Can You Buy Codeine Over the Counter?

Codeine is an opioid pain reliever and widely used analgesics, commonly used for mild to moderate pain and cough suppression. However, its availability varies by region due to concerns over misuse, addiction, and health risks.

Previously available over-the-counter (OTC) in Australia, low-dose codeine products were made prescription-only to curb opioid misuse and dependence. This decision was driven by the risk of addiction, respiratory depression, and other serious side effects, especially for individuals with conditions like asthma or COPD.

While codeine can be effective for both chronic pain and acute pain relief, its prescription-only status highlights the importance of responsible use under a healthcare provider’s supervision.

This article explores the regulatory status of OTC codeine, the use of codeine for pain management, and the availability of codeine-containing combination analgesics and other codeine-containing products.

Can You Buy Codeine Over-the-Counter in the USA?

No, you cannot buy codeine over-the-counter (OTC) in the United States. Codeine is a controlled substance due to its potential for misuse, addiction, and dependence. It is classified as a Schedule II, III, or V drug, depending on its formulation and combination with other medications. This restriction applies to all codeine-containing products, including some cough syrups.

Codeine’s Legal Classification in the U.S.:

• Schedule II – Pure codeine (highly restricted, requires a prescription).
• Schedule III – Codeine combined with non-narcotic drugs (e.g., acetaminophen or aspirin), available by prescription.
• Schedule V – Low-dose codeine cough syrups, available with a prescription in most states but may be obtained OTC in limited states with pharmacist approval.

Can You Get Codeine Cough Syrup Without a Prescription?

Some states previously allowed the sale of low-dose codeine-containing cough syrups (Schedule V) over-the-counter, but most states now require a prescription. Even where OTC sales were permitted, restrictions were in place due to concerns about the use of codeine and its potential for abuse.

In states where OTC purchase is permitted, you must:

• Speak with a pharmacist before purchase.
• Show a valid ID proving you are 18 or older.
• Have your purchase recorded in a database to prevent misuse.

However, due to the opioid epidemic, most states have restricted or eliminated OTC sales of codeine cough syrup altogether.

Where Can You Buy Codeine in the U.S.?

Codeine is only available through a prescription from a licensed healthcare provider and can be obtained at pharmacies when prescribed for pain relief or cough suppression.

Why Is Codeine Restricted?

• Risk of Addiction & Dependence – Codeine is an opioid that can cause physical dependence with prolonged use.
• Potential for Abuse – Misuse of codeine-based cough syrups has led to the illegal production of “lean” or “purple drank.”
• Side Effects & Overdose Risk – High doses can cause respiratory depression, drowsiness, and even fatal overdose.

Alternatives to Codeine for Cough & Pain Relief

If you need an OTC alternative for pain or cough relief, consider:

• Dextromethorphan (DXM) – A non-opioid cough suppressant available in OTC syrups.
• Guaifenesin – A common expectorant that helps clear mucus.
• Acetaminophen or Ibuprofen – For mild to moderate pain management. Also known as non-steroidal anti-inflammatory medicines (NSAIDs).

Where can you buy Codeine Over-the-Counter (OTC) outside of the USA?

In the United States, codeine is a controlled substance and is only available by prescription due to its high potential for addiction. Strict regulations have been implemented to prevent misuse. However, in other parts of the world, low-dose over-the-counter codeine is still available over-the-counter (OTC) under specific conditions.

In the United Kingdom and some European countries, codeine can be purchased in small doses from pharmacies without a prescription. It is commonly found in codeine-containing combination analgesics such as Co-Codamol (codeine + paracetamol), Co-Codaprin (codeine + aspirin), and Nurofen Plus (codeine + ibuprofen). Additionally, codeine cough syrups (linctus) are available for treating dry cough. These codeine-containing medicines are subject to regulations.

The availability of OTC codeine varies by country:

• Australia & New Zealand – Previously available OTC, but now restricted to prescription-only due to concerns about misuse and addiction.
• Canada – Some provinces allow low-dose codeine-containing medications to be sold without a prescription, but buyers must consult a pharmacist and meet certain criteria.
• Ireland & South Africa – Codeine is still available over-the-counter, but only in limited amounts and in combination medications.

Despite its accessibility in some regions, codeine is highly addictive, and misuse can lead to dependence and withdrawal symptoms. If you or a loved one has a history of substance abuse, alcohol addiction, or mental health disorders, the risk of codeine misuse increases. Always consult a healthcare professional before using codeine-containing products to ensure safe and responsible use.

Side Effects of Codeine Abuse

Codeine abuse can lead to serious physical, psychological, and long-term health risks. As an opioid, codeine affects the central nervous system, slowing down vital functions and creating a high risk of dependence and addiction.

Short-Term Side Effects of Codeine Abuse

Even at lower doses, codeine misuse can cause:

• Drowsiness & Sedation – Extreme fatigue, sluggishness, and mental fog.
• Euphoria & Relaxation – A temporary sense of well-being that leads to addiction.
• Nausea & Vomiting – Common side effects, especially with high doses.
• Constipation – Opioids slow digestion, causing severe gastrointestinal discomfort.
• Dizziness & Low Blood Pressure – Increased risk of fainting and lightheadedness.
• Respiratory Depression – Slowed breathing, which can lead to oxygen deprivation.
• Itching & Skin Rash – Some users experience histamine reactions.
• Blurred Vision & Impaired Coordination – Increased risk of accidents and falls.

High doses can lead to overdose, causing severe breathing problems, unconsciousness, and death.

Long-Term Effects of Codeine Abuse

Chronic codeine abuse can lead to serious health complications, including:

• Physical Dependence & Addiction – The body adapts to codeine, leading to withdrawal symptoms when stopping use.
• Liver & Kidney Damage – Many codeine medications contain acetaminophen, which can cause organ failure when taken in large amounts.
• Chronic Constipation & Gastrointestinal Issues – Long-term use can lead to bowel obstruction and severe digestive problems.
• Cognitive Impairment – Prolonged use affects memory, focus, and mental clarity.
• Mood Disorders – Depression, anxiety, and irritability are common with long-term abuse.
• Increased Risk of Infections – Opioid misuse weakens the immune system, increasing vulnerability to illnesses.
• Social & Financial Consequences – Job loss, legal troubles, and strained relationships are common among individuals struggling with opioid addiction.

Withdrawal Symptoms of Codeine Abuse

If you have been prescribed or have purchased codeine or any related codeine-containing products over the counter for pain or a cough, and you believe you may be dependent or addicted to it, you may experience some withdrawal symptoms. Withdrawal symptoms may come in two phases. The early phase occurs within a few hours of your last dose, and other symptoms may occur later as your body readjusts to working without codeine.

Treatment for Codeine Addiction

Withdrawal symptoms can last for a week or may persist for up to months (as Post-Acute Withdrawal Syndrome) after you stop taking Codeine recreationally. If you or someone you love is addicted to Codeine, please contact one of our Recreate Life Counseling addiction specialists. Health professionals are available to talk to you confidentially, 24 hours a day and 7 days a week. Let Recreate Life Counseling get you the help you deserve and primary care intervention today for a full recovery from Codeine dependency.

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Published on: 2020-07-17
Updated on: 2025-02-20