Since the recent rescheduling of codeine, patients who have been taking over-the-counter products are increasingly presenting to their GPs. For this reason, we are highlighting this article, which featured in a recent Medicine Today supplement.
- If a patient requests a codeine prescription, first establish the reason they take codeine and their pattern of use.
- If a patient has been using codeine regularly over a relatively long period (e.g. more than a month), assess for likely dependence.
- A taper from codeine (e.g. with symptomatic medication or a medication such as buprenorphine–naloxone)is a reasonable approach in the first instance where a diagnosis of codeine dependence is not established.
- When a patient clearly meets criteria for opioid dependence, with a well-established pattern of daily high-dose use, and taper approaches have failed, consider medication-assisted treatment for opioid dependence (e.g. with buprenorphine–naloxone), with the support of alcohol and drug services for nonaccredited prescribers.