Where to Purchase Codeine

The availability of codeine containing medicines has been associated with misuse, dependency and addiction. Despite this, they are widely available and are often used by customers for short-term pain relief.

Using the Nudge theory, pharmacy teams were provided with a tool to support interactions with customers purchasing over the counter (OTC) codeine containing products to nudge them towards safe and responsible use. The results showed that the tool was easy to use and was receptive by the majority of customers.


A codeine-containing medicine is a powerful painkiller, but it can cause side effects such as constipation and feeling sleepy. It is important to follow the instructions on the pack. It is also important to avoid alcohol while taking this medication. If you are pregnant or breastfeeding, talk to your doctor before using it. Children should use this medication only under a doctor’s supervision.

A new A6-sized card, promoting safe and appropriate use of codeine, was piloted in 36 community pharmacies across the Boots UK chain, selected to represent a range of formats and locations (high street, local community and shopping centres). The card was developed by pharmacy teams with input from regulatory experts and clinical leads. It was designed to be delivered alongside pharmacy staff’s usual provision of medicines advice to customers.

The card encouraged customers to consider if they really needed codeine, and to make sure they only take the smallest dose for the shortest time. It warned that codeine can be addictive, and that long-term use increases the risk of dependence and addiction. The card also reminded customers that it is important to inform their GP if they have been buying or using codeine over the counter for more than a week.

Tracker data showed that the card was endorsed by around one third of all interactions. However, most of these interactions continued to progress with the intended purchase of OTC codeine, and pharmacy staff remained confident that they were able to support customers’ product selection in the vast majority of cases.

There are a number of reports of serious adverse events and deaths associated with lower-dose OTC codeine products, particularly combinations with paracetamol or NSAIDs. These include gastrointestinal ulceration, hepatotoxicity and a number of cases of narcotism. A combination of these medicines can also increase the risk of seizures in people with a history of epilepsy or other seizure disorders, and can cause dizziness and blurred vision. This is why it is important to tell your doctor or pharmacist if you have any other medical conditions, especially heart problems or stomach upsets, or are taking other medicines, including those bought without a prescription.


Codeine is an opioid that can be used to treat pain or to suppress a cough. It can also increase the risk of side effects such as constipation, dizziness and drowsiness. People who use codeine for a long time or at high doses may become dependent on it. People who misuse codeine may develop serious side effects such as slowed breathing or death. People should only use this medicine under the direction of a doctor. Children under 12 should not use it. People with certain medical conditions such as slowed breathing, liver or kidney problems, or an enlarged stomach should not take this medicine. People who are taking antidepressants or other narcotic medicines, or have a blockage in their stomach or intestines, should not take this medicine. People who are allergic to codeine or other narcotic medicines should not take this medicine. People should not drink alcohol while taking this medicine.

The purpose of this study was to test whether a simple ‘patient safety card’ could influence the safe and appropriate use of OTC codeine products by community pharmacy customers. This was based on the theory that if consumers consider both the benefits now and potential costs later, they can be nudged into altering their behavior [41].

A paper copy of the ‘patient safety card’ was provided to community pharmacies and included in a tracker for OTC codeine purchases over five weeks during June and July 2020 (Figure S1). The tracking sheet recorded the staff member’s ease of using the card, their perception of customer receptiveness, and an annotation to record if the customer was known to the pharmacy team (“known customer”).

It is important for all consumers to understand the risks associated with OTC codeine. Although the risk of misuse and dependence is low, it can still occur. In 2010 attempts were made to reduce the harm caused by codeine by moving it behind the counter and requiring clear warning statements on the product packaging. However, our previous research indicated that this change did not significantly decrease misuse or dependence. The re-scheduling of codeine is an opportunity to re-visit this issue and make further improvements to reduce risk to consumers.


Taking codeine for longer than prescribed or with other medications that slow your breathing can cause very serious side effects, including death. This medication may also affect your fetus if you are pregnant. Tell your doctor if you are pregnant or plan to become pregnant while using this medicine. Do not use this drug while breast-feeding. Babies born to mothers who have taken this drug may have withdrawal symptoms. If your child is showing signs of withdrawal, get medical help right away.

You should not take this medication if you are allergic to codeine or any other opioids, or if you have a history of liver disease or stomach problems. This drug may make you dizzy or drowsy. Do not drive or perform any other activities that require alertness until you know how it affects you. This drug can interact with certain medications, including azole antifungals (such as ketoconazole), bupropion, cimetidine, erythromycin, HIV medicines (including nevirapine and naloxone), rifamycins (such as rifampin or rifabutin), and some seizure medications (including carbamazepine or phenytoin). Talk to your doctor about all your medications before taking this medication. This drug can cause false results with some lab tests, including amylase and lipase. Tell all of your doctors and laboratory personnel that you take this medication.

This medicine is a narcotic and is in the same class as heroin. It is illegal to possess or buy without a prescription from your doctor, and it can be dangerous. The FDA has strict rules about how the medicine is manufactured, labeled, and sold. You should only purchase this medication from a licensed pharmacist.

In an effort to reduce harm from OTC codeine, the Medicines Control Agency has recently reclassified all products containing codeine as prescription only medicines. This has been followed by a period of public consultation and consideration of feedback. However, it is unlikely that this change will have a significant impact on codeine misuse and dependence. Instead, the focus should be on improving how OTC painkillers are dispensed to customers at pharmacies and how they are used by patients in general.


Codeine is a strong pain medicine. It can cause side effects like constipation and feeling sleepy. It can also affect breathing, if taken in large doses or for long periods of time. You can only get codeine from a doctor and with a prescription. It is possible to become dependent or addicted to codeine. Your doctor will explain how to use it safely and reduce your risk of addiction. It’s important to follow your doctor’s instructions exactly. It’s also important to check your codeine dosage regularly to make sure it’s correct. If you’re using a different strength, be sure to check the label and dosing instructions on the new bottle.

Despite being a legal and relatively safe opioid, codeine is a Schedule II drug. This means it has a high potential for abuse and can lead to psychological or physical dependence. It’s also possible to overdose on this medicine. Overdoses can be dangerous and even fatal. If you or someone you know has an overdose, seek emergency help right away. If you’re with someone who is overdosing on codeine, try to stay calm and call 911 or your local emergency number. If you can, give them naloxone to help reverse the effects of the drug. This is available from your local pharmacy or some community health centres.

Most codeine-related deaths occur because of an accidental overdose. However, some people misuse OTC codeine products and overdose intentionally. People who do this often have a history of mental health issues and substance use problems. They may also have a medical condition, such as depression or diabetes, that increases their risk of overdose.

Pharmacy staff can help prevent OTC codeine misuse by discussing the benefits and risks with customers. Previous research shows that this can help support appropriate product selection and reduce ‘gateway’ risk. This type of interaction is also an opportunity to reinforce the importance of regular medical checks and healthy lifestyles.