What Was the '222' Tablet?
For many years, the '222' tablet was a widely recognized combination pain reliever in Canada. Known as an AC&C formulation (acetylsalicylic acid, caffeine, and codeine), it combined multiple ingredients to provide relief from mild to moderate pain. While sold without a prescription, it had to be requested from a pharmacist, distinguishing it from general over-the-counter products. The medication was used for various types of pain, including headaches, menstrual cramps, dental pain, and arthritis. However, the availability of this specific brand formulation ended, and it is no longer sold in Canada.
The Specific Codeine Content
The primary inquiry, "how much codeine is in a 222?", relates to the narcotic analgesic component of the medication. The low-dose nature of the tablet was key to its non-prescription status. The exact formulation varied slightly, but the concentration of codeine was consistently low compared to prescription-only versions. Official records from Health Canada list the '222' tablet as containing 8 mg of codeine phosphate per tablet. This contrasts slightly with some reports citing 7.5 mg, which might reflect variations between specific brands or regions (such as the co-codaprin products mentioned in other sources). Regardless of the minor discrepancy, the low-dose concentration was a defining characteristic.
The Role of the Other Active Ingredients
The '222' formulation did not rely solely on the codeine for its analgesic effects. It was a synergistic combination designed to provide comprehensive pain relief. The functions of the other active ingredients are:
- Acetylsalicylic Acid (ASA): Also known as aspirin, ASA is a non-steroidal anti-inflammatory drug (NSAID) and an analgesic. It works by reducing inflammation and pain through a different mechanism than codeine, providing a dual-action effect.
- Caffeine Citrate: Caffeine, a stimulant, was included to counteract the drowsiness often caused by codeine. It can also help enhance the analgesic effects of ASA and codeine.
Why Are '222' Tablets Discontinued?
The discontinuation of the '222' tablet is part of a wider regulatory movement in many countries, including Canada, to re-evaluate and restrict access to opioid-containing products. While 8 mg is considered a low dose, all opioids carry risks of dependence and abuse. The decision to remove over-the-counter (OTC) codeine was based on public health concerns and evolving best practices in pain management. Health authorities recognized the need for greater control and oversight over all opioids, regardless of their concentration. Patients now require a doctor's prescription for any medication containing codeine, ensuring that its use is medically supervised and risks are properly assessed.
Comparative Table of Codeine Formulations
To understand the context of the '222' tablet, it is helpful to compare it with other similar combination products that were available in Canada and elsewhere. These formulations used a numerical naming convention based on their codeine content, which increased with the number, reflecting the need for stricter controls.
| Formulation | Codeine Content | ASA Content | Caffeine Content | Prescription Status (in Canada) | Current Availability (Canada) |
|---|---|---|---|---|---|
| 222 | 7.5-8 mg | 375 mg | 30 mg (as citrate) | OTC (requested from pharmacist) | Discontinued |
| 282 | 15 mg | 375 mg | 30 mg (as citrate) | Prescription | Discontinued/Prescription required |
| 292 | 30 mg | 375 mg | 30 mg (as citrate) | Prescription | Discontinued/Prescription required |
| Tylenol 1 | 8 mg | N/A | 15 mg (as citrate) | OTC (requested from pharmacist) | Discontinued/Prescription required |
Potential Risks and Adverse Effects
Even at the low dose found in a '222' tablet, codeine poses potential risks. The combination with ASA and caffeine also contributes to the side effect profile.
- Opioid Side Effects: These can include drowsiness, constipation, nausea, and, in susceptible individuals, respiratory depression. Codeine is metabolized in the body into morphine, and individuals who are "ultra-rapid metabolizers" of codeine due to a specific gene can experience dangerous overdose symptoms even with standard doses.
- Aspirin Side Effects: ASA can cause stomach upset and, in some cases, serious gastrointestinal bleeding. It should be used with caution by those with bleeding disorders, kidney disease, or a history of ulcers.
- Caffeine Side Effects: At high doses, caffeine can cause restlessness, jitters, and a rapid heartbeat.
- Dependence and Withdrawal: Prolonged or repeated use of any opioid, including low-dose codeine, can lead to physical dependence. Suddenly stopping the medication can cause withdrawal symptoms.
Conclusion
In summary, the discontinued '222' tablet contained 7.5 to 8 mg of codeine phosphate per tablet, along with acetylsalicylic acid and caffeine. While it was once available non-prescription in Canada, it has since been withdrawn from the market as part of broader efforts to regulate opioid-containing medications. The move reflects a greater public health awareness of the risks associated with opioids, including low-dose formulations. Anyone seeking treatment for mild-to-moderate pain should consult a healthcare professional to discuss safe and currently available alternatives, as the '222' formula is no longer a valid treatment option.
