With Australia now in the midst of winter, less than 10 years ago Integrity Sampling’s workplace drug testing results would have seen a slight change. While cannabis – or more correctly THC – was the main drug detected back then and still is, there would have been an uptick in people caught with opioids in their system at this time of year.
But that’s no longer the case and it’s all to do with an important change made by authorities. Not to reduce heroin use or the use of any other illegal drug, but to make codeine prescription only.
In this blog, we look at the history of codeine use in Australia, why the rules changed, what medications replaced codeine, and whether medicinal cannabis is now emerging as an alternative for some former codeine users. We’ll also look at why the change has impacted workplace drug testing positives.
Codeine use in Australia
For decades, Australians had something of a love affair with codeine. In truth, for some people, it became more of an addiction.
People used it for pain relief, headaches, sports injuries, and cold and flu symptoms. During winter, many workers took codeine-based products without giving it much thought. As a result, opioid detections during workplace drug testing often increased during the colder months.
That all changed in 2018.
Australia made codeine prescription only, ending easy access to low-dose codeine medications sold in pharmacies.
What is codeine?
Codeine is an opioid medication used to treat mild to moderate pain and suppress coughing. For many years in Australia, low-dose codeine products could be purchased over the counter from pharmacies without a prescription.
Winter often saw a spike in codeine use. Australians battling coughs, sore throats, headaches, and body aches frequently turned to codeine-based cold and flu tablets.
Because these products were easy to access, many Australians believed they were completely safe. However, regular use carried significant risks, including dependence, tolerance, overdose, and other harms.
On 1 February 2018, Australia officially made all codeine products prescription only. The decision followed years of concern from medical experts, addiction specialists, and regulators. Studies showed increasing rates of codeine misuse and dependence across the country.
One major concern was that people were becoming addicted to low-dose codeine products without realising it. Some users began taking larger amounts to achieve the same effect as their tolerance increased.
This created serious health risks. Excessive consumption led to liver damage, stomach ulcers, kidney damage, and even death in some cases.
The decision to up-schedule codeine aimed to:
- Reduce codeine misuse and addiction
- Improve medical oversight of opioid use
- Encourage safer pain management
- Reduce accidental overdose risks
- Improve public awareness about opioid medications
Ultimately, the move helped reduce harm. According to RACGP, In the year after the change, overall use of codeine dropped by nearly 50 per cent and there was a 51% drop in codeine poisonings. Additionally, there was no increase in poisonings with high-strength codeine, which some were concerned would occur.
How did the codeine ban affect workplace drug testing?
One issue with taking codeine is its side effects. These include drowsiness, tiredness, confusion, difficulty concentrating, blurred vision, dizziness, nausea, erratic behaviour and sweating.
For someone taking the types of codeine available over the counter as directed before February 2018, the side effects were negligible. So too were the health and safety risks and the likelihood of codeine causing a positive workplace drug testing result.
However, because some people thought codeine was safe, they didn’t take the medication as directed. They deliberately or accidentally failed to follow the recommended dosage. In some cases they took double or triple the dose believing it would help them recover faster. Others took more because they had developed a dependence on the drug.
This meant more people were putting themselves and others at risk – on the road and in the workplace. And it meant we often saw a rise in positive opioid results during our workplace drug testing in winter.
What replaced codeine in Australia?
Another reason for the change to making codeine prescription only was the knowledge that there were alternative, safer medications Australians could turn to. This included paracetamol, ibuprofen, naproxen, and topical pain creams and gels.
Healthcare providers also placed greater focus on non-medication approaches to pain management, including:
- Physiotherapy
- Exercise programs
- Heat and cold therapy
- Lifestyle changes
- Psychological support for chronic pain
An interesting development since the codeine ban has been the rise of medicinal cannabis in Australia.
Like codeine, medicinal cannabis is prescription only. It is now used by some Australians for chronic pain, sleep issues, anxiety, and other medical conditions. Some former codeine users have shifted toward medicinal cannabis as an alternative pain management option, particularly those seeking a non-opioid solution.
However, medicinal cannabis presents its own challenges, including in the workplace.
THC, the psychoactive component in some medicinal cannabis products, can impair reaction times, coordination, and judgement. Even legally prescribed medicinal cannabis can create safety risks in high-risk workplaces.
This creates important considerations for workplace drug testing and fitness for work policies. As medicinal cannabis use grows, many workplaces have reviewed their policies to ensure they’ve addressed both the use of illicit drugs, as well as prescription drugs like medicinal cannabis and opioids.
Opioids still an issue
While the codeine change is a positive story, opioid harm has certainly not gone away.
To this day, there are still many people who use codeine and other stronger opioid prescription medications for pain. Some of these medications are taken as directed by doctors, while some are taken illicitly, with the use of prescription or medical supervision.
Opioids remain a significant concern in Australia and other parts of the world. In fact, they are the drug type responsible for the highest number of overdose deaths in Australia, accounting for nearly half (approximately 45.7%) of all drug-induced deaths.
We’ve made progress – and the codeine change is one such improvement. But there’s a lot of work still to do.
What can workplaces learn from the codeine story?
Australia’s history with codeine highlights how quickly community attitudes toward medications can change. Today, workplaces face similar conversations around medicinal cannabis and other prescription medications.
The key lesson is simple. Legal does not always mean safe for work.
Employers should ensure they have:
- Clear drug and alcohol policies
- Medication disclosure procedures
- Employee education programs
- Fair and consistent workplace drug testing processes
- Support pathways for workers experiencing dependency issues
At Integrity Sampling, we help businesses understand the changing landscape of workplace drug testing, prescription medications, and workplace safety so they can create safer workplaces for everyone.
Contact Integrity Sampling today if you need help with any aspect of your drug and alcohol management.
FEATURED IMAGE CAPTION:
A person takes medication before going to work. But will the medication impact his ability to work safely? Could it cause him to fail workplace drug testing?
