Shorter, Community pharmacist

Well that's just dodging the issue. Pholcodeine is a perfectly good alternative for an actual dry cough.

I've said it before and will keep on - codeine OTC provides limited benefit and massive abuse, make it all POM.

The point raised in the article about treating the addicts is quite valid. However, GPs would be warned in advance; I suspect few would turn the black market unless they are already iun touch with it; and the withdrawal symptoms may be unpleasant, but they would be tolterable for most people - and even acceptable once they have it properly explained that the headache "coming back" is not their original headache reccuring.

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