Why I’m losing codeine sales

woman taking pill

If you’re not using MedsASSIST, you’re helping neither patients nor pharmacy, writes Samantha Kourtis

Since MedsASSIST was rolled out and I decided to use it in my pharmacy, I’ve experienced a significant drop in OTC codeine sales.

It’s not because we’re refusing sale. We actually have not found a reason to refuse supply in the last two months, because our intention is to build rapport, and thus build a relationship with our patients and their doctor to achieve a good health outcome.

Refusing supply isn’t going to achieve that. So the approach we’ve taken is to record the sale and work with our customers to help them address their problems.

Instead, we’ve attributed our decline in sales to a reluctance from the consumer to show their driver’s licence and have the sale recorded. Customers have started saying, “I’m not showing my licence; I’ll get it from the other pharmacy where they don’t record it”.

The problem is that while we’re using MedsASSIST, surrounding pharmacies in our community aren’t.

In a way, it’s been good to see a reduction in codeine sales. We’ve helped patients towards improved clinical outcomes, and had some impact on patient use of codeine. There’s already a handful of great stories out there as a result of MedsASSIST.

But until MedsASSIST is nationwide and compulsory, we will not necessarily have the impact we want, because consumers know that they can go to certain pharmacies and not have the purchase recorded.

In my first month of recording, I had patients who thought I personally was monitoring their codeine use. I’d been seeing them maybe weekly, but when I brought up the list, found that they’d been shopping daily at other pharmacies.

So MedsASSIST has the potential, like Project Stop, to open our eyes to the challenges our patients face. It must be exhausting and very stressful to have to go to multiple pharmacies every week to get medicine you perceive a need for, whether for pain, or if you’ve inadvertently become addicted in the course of treating pain.

MedsASSIST is a great tool to prove to the TGA and Government that pharmacy is well placed to monitor and support patients with pain and addiction to opioids. But until we’re all using it, like Project Stop – and we all know how long that took to roll out – it will not achieve the outcomes we want in the numbers we need.

I think that some pharmacies have chosen not to implement MedsASSIST because they perceive IT issues, workflow issues and loss of sales; some may be arcing up about another Guild-endorsed program.

However, if codeine does go prescription-only, there will be impact to your front of shop turnover. Your profitability on painkillers will decrease and your workload will increase. Imagine if all that codeine now had to come through the dispensary!

But more importantly, the impact on patient outcomes would be huge.

In many places in Australia, you can’t get in to see a GP for two weeks. The medicine will become more expensive for patients – on top of GP fees for those whose GPs do not bulk bill – and we as pharmacists and doctors already know that people who want to misuse codeine and opioids at an S4 level already do it.

They doctor shop, they present to Emergency and they buy it off the street already.

As well, there is strong evidence that doctors would be more inclined to prescribe higher doses of codeine than those currently available over the counter.

This would also really disadvantage those who have an accurate diagnosis of their pain, such as period pain or migraine or joint pain that responds to these low doses of codeine, and who are using the products sparingly and appropriately without needing to see a GP.

I wish everyone would stop thinking short-term and focus on the bigger picture, and what we’re trying to achieve here. Because codeine going prescription-only will not help anybody at all.

I am feeling a loss in my sales right now. And I know that the day codeine goes prescription-only because pharmacy didn’t get on board with this monitoring tool, the loss to my sales will be phenomenal.

But it’s more important that we’re careful with this issue as a health profession. We shouldn’t be focused on the dollar; we should be focused on patient outcomes.

I can’t see how patient outcomes would be improved with codeine being restricted to prescription only.

And from a professional perspective, pharmacists need to shout aloud from the rooftops that we are perfectly competent and capable of dealing with codeine in the S3 environment.

Refusing to implement MedsASSIST is doing exactly the opposite.

Samantha Kourtis’ pharmacy, Charnwood Capital Chemist, was the 2014 Pharmacy of the Year. Kourtis was also named ACT Telstra Businesswoman of the Year 2014.

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