Codeine linctus could become a prescription-only medication (POM) under new proposals from the Medicines and Healthcare Products Regulatory Agency (MHRA).

This follows ‘multiple reports’ that the cough suppressant is being used recreationally for its opioid effects.

The MHRA has asked the public to share their opinions on how codeine linctus should be classified in a consultation opened today.

The consultation asks whether respondents thinks codeine linctus should be reclassified as a prescription-only-medication, and whether this would limit the potential for recreational use or use for illegal purposes.

It also asks whether reclassifying codeine linctus would help the pharmacist to monitor the use of the medicine in those who would benefit from being prescribed it.

And it asks whether training materials for pharmacists would be useful to help educate pharmacists or patients.

The consultation also considers what impact the proposal to reclassify the drug as prescription-only would have on primary care.

It is open for all members of the public to respond to until 11:50pm on 15 August 2023.

Since 2019, all opioid medicines in the UK have had to carry addiction warnings on their labels, following an increase in opioid prescribing and codeine-related deaths.

And a 2021 study found that the use of opioids increased by 40% during the pandemic while some patients were forced to wait longer for orthopaedic surgeries.

Concerns have been raised in the past about the impact of mandating prescriptions for codeine on GP workload.

In 2020, some experts advising NICE on its first-ever guideline on chronic pain called for a ban on over the counter (OTC) codeine sales, whilst others raised concern that a ban could lead to increased workload for GPs.

Dr Jens Foell, a GP and honorary senior clinical lecturer at Imperial College London, who was on the NICE guidelines committee said at the time: ‘I don’t like OTC codeine because it builds a culture of pill-popping and I’m aware of people who are really dependent and addicted to codeine.

‘But I don’t know how many people use it and I also don’t know what it would mean to take it away in terms of increased demand on GP practices so there may be a price to pay.’

The guidelines, published later in 2020, said that patients with chronic pain should not be prescribed opioids as they could be ‘harmful’, and instead alternatives such as certain antidepressants, an exercise programme, cognitive behavioural therapy or acupuncture should be considered.

But Cochrane reviewers concluded in 2023 that there was insufficient evidence to justify the use of most antidepressants that are currently prescribed for chronic pain.

Earlier this year, NHS England launched a new framework for pharmacists, prescribers and ICBs that aims to reduce inappropriate prescribing of five classes of medicine that might cause addiction, including antidepressants, opioids, gabapentinoids, benzodiazepines and sleeping pills.