A crackdown on access to codeine combination analgesics could leave us all worse off, writes Dr Deon Schoombie.
Millions of Australians use over-the-counter medicines on a regular basis for a wide range of common ailments.
The availability of these medicines plays a vital part in our national health landscape, helping individuals to treat everything from cough, colds and sore throats, to eye and skin disorders, as well as to help maintain good health.
Hundreds of thousands of Australians will have visited their pharmacist at some time seeking relief from pain, and one of the common treatments recommended will be analgesics containing codeine.
Codeine combination analgesics are regulated by Australia’s Therapeutic Goods Administration as a Schedule 3 or Pharmacist Only medicines, which means that they can be purchased in pharmacies, but only after consultation with a pharmacist.
Now, changes before Federal Government could see consumers needing a prescription before they can obtain these medicines.
The group that decides these matters, the Advisory Committee on Medicines Scheduling, is considering re-scheduling codeine combination analgesics from S3 to S4, meaning they would become prescription medicines.
If this goes ahead there will be significant implications for millions of consumers. For a start, they will need to visit a GP to obtain a prescription for medicines that were previously available in a pharmacy, so treating pain, cold or flu with them will no longer be a straightforward matter.
For many people, this will entail time off work, additional travelling time, and of course, time spent in a GP’s surgery and the cost of a GP consultation.
If a health issue arises on a weekend, it may mean a visit to a hospital emergency department. For people in regional, rural and remote areas needing a prescription at short notice, access to a GP can also be problematic.
Why then is the scheduling committee considering something that, on the face of it, will make access to these common medicines more difficult and inconvenient?
The ACMS cites “potential issues of morbidity, toxicity and dependence” as the factors behind the re-scheduling consideration. In everyday terms, this could well be described as abuse, misuse and addiction.
The Australian Self Medication Industry, which represents the non-prescription medicines industry, acknowledges that addiction is a serious problem that warrants specialist attention.
However, ASMI cautions against knee-jerk reactions, and draws attention to the overwhelming benefits from broad community access to this class of medicines.
In the area of consumer medicines, there is a fine balance between prudent regulation in the interests of safety and efficacy, and over-regulation which causes widespread inconvenience to large segment of the population.
The overwhelming majority of people use codeine-combination medicines responsibly.
What the committee is considering has the potential to effectively inconvenience a very large number of people in order to safeguard a relatively small number who misuse these medicines.
Australia already has in place several measures to curb misuse, such as limiting pack sizes and requiring them to be available only after consultation with a pharmacist.
This means that consumers must interact with a pharmacist every time that a codeine combination analgesic is needed, giving pharmacists the opportunity to educate, counsel and monitor usage.
The pharmacy profession and industry also support the establishment of a real-time monitoring system coupled with pharmacist training, guidelines and protocols, to allow pharmacists to identify consumers if they begin to purchase inappropriate quantities of codeine-combination analgesics, and refer them to a GP or pain clinic for intervention.
If there is evidence of systematic abuse, then it needs to be addressed by targeted education and support, not through a blunt measure that risks shifting the problem to prescription medicines and GPs.
In the current healthcare climate, Australia does not need new interventions that will force more people into GP surgeries or hospital emergency departments, especially for minor ailments that can be effectively treated by a pharmacist.
Recent research by the Macquarie University Centre for the Health Economy found that re-scheduling of current S3 analgesics to S4 would result in an additional $93 million in costs for GP visits and a further $162 million in lost productivity.[i]
More onerous scheduling may seem like a neat fix, but it has to be weighed against the backward step it entails for millions of responsible health consumers.
Before restricting access, we need to consider what this will mean for everyday Australians, and the impact it will have on already overstretched GP and hospital waiting rooms.
[i] Macquarie University. The Value of OTC Medicines in Australia. March 2015.
Dr Deon Schoombie is the executive director of ASMI.