Blog - Codeine Update

Pharmacy prescription bag

The changes around codeine availability on prescription only commenced on 1 February 2018 – pharmacies also started to record over the counter sales of codeine in December 2017, to limit stockpiling of codeine products by consumers in advance of the changes. What do the changes mean for drug testing?

Firstly, some individuals are being detected on-site and with laboratory confirmations for codeine associated with codeine bought before the change to scheduling.

Are they in breach of workplace policies because they do not have a prescription?  Technically, yes.

Policies generally state that any drug detection due to prescription medicines must be verified by the worker holding a prescription. However, workplaces may consider advising workers that the new arrangements may mean they are in breach if they use codeine without a prescription and that there may be a grace period during which education will take precedence over enforcement and sanctions.

Second, the conversation around codeine is now shifting to consider consequences of codeine dependency and misuse:

It may be timely to remind employers that they may examine the records of drug testing for workers who persistently declare use of codeine products with an aim to providing more education about the risks associated with codeine use.

Thirdly, we come to the ongoing issue of poppy seeds. Workers testing positive for morphine and codeine may declare poppy seeds in diet as a potential source. This may also be declared to mask overuse or misuse of codeine products – with or without a prescription.  Again, employer vigilance and employee education remain the keys to reducing harms associated with codeine.  If the worker is really a poppy seed fanatic, then we are reduced to examining concentrations of codeine and morphine in tested fluids and comparing, more rigorously, with published data on doses of codeine associated with concentrations appearing in urine and oral fluids. The thebaine test for poppy seed use is of limited value and it may take some time for us to have real data to support conclusions in this space.

Boilerplate John