Feds consider Manitoba’s codeine restrictions

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This article was published 15/09/2017 (2956 days ago), so information in it may no longer be current.

OTTAWA — Health Canada is pondering whether to emulate Manitoba pharmacists’ move last year to restrict access to codeine products, though there is no proof the policy has helped or hindered the opioid crisis.

“We have to be careful when we make these sweeping policy changes, to think through the unintended, negative consequences,” said Ian Culbert, executive director of the Canadian Public Health Association.

“These kinds of changes might seem intelligent from a bureaucrat’s desk in Ottawa, but when you’re hitting the ground… in downtown Winnipeg, the impact can be quite negative.”

In February 2016, the College of Pharmacists of Manitoba issued a notice that all drugs containing codeine would require a prescription.

The decision was not made by the government.

In the rest of Canada, drugs containing low doses of codeine — such as Tylenol 1, Robaxacet-8, Calmylin and certain cough syrups — still don’t need a prescription, despite being addictive when taken in large quantities or mixed with other over-the-counter drugs such as Gravol.

Researchers have questioned the effectiveness of codeine, which includes acetaminophen.

It’s an opioid used to relieve mild pain and coughs and it contains just small amounts of narcotics. That means addicts need to use large amounts to feel the effects, at which point the acetaminophen can damage their kidneys.

Health Canada published a notice last Saturday that it’s pondering changing federal regulations to copy the Manitoba-only prescription policy.

Ottawa has launched a 60-day consultation period.

The agency notes that codeine is already prescription-only in several European countries such as France and Russia.

It cites an Ontario study that found 500 people entering rehab due to addictions solely caused by low-dose codeine from 2007 to 2015. In that same period, an average of 880 people entering rehab each year listed these drugs among their five “problem substances.”

The notice also mentions concerns about “a shift from codeine to other, potentially more dangerous drugs” as well as “illicit markets.”

Culbert said that concern should be front and centre.

He notes Canada’s fentanyl scourge has been traced to restrictions placed on OxyContin, a less harmful drug that was once available off-the-shelf. Manufacturers made “tamper proof” tablets that were harder to inject, prompting opioid users to opt for fentanyl, which can be deadly in trace amounts.

Culbert chalks that up to policy changes made when experts didn’t hear from drug users.

“The problem with almost all drug policy in this country, is that it is extremely paternalistic and is disempowering,” he said.

Canada’s top doctor said Health Canada will look at the effect of Manitoba’s change before moving ahead.

“It’s in a consultative stage,” said Theresa Tam, the federal chief public health officer, adding it was “not a fait accompli.”

She said on Thursday that the data from Manitoba would be “part of the analysis that is actually going to be provided.”

dylan.robertson@freepress.mb.ca