Tramadol and codeine: secure prescriptions, prescriptions… 5 questions to understand what will change in the delivery of opioids

Le Tramadol, antidouleur de la classe des opioïdes, placé sous surveillance en France. MAXPPP – Luc Nobout

Tramadol and codeine, opioid drugs that continue to be abused in France, will have to be prescribed on a so-called “secure” prescription, i.e. one that cannot be forged, starting December 1, the French National Agency for the Safety of Medicines (ANSM) announced on Thursday. Here are five points to understand what to expect.

What are tramadol and codeine ?

Tramadol is the main treatment in the opioid family. These are commonly used as painkillers, but have a high risk of addiction with significant health risks.

Codeine is also an opioid medication used to relieve coughs and mild to moderate pain, which can be addictive when used in high doses and over a long period of time.

These medications can only be dispensed upon presentation of a prescription.

Why the rule is changing ?

Despite several measures already taken to reduce the risks of misuse, various surveys have shown the persistence of cases of abuse, overdoses, dependence and presentation of falsified prescriptions for these treatments.

In order to further reduce the risks, the ANSM announces that as of December 1, medications containing tramadol or codeine, alone or in combination with other substances (paracetamol, ibuprofen…) will be dispensed only upon presentation of a secure prescription.

What is a secure prescription ? 

This type of prescription must meet criteria to make it tamper-proof: mention of mandatory information pre-printed in blue to identify the prescribing healthcare professional, appearance of a watermark representing a caduceus, presence of micro-letter squares to make falsification difficult, minimum weight set at 77 g/m2…

The dosage, the dose and the duration of the treatment must be written in full.

By how much will the prescription period be reduced ?

Another measure announced on Thursday: as for tramadol, the maximum prescription period for codeine will be reduced to 12 weeks from December 1. Beyond that, continuing treatment with codeine will require a new prescription.

These two measures also concern dihydrocodeine, an analgesic used to relieve moderate to severe pain.

Why this new framework ?

Opioids, prescribed and consumed in a largely uncontrolled manner in the United States, have caused a massive health crisis there in recent decades, particularly with fentanyl.

In France, the situation is not comparable, but many health professionals are concerned about an increase in cases misuse of opioids such as tramadol, particularly used as a sedative.