AMA castigates “peddling of alternative codeine models”


But the Guild has hit back saying it’s time to put common sense and patients before “tired old turf wars”

The Australian Medical Association fully supports the TGA’s decision to upschedule codeine, President Dr Michael Gannon reiterated on Thursday.

“There is compelling evidence to support the decision to make codeine prescription only,” said Dr Gannon, adding that all parties need to work together to move forward on the issue.

“The decision has been made – what we need to see now is cooperative implementation,” he said.

“We are extremely concerned at recent reports of some groups endeavouring to influence or coerce State governments to change, delay, or dilute the impact of the TGA decision.”

Dr Gannon is referring to the Pharmacy Guild of Australia’s announcement last month that it is working on a model that would see certain limited circumstances in which patients could continue accessing codeine-containing medicines directly through community pharmacies without a prescription.

It had also stated that pharmacy representatives have been active in meeting State and Federal Ministers and politicians, as well as stakeholders, to inform them of its proposal.

The Guild has hit back at Dr Gannon’s statement, saying it is a “disappointing misrepresentation of the Guild’s approach” and calling on the AMA to introduce real-time monitoring before next February.

“Community pharmacy voluntarily put a real-time system – MedsASSIST – in place last year for over-the-counter codeine pain relief medicine. What is the AMA doing?” said the Guild.

Guild National President George Tambassis said: “The Guild is not seeking to reverse the upscheduling decision.

“However upscheduling alone will not address issues of addiction and could actually exacerbate them, particularly given the lack of any mandatory national real-time monitoring system of doctors and the likelihood that some patients will be prescribed higher-strength codeine-containing products.

“Neither the Guild nor community pharmacies are acting irresponsibly. It’s time for the AMA to put common sense and patients before tired old turf wars,” said Mr Tambassis.

However Dr Gannon was firm: “The AMA urges all stakeholders to not deviate from the TGA decision, which was made with open and transparent consultation.

“At this stage, we do not want to see the peddling of alternative models, dressed up as ‘patient concern’, which undermine the TGA position.”

Dr Gannon argues that the codeine decision is an independent decision that was made in the “best interest” of Australians.

“We call on all those who work in the wider health community – including pharmacy – to quickly implement the changes that are necessary,” Dr Gannon said.

PSA National President Dr Shane Jackson said the pharmacy member organisation remains “fully committed” to supporting pharmacists to manage the planned February 2018 change in the scheduling of codeine.

However he says they “don’t believe it will fix the problems of pain in the community as it’s a blunt approach to address the over-use of opioids in Australia”.

“The lack of a uniform mandatory real-time recording system has stifled pharmacists’ ability to identify patients who have been abusing, or misusing codeine,” Dr Jackson told AJP.

“That’s why a national real-time recording system is fundamental to future availability of codeine-containing analgesics – and PSA has publicly supported this move.

“Community pharmacists have the skills, knowledge and expertise to expertly advise patients on the effective and safe use of OTC analgesics for the treatment of acute, short-term pain.”

He says the PSA believes:

  • Mandatory real-time recording of opioids including codeine is fundamental to addressing the issues of opioid misuse in Australia; and
  • There is a need to provide support for pharmacists, consumers and general practitioners with the planned changes to prescription-only.

“PSA position has always been we support consumers continuing to have appropriate access to codeine containing OTC products with the advice of a pharmacist.”

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5 Comments

  1. Ron Batagol
    11/08/2017

    OMG-pharmacy organisations- get over it! How many times do we have to reiterate-OTC Codeine is dead in the water as it is in many other countries, for good reasos , whichever way you choose to spin it, nobody is going to think it’s worthwhile making and promoting it as OTC. Best thing pharmacist and pharmacy organisations can do is to encourage best practice professional advice on risk/ benefits/cautions for OTC customers using what will be available and to link up with the monitoring programs being rolled out!

    • Anthony Tassone
      12/08/2017

      Ron

      With the upmost respect I think there has been some disregard of the position of consumers in this debate by supporters of the up-scheduling decision.

      In a joint media release in December 2016 following the decision by the TGA delegate to up-schedule codeine, Pain Australia and the Consumer Health Forum called for better pain management services and re-iterated their opposition to codeine being up-scheduled. A link to the media release is below:

      http://www.painaustralia.org.au/static/uploads/files/20161220-codeine-joint-statement-wfwhivddpesj.pdf

      A relevant excerpt from the release is also below:

      “Both CHF and Painaustralia have opposed making codeine products prescription-only
      previously because it would penalise the majority of users who do not abuse it by
      requiring them to visit a doctor and potentially incur additional costs.
      The Government now needs a plan to help people with addiction to codeine or
      recommendations for referral to pain services for people misusing codeine.”

      Some countries overseas who have up-scheduled codeine have not had a comparable pharmacy or pharmacist only scheduling category and certainly have not had a real time monitoring solution in place should there be a drug misuse concern from visiting multiple pharmacies.

      In a currently underway consumer survey through community pharmacies with 585 responses received to date, relevant interim findings include;
      – over 90% of consumers supported pharmacists being able to supply codeine without a prescription under strict conditions including monitoring usage in a real-time recording system;
      – the most common reason for requesting an over-the-counter codeine product was for headache/migraine (treatment of an acute pain condition in line with the Guild’s proposal for still maintaining some OTC access in certain circumstances);
      – 72% of respondents indicated they would most likely visit a doctor to obtain a prescription for a codeine product they were using following up-scheduling;
      70% would not even consider an OTC alternative, and only 26% indicated they would definitely switch to an alternative medication available over the counter.

      One can only assume a level of exasperation with your post suggesting pharmacy organisations need to ‘get over it’ and ‘whichever way you choose to spin it’ however the Guild makes no apology for advocating for a common sense approach that will maintain some OTC access for acute pain episodes underpinned by a mandatory real time monitoring system as a clinical decision making support tool.

      You refer to ‘linking up with the monitoring programs being rolled out’. Currently there is only one prescription real time monitoring system in Tasmania which only records Schedule 8 items, its use is non mandatory and may not be scaleable for other larger states. This is not a criticism of the Tasmanian ‘DORA’ system as prescribers and pharmacists have already found it of some benefit, but there are some limitations.

      Victoria is anticipated to have a real time prescription monitoring system functional in 2018 and is the only state or territory at this point to have inclusion of schedule 4 substances of concern that will include; benzodiazepines, z-class substances, quetiapine and at a later point following its up-scheduling, codeine. This is in addition to having drug addiction counseling and support services and training of the doctors and pharmacist workforce in using the system and interacting with patients.

      It is unclear when the other states or territories will have a functional real time prescription monitoring system and what substances (whether they are only from Schedule 8 or may include Schedule 4) will be included.

      Unfortunately at this point, it is not as simple as ‘linking up with the monitoring programs being rolled out!’

      Anthony Tassone
      President, Pharmacy Guild of Australia (Victoria Branch)

      • Ron Batagol
        14/08/2017

        Thanks Anthony for that feedback. I understand completely the concerns on behalf of consumers who have been responsibly using codeine-based products for pain relief. It’s always difficult when legal availability channels are changed, albeit, as many of us believe, such a change reflects the consensus of informed and expert advice here and overseas. I remember we saw a similar reaction way back in the 1970s when Phenacetin was removed from Aspirin, Phenacetin, Caffeine combination pain relief products, after research on toxic outcome by Australian renal specialists. My point is that in all these cases, pharmacists have a unique opportunity to work with the situation as it evolves, and to assist clients to use what are available alternatives with best practice medication management advice , and also to be actively involved in monitoring inappropriate use and /or habituation or substance abuse. (Btw, the Guild is to be congratulated for being on the front foot in pushing for National ongoing monitoring programs for drugs/medications of ongoing concern).

    • Ronky
      14/08/2017

      It’s not “pharmacy organisations”, Ron, it’s just one organisation representing a tiny minority of pharmacists. The PSA’s ambiguous quoted statements seem to betray a tinge of embarrassment about the way that the Guild is carrying on.

  2. Ronky
    14/08/2017

    How much more out of out of touch with reality can the Guild get? To dismiss as “turf wars” a call to simply respect the scheduling decision, which was made following the most fulsome discussions and considerations by all stakeholders and considering all possible alternatives including MedsASSIST.

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