Have you ever had to sell something that you didn’t quite believe? Tough isn’t it, says pharmacist Peter Feros
But the scenario above is what we pharmacists are being asked to do in the lead-up to the end of OTC codeine-containing analgesia from 1 February.
Another analogy is acting as medicines coppers for the Government – a role pharmacists are asked too regularly to perform and one that gets in the way of the clinical relationship between the pharmacist and patient.
While there may be some valid clinical reasons for the decision by the Therapeutic Goods Administration, behind it is a view that pharmacists are not equipped to allow their safe, judicious use to relieve acute, rather than chronic, pain.
Irrespective of how many new training materials we receive to manage the transition, we know we will face a tsunami of complaints from worried and upset patients – the vast majority of whom will not be codeine-abusers and simply seekers of relief.
And what’s the reaction of someone in pain when they’re told they can’t have what usually offers some relief? We certainly can’t expect a calm, logical and measured response.
Especially when told that the strong pharmaceutical relief they seek can only be accessed via a doctor’s prescription. And especially when serving an area where immediate access to a GP is problematic. This covers most of Australia, but especially in rural areas where the healthcare goal of equity of access remains a distant hope.
The goal of gaining government agreement for an ‘except-when’ status, where pharmacists can use their professional judgement to provide patients with relief for acute cases, not chronic, has to be a priority.
One thing we can do to help this cause is to capture case studies of people who will be, or are, affected by the dramatic curtailing of access, and share them with our state and federal politicians.
Despite being a pharmacist and living in Sydney’s northern suburbs, I have my own case study that helped to really underline the issue of access:
On 24 April 2017 I had a stroke while holidaying in the UK. Following treatment and a return to Australia, two months later I woke on a Friday morning with a slight niggle in a back tooth. My regular dentist had no emergency bookings available and, as he doesn’t practice on weekends and I deemed it not an emergency, agreed to take the first available Monday booking.
Mid-afternoon the niggle progressed to a dull ache so I took 2 x 500mg paracetamol tablets. The pain was worse when I arrived home at 6.30pm so I took two more paracetamol tablets, and two more again before bed-time at 10.30pm.
At 12.30am I awoke with severe toothache. After trying an Internet-listed 24-hour dental service, I was asked to leave a message which would be responded to within 10 minutes. That call never came so I booked an appointment with another dental practice for Saturday morning.
Mine was a pontine stroke and, not wanting to take another gram of paracetamol before time, I rode the pain until 3.30am when I took two Mersyndol Caplets which also contain codeine and doxylamine. This helped me sleep until 7.15am when the pain woke me again.
Because of the stroke, I have to take blood pressure readings morning and night. So I took my morning reading. Two days earlier, a hospital reading of my blood pressure was 130/94. Yet on this morning the blood pressure reading was 159/112!
So, in addition to arranging the dental appointment, I also arranged an appointment with my doctor to address the extremely elevated blood pressure and the severe pain.
My GP suggested the elevated blood pressure was most likely due to severe toothache pain and resultant lack of sleep.
As a pharmacist, I keep a home formulary of medications including the codeine-containing Mersyndol. Without the Mersyndol, just like most citizens, I would have gone to the emergency department of Royal North Shore Hospital to get suitable analgesia.
- prescribed endone for the severe pain;
- changed my blood pressure tablets; and
- arranged a follow-up appointment.
After February 2018, when access to codeine becomes significantly restricted, most citizens with severe toothache, with or without other medical contraindications such as a history of stroke and high blood pressure, will have no other option than to go to a hospital to find doctors and painkillers at the one site.
Share your case studies with us and they can be brought to the attention of those lobbying for pharmacists to be granted ‘except-when’ status.
* Peter Feros owns multiple pharmacies and has for decades been a regular commentator on the business and profession of pharmacy.