The very unofficial habit of Americans coming to Canada to buy low-dose codeine tablets with acetaminophen may not be around too much longer. Health Canada wants to ban sales of tablets with codeine without a prescription.
That essentially leaves Americans out since they would need either a) a Canadian prescription, which would seem impossible to get or b) an American prescription, which means they wouldn't need to go to Canada.
Codeine is an opioid. Fentanyl is the more common opioid that we hear about in terms of abuse and overdose. The argument can be made that low-dose codeine — 8 mg codeine with acetaminophen — isn't really the problem.
The loophole for the medications is the maximum of 8 mg of codeine in a pill and 2 other medications have to be present. Caffeine counts as one of those medications. The 222s have acetylsalicylic acid (ASA), codeine, and caffeine.
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The regulatory notice "notes that more than 500 people entered addiction treatment centres in Ontario alone between 2007 and 2015, with non-prescription codeine as their only problem substance."
If we place the number at 540, that would be an average of 60 people per year in Canada's most-populous province. Chances are there are more people who overdose on regular aspirin.
Unfortunately for those who get relief from the low-dose codeine product, the tide is moving in the opposite direction:
- Manitoba ended over-the-counter sales of low-dose codeine products in February 2016.
- Australia is the latest jurisdiction to have a ban though that won't start until February 2018.
- At least 2 drug manufacturers have stopped making low-dose codeine products recently.
- The Health Canada notice says other countries have made that transition to requiring a prescription, such as Belgium, Czech Republic, Finland, France, Greece, Iceland, India, Italy, Norway, Russia, and Sweden.
The Chris Berman video from 2008 (and another reference in 2012) are not the best examples for why low-dose codeine products should be available without a prescription. I still shake my head at the idea that someone can take 4 of the 222 tablets and still be coherent on television. I still can't understand why a New York Jets game around Christmas time would require medication of any kind unless you were playing in the game.
The tablets and the cough syrups do help people because they take the doses as prescribed for real pain, and they find relief from those products. The one point where all sides agree is that these products sell very well in Canada. Of course, we don't know the percentage of sales from Americans crossing the border.
The Americans who take the pills and syrups may not be able to see a doctor, or they are told that their pain doesn't require anything special for their treatment. Even at $10 Canadian plus time and cost to travel to and from Canada, the codeine products are much cheaper than seeing the doctor.
The codeine pills are also a problem not just for the codeine but the fear of overdosing on acetaminophen. The 222s don't contain acetaminophen, so they would be an alternative for those concerned about acetaminophen.
Canadians generally have better access to health care than Americans so requiring a prescription may not be as much of an inconvenience. For Americans, the rule change would mean struggling to find an alternative.
The standard for prescription-strength codeine is 30 mg per tablet and those require a prescription. So you could argue that 4 of the 8 mg tablets would match the strength of a single prescription-strength pill. That is also a lot of acetaminophen as well. The recommended dosage is 1 or 2 tablets of the low-dose codeine product.
If this were a concern on the American side, we would have heard about this long ago. You can imagine Sheila Broflovski singing Blame Canada if codeine was making a negative impact in the United States. As paranoid as the United States is about drugs, the government allows Americans to bring low-dose codeine products in limited amounts into the United States.
We are open to improvements in the system. Warning labels are not currently on low-dose codeine products but would make for a nice compromise. If buying the product could require proving you are not Canadian, some people would be willing to make that compromise.
Canada is a wonderful but strange country. Prostitution is legal but medium-rare burgers are illegal. Codeine, in small doses, is legal and even Americans can legally bring the drug across the border (50 tablets per person per 30 days). Marijuana will soon be legal in Canada but if Health Canada gets its way, even low doses of codeine will need a prescription.
Canada is like the cool brother who doesn't get into too much trouble. The odd but kind policy on low-dose codeine products showed how cool Canada can be. To lose that, besides the obvious benefits from relieving pain, is to make Canada seem less cool.
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Comments on this proposal can be placed during the 60-day comment period from now until November 8.
"Anyone interested in this process or who has comments on this notice should contact Legislative and Regulatory Affairs, Controlled Substances Directorate, Healthy Environments and Consumer Safety Branch, Health Canada"
- mail: Address Locator: 0302A, 150 Tunney’s Pasture Driveway, Ottawa, Ontario K1A 0K9
- e-mail: [email protected]
Americans could presumably make a comment, though Health Canada would only be interested in hearing from Canadians.
video credit: YouTube/Northwest57
photo credit: me
Health Canada is out of their tiny little minds. The opioid epidemic is not based on codeine. its from fentanyl and fake pills being sold on the street. most people who have used any kind of an opiate will agree it would take something like 20pills to even catch a buzz. and a mild one at that. also impossible to even take 20 because you would be strung out on caffeine and or die from too much acetaminophen. this ban makes zero sense. As canadians we no longer have the right to treat our own pain. we must beg and grovel and justify our need to a doctor who is unattainable by many canadians. prescription only is another way of saying you are outright banning the medication. I hope canadians rise up and fight this injustice.
Posted by: John | November 13, 2017 at 11:15 PM