Ask Your Pharmacist

July 17, 2018
Q:

Can you still buy 8mg codeine products (Tylenol #1) without a prescription in New Brunswick?

A:

Yes, you can still buy Tylenol #1 and other exempted codeine products without a prescription in New Brunswick, but the process to do so has changed.

In Canada, products containing up to 8mg of codeine, an opioid narcotic painkiller, can be sold without a prescription with a pharmacist’s intervention. These products must contain two or three other active ingredients and are used mainly for pain (ex. Tylenol #1, 222’s, Robaxasol) or for cough and cold (Calmalyn, Dimetapp C). These are popular products in New Brunswick as they are effective in what they do. They are, however, narcotics and with that comes the risk of addiction, overdose, and abuse. Canada is experiencing a crisis of opiate addiction and New Brunswick is leading other provinces with a recent regulatory change that affects the sale of over-the-counter (OTC) codeine products. Concerns were raised about the ease of access to these products as there was no barrier stopping someone from purchasing them from multiple pharmacies. In June 2018, the NB College of Pharmacists approved regulatory changes requiring pharmacies to track the sale of OTC codeine by submitting the sale through the NB Drug Information System (DIS)/Prescription Monitoring Program (PMP). This means the product sold will show up on patients’ Electronic Health Record (EHR) used by hospitals, pharmacies, and doctors’ offices across the province. This system notifies pharmacists if patients are receiving medications through other pharmacies which helps to ensure safe usage at appropriate intervals.

We are currently in a transition stage when it comes to these new regulations about codeine products in New Brunswick, but it is important that patients are aware of the changes. The process for purchasing OTC codeine products does vary, and with the new regulations, some pharmacies may choose not to sell them at all. Here is an idea of what to expect when making such a purchase. You will be asked to identify yourself somehow and some pharmacies will require a form of ID. This will be to locate your health record for documenting the sale. Expect to be asked basic background questions regarding allergies, health conditions, current medications, and intended use as the pharmacist will need to assess if this medication will be safe and effective for your needs. As these products are posted on your Electronic Health Record, there may be obstacles if you are purchasing some codeine products for someone else. This situation is ultimately up to the pharmacist’s professional judgement. As a pharmacist, I prefer the person who is intending to use the product be present as I do want to ensure the accuracy of the Electronic Health Record. My patients will often call if someone else will be picking up for them which allows me to assess the appropriateness of the product and maintain accurate records. If you are not able to get in yourself, I recommend you take this approach and call your pharmacy prior to purchase.

Opiate dependence and opiate-related deaths are at an all-time high, so taking measures to ensure safe usage and limit unnecessary access is as important as it has ever been. Stigmatizing people who do use OTC codeine is absolutely not the intention with these changes so do not take it personally if you do receive more questions than you are used to the next time you purchase such a product. As always, your privacy is important so don’t be afraid to ask to speak privately with your pharmacist if you feel uncomfortable or have any concerns.

Jared Mactavish (BSc., Pharm) is a pharmacist in Saint John. His opinions expressed in this newspaper are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment. Send your questions to AskYourNBPharmacist@gmail.com