Codeine: Legal consequences

Last modified: Thursday, 25. December 2008 - 10:29 am

Legal consequence of Codeine

Whether requiring a written order in a hospital chart (or other inpatient health care institution) or a prescription written on a special form, hospital and community pharmacies exercise special caution when dispensing codeine and other controlled substances. In some cases, a doctor may choose to telephone the patient’s pharmacy with the prescription. However, for medication such as codeine, they must provide their DEA number and some relevant medical information. This helps to prevent someone from calling a pharmacy to obtain codeine by impersonating a physician. It is unlikely that anyone other than a physician or dentist would have access to both a valid DEA number and the medical knowledge necessary to sound credible to pharmacy staff when ordering such a medication.

It is illegal to write a prescription or an order for codeine without a valid medical license. Those professionals that may legally write prescriptions or orders for codeine include medical doctors (MD), doctors of osteopathy (DO), podiatrists (PO), dentists (DDS), and veterinarians (DVM). Physicians or dentists who knowingly write multiple prescriptions for patients without a valid medical reason are subject to possible disciplinary action and criminal prosecution. Writing and filling fake prescriptions for profit is a more serious offense. Likewise, it is illegal to obtain, or try to obtain, prescriptions for codeine under false pretenses (fabricated symptoms and scenarios). Nineteen states have a law (a felony in some) prohibiting a patient from obtaining the same controlled substance from multiple prescribers within a limited time period (doctor shopping). Unlike the illegal activities associated with most other drugs, the perpetrators of crimes involving prescription drugs are most often white, middle-class women. Their crimes usually involve doctor shopping and/or prescription forgery.

Many people in the government and medical community fear that increased production of opioid drugs correlates with increased rates of abuse and addiction. Pharmacies were increasingly burglarized for their opioid drugs, which seemed to bolster this argument. However, the newsworthiness of those crimes serves to overemphasize one side of the debate. Studies have consistently shown that patients with chronic pain who use opioids appropriately rarely become addicted. In 2001 and 2002, a number of groups advocating for effective pain management joined with government agencies, including the Drug Enforcement Administration (DEA), to begin a long-term effort to increase the availability of effective pain management drugs for patients, while decreasing the illegal use and abuse of these drugs.

Legal history

In the United States, the Harrison Narcotics Act of 1914 provided the first real regulation of the general sale of opiates. The exceptions were sales to licensed physicians for use on their own patients, and sales to those people who could provide a written prescription from a doctor. The adoption of laws controlling the production and distribution of all prescription medications occurred primarily because of morphine and codeine.

Codeine is a controlled substance in the United States. Its manufacture and distribution are controlled by the Food and Drug Administration (FDA) and the DEA. The majority of other countries have controls similar to those of the United States. International control is overseen by the International Narcotic Control Board (DSfCB).

Several foreign countries and some states continue to sell medications with small amounts of codeine over the counter. In the United States, though, even OTC codeine medications have restrictions. A person purchasing codeine must be at least 18 years of age and provide valid identification. In addition, their name may be entered in a special logbook maintained by the pharmacy.

Federal guidelines, regulations, and penalties

Injectable forms of codeine are classified under the Controlled Substances Act (CSA) as Schedule II, even though they do not typically contain more than 60 mg per dose. Analgesics containing 15-60 mg of codeine per single dose carry a Schedule III classification (although the upper single dose limit in many states is 90 mg). Schedule III drugs have a lower potential for abuse than drugs in Schedule II, and abuse of the drug may lead to moderate or low physical dependence and/or high psychological dependence.

Medications containing less than 15 mg of codeine per single dose (most contain either 8 mg or 12 mg) are classified as Schedule V. Cough suppressants with codeine make up the majority of this category. Drugs in Schedule V have a low potential for abuse, but abuse may lead to limited physical dependence and/or psychological dependence compared to drugs in Schedule IV.

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