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In the UK, prescription codeine is often mixed with methadone in a high-powered liquid that is then used to make heroin; a combination known as "M88."
And now, the US military wants that all changed.
In a letter obtained by Reuters, the Pentagon is pushing for new restrictions around its use of drugs like morphine, codeine and hydromorphone, which are needed to treat pain, as well in post-traumatic stress disorder and for the treatment of post-surgical pain.
While the US has no laws banning its military personnel from using codeine-laced painkillers, the military has been using this medication since it became available as a prescription drug in 1971.
A new federal policy will be introduced in 2015 requiring all military pharmacies to stop selling codeine-laced hydrocodone products as well heroin and cough syrups, according to a copy of the letter obtained by Reuters.
The military currently uses approximately 1,700 active duty personnel on opioid use-relief programs, and many of these individuals had previously prescribed Codeine-Acid cough syrup and hydromorphone.
"The administration is seeking to move away from codeine and heroin use in military medical care," a US Army spokesman told Reuters.
"We can do this not only by increasing our efforts, looking at own pharmacy practices, but also by working to develop more effective therapies that can help our people with chronic pain safely manage their suffering."
The US Army's move comes despite an April announcement by the Department of Defense that it would cut funding for opioid prescription drugs by about $6.5 billion over three years, following a sharp increase in opioid deaths and abuse the military.
In May, the Pentagon's health affairs arm, which oversees pharmacy programs, said it would work with lawmakers to make it more difficult purchase opioid-containing drugs through the mail or prescription sites.
The Department of Defense had already been taking steps to restrict prescription painkillers as part of a broad effort that already banned the drugs in 2011 amid warnings from the Department of Health and Human Services.
But the new policy will allow military to apply for exemptions from the new federal rules.
While the move comes as a relief to some military personnel suffering from chronic pain, others say they will still be forced to choose between opioid pills that aren't federally approved and the powerful drugs used to control patients' pain.
Retired Colonel Rick Hite, former director of the military's Center for Interdisciplinary Management of Pain at Fort Sam Houston in San Antonio said the news is troubling.
"The change will affect many, many people who depend on codeine and will either be unable to obtain medications from the pharmacy that they prefer or use the codeine-only products that are still being prescribed to them," he said in an email.
"It is important that those affected be made aware of all available treatment options, including the use of non-opioid medications," he warned.
In a telephone interview with Reuters, Hite said.
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