A snapshot of scepticism

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A new study has quantified the disconnect between GP views on the codeine upschedule, and those held by pharmacists and codeine users

The study, Attitudes in Australia on the upscheduling of over-the-counter codeine to a prescription-only medication, was presented at last week’s APSAD Alcohol and Drugs Conference.

Researchers Jacqui McCoy, Raimondo Bruno and Suzanne Nielsen investigated attitudes towards the upschedule before it was announced, and found that pharmacists expect several negative effects if such an upschedule were to take place.

The groups surveyed included 354 codeine consumers, 220 pharmacists and 120 GPs.

“Pharmacists, on average, were significantly more likely to indicate their opposition to the proposed change than GPs,” the authors write.

“Furthermore, pharmacists, compared with GPs, exhibited strong agreement that there would be a range of negative impacts if codeine is upscheduled to prescription-only, including negative impacts that consumers themselves did not endorse.

“Interestingly, pharmacists also reported concern around their capacity as a health professional to assist consumers in their pain relief in the absence of OTC codeine, suggesting that for some pharmacists, there may be a lack of awareness or lack of agreement around alternate OTC products with comparable efficacy.”

Overall 70% of pharmacists opposed the restriction of OTC codeine, as well as 83% of codeine users, while only 31% of GPs opposed the measure.

Among consumers, opposition to the upschedule did not differ significantly according to the estimated level of risk for codeine dependence among consumers, the authors write.

“Statements of whether codeine restriction would result in a reduced risk of codeine dependence, better general health support and pain management generated the largest differences in attitude among the codeine consumer sample.

“This contention signifies consistent scepticism as to whether the upscheduling of codeine would achieve two of its primary targets: lowering problematic codeine use rates and supporting effective pain relief.

“When codeine is rescheduled, campaigns with consumer information on other pain management options will become important for customer education, particularly given evidence supporting the efficacy of alternate OTC products.”

More education about different options for managing pain may also help reduce potential reliance on one type of medication, the authors write, as well as driving help-seeking behaviour.

“As dependent consumers have identified pharmacist advice as an important factor in not only identifying their problematic codeine use but also influencing them to seek further help, endorsing processes that maximise the pharmacist–customer interaction is a key intervention towards reducing codeine-related harms.”

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