Australians have expressed anger and confusion about codeine on NPS MedicineWise’ Facebook page
The cascade of comments came after NPS posted alerting consumers to the upcoming codeine schedule change.
NPS linked to an article on its website highlighting the upschedule and inviting consumers to see if codeine was an active ingredient they take via the organisation’s Medicine Finder.
Dozens of people commented on the article, angry or upset over the TGA’s decision, and concerned as to whether they will be able to manage their pain effectively in the future, or be able to see a GP.
“What happens when you know the cause and your disease is incurable and you have flares at work? Do you have to take the day off from your tax paying job to waste more money with a bulk billing clinic?” asked Alicia Gray.
“I’ve had chronic, often severe, pain for 20+ years, I have willingly explored and use all the options, medications and alternatives like stretching, heat packs etc, I am in the words of my specialist “remarkable” in my ability to cope with the pain,” wrote another Facebook user, Sheridan Barac.
“But if I want and need to be a self supporting member of society, I do need codeine a few times a week to enable me to work, stronger pain meds affect my concentration and I take them only on the few, can’t get out of bed days, meds like ibuprofen and paracetamol do not help at all.”
“The last time I attempted to get in to my doctor the wait was more than a week,” wrote Rebecca Taylor.
“That doesn’t cut it when you’re in excruciating pain, have 3 kids, a job and can’t function! More time off work! Plus my out of pocket for a trip to the doctor is $40! That’s not counting the cost to medicare. For an $8 packet of pain relief!”
More than a few people were worried about how they would manage their migraines post-January.
“Well that’s just great,” wrote Rachael Young. “Treating my migraines just got a whole lot harder and more expensive not to mention every doctors office will be 10 times harder to get into.”
Others expressed disbelief that OTC non-codeine-containing analgesics would be of benefit to them.
“If pharmacists can recommend over the counter treatments that ‘are just as effective as low dose codeine but lack many of the side effects’, why aren’t they already doing so?” asked Vi Let.
“Are you suggesting that Australian pharmacists are knowingly recommending a treatment with harmful side effects over a less harmful but equally effective option?”
NPS MedicineWise valiantly explained to several people several times that they could talk to a pharmacist about relief from short-term pain, or a GP to advise on more chronic conditions.
A spokesperson for the Pharmacy Guild told the AJP that “every time this issue is raised in social media there seems to be a groundswell of people who object to the fact that their convenient access to medicines they believe they have used safely and effectively is about to be forfeited”.
“That anger is likely to grow as we get closer to 1 February.
“That’s why the Guild has proposed a sensible codeine exception that would retain safe and convenient access for appropriate use, with mandatory real time recording.”
Life after codeine
The anger expressed on social media highlights the need to “start discussions about life after codeine with patients,” says Karalyn Huxhagen.
Ms Huxhagen, former Pharmacist of the Year, group facilitator of the Mackay Pain Support Group and winner of the 2015 PSA Award for Quality Use of Medicines in Pain Management, presented on the issue at last weekend’s Pharmacy Controversies Seminar, held by the Australian College of Pharmacy.
“There are many alternatives available, and we need to have the discussions with them now as to is their pain acute? Is it chronic? Do they truly need the codeine part of it for their pain management?
“As pharmacists I think we need to know what else is available, and what else is of therapeutic value for these patients as well. We may or may not recommend items within the pharmacy, but we do have to give them intelligent ideas as to why they should revisit their GP to discuss better management of their pain.”
Ms Huxhagen says that pharmacists need to team up with other allied health professionals, such as podiatrists, physiotherapists, exercise therapists and occupational therapists, because items such as orthotics, or even “knowing which way to sit at your desk” can do a great deal to address some pain problems.
“We should be buddying up with these people, and if we refer people to the OT or the physio, stocking the items which are their favourite items.”
She also expressed concern at the number of people worried about treating their migraines post-upschedule.
Many may not have migraine at all, she says: just as cold symptoms are often incorrectly referred to as “flu,” the term “migraine” may be applied to bad headaches.
“A lot don’t truly have migraine, they have rebound headaches and call it migraine,” she says.
“I find with the mining guys and girls in particular, a lot of it is dehydration. They get so dehydrated, suck on codeine and blame migraine.”
But when people do suffer from migraines, “codeine in itself is a pretty poor painkiller. And if you truly are a migraine sufferer, you should be looking at the whole spectrum of why you get migraines: food intolerance, hormonal imbalance… migraine is a complete disease treatment portfolio in itself, and if you’re just relying on codeine to manage it, it’s poorly managed.”