Codeine crackdown will be a headache say pharmacists
A CODEINE crackdown which will see common pain medications require a prescription won't end abuse of the drug, and will make it even harder to track.
That's the claim from the Pharmacy Guild of Australia, which says making products like Nurofen Plus, Panadeine, Mersyndol and Codral available only with a prescription next year will lead to an increase in 'doctor shopping'.
The changes on February 1, 2018 will see codeine products 'upscheduled', meaning people who use the products for health issues like back pain, migraines, period pain, dental pain or cold and flu will have to go to the doctor to get access to them.
The Therapeutic Goods Administration (TGA) made the decision last year because consumers frequently became addicted to codeine.
And while the Australian Pharmacy Guild is on board with an education campaign advising consumers of the changes, it maintains upscheduling is an unnecessary headache.
It says a system in place in many pharmacies for almost two years has already seen a drop in use, and detecting who may be abusing codeine better than doctor's surgeries and medical centres can.
The Guild is currently lobbying individual State and Territory governments for exceptions to the scheduling restriction, which would mean pharmacists could continue to dispense the products, with a number of conditions and restrictions, national president George Tambassis said.
"Under our plan, codeine will still go prescription only, but there will be exceptions which would allow pharmacists to supply," he said.
Those conditions would include the medication could be used for acute, rather than chronic pain, and be sold in very small quantities, and their supply would be marked in a real-time recording system.
The plan being put to State governments would make use of the MedsASSIST monitoring system already in place in many pharmacies, Mr Tambassis said.
The program, developed by the Guild, is a monitoring system which identifies and supports patients who may be misusing codeine containing over-the-counter analgesics, he said.
It requires customers buying the medications to provide a drivers licence, similar to what is required of customers buying products containing pseudoephedrine, ahead of purchase.
"The programs links the participating pharmacies. As soon as you give your driver's licence, your history pops up on the computer - regardless of which pharmacy you've been to," Tambassis said.
"If it shows customers are using the medication wrongly or too frequently, it's a tool to alert us, and allow us to start a discussion with you."
"We have that for almost two year now, but unfortunately no government has asked for it to become mandatory."
He says about 70 per cent of community pharmacies are using MedsASSIST and there's been a drop of 20 per cent in the sale of codeine-containing medications in that time.
"We believe the mandatory recording system is the best way to limit the sale of those drugs," he said.
"DOCTORS CAN'T DO THIS"
The Guild believes the prescription-only rule won't stem codeine abuse, because doctors don't use a national tracking system which would highlight misuse.
"We fear doctor shopping. The doctor has no way of knowing - other than a patients' word - if the codeine they are being asked to prescribe was recently prescribed by another doctor," he said. There is no medical centre anywhere in Australia that has anything near what we have with MedsASSIST."
"And there's been no proactive action taken by any doctor groups to put in place a real time recording and monitoring tool to help identify patient misuse.
"Not only will doctors be swamped when this changes in February, but this is a professional slap in the face for pharmacists."
The Guild believes patients using these medicines should still have access without a prescription.
"We want to maintain safe and convenient access to those using these medicines safely and appropriately, while putting extra safeguards in place," Mr Tambassis said.
"What our opponents on his issue are saying is they want to remove convenient access for consumers.
"They want to put no safeguards in place except for a prescription."
WHY THE CHANGE?
Doctors groups including the Australian Medical Association support the prescription-only plan.
The Therapeutic Goods Administration's move to limit supply to prescription-only followed the lead of the US, most of Europe, Hong Kong and Japan.
All those countries stopped the sale of codeine products without a script after studying evidence of the harm caused by their overuse and abuse.
"Low-dose codeine-containing medicines are not intended to treat long-term conditions, however, public consultation indicated that many consumers used these products to self-treat chronic pain," the TGA said as it announced the change.
"This meant that consumers frequently became addicted to codeine. The TGA decision maker also took into consideration that there is little evidence that low-dose codeine medicines are any more effective for pain relief or cough than similar medicines without codeine."
The decision came after reports codeine addicts were swallowing up to 100 tablets a day, and people were "pharmacist shopping" to get around rules restricting purchases of more than five days' supply of the drug at one time.
Companies who make the products have had mixed reaction to the up-scheduling.
The maker of Panadeine products, GlaxoSmithKline has ceased manufacturing those products, declaring it will pull them from Australia.
Other companies are believed to be reformulating popular brands by removing the codeine so they can still be bought over the counter.