Bowing to pressure?

Despite Guild reportedly “backing down” from lobbying over codeine upschedule, health groups are still concerned as ministers set to meet today

With health ministers across the country to meet on Friday, health groups have shared a joint concern that lobbying by the Pharmacy Guild may have put the codeine upschedule plan in jeopardy.

Health Minister Greg Hunt stated last week at the RACGP conference that “the Guild has reversed its position and has accepted the upscheduling in full”, although a spokesperson for the Guild told the AJP the organisation had not been seeking to reverse the TGA decision to upschedule codeine.

“However we have put forward a proposal to the States and Territories, which have responsibility for the drugs and poisons schedules in their jurisdictions, for a confined exception for acute pain only under a strict patient protocol with mandatory real time monitoring,” the spokesperson said.

“At this stage no State has accepted our proposal.”

Meanwhile a joint release from the Society of Hospital Pharmacists of Australia, Royal Australasian College of Physicians, Painaustralia, RACGP, Consumers Health Forum and Rural Doctors Association of Australia has expressed concern that health ministers meeting on Friday may seek to overturn the codeine upschedule in their states.

“We are concerned that some state and territory health ministers may bow to pressure from some pharmacy owners and seek to overturn in their states the decision supported by the Federal Health Minister, Greg Hunt, to make codeine available only after consultation with their GP,” the organisations have stated.

“The Pharmacy Guild representing owners has indicated that it is no longer campaigning for the regulation change not to proceed.

“However we fear that health ministers may press for this important decision to be watered down in the wake of a campaign suggesting people will be disadvantaged by having to go to the doctor to get a prescription for codeine.”

They say this suggestion is “highly misleading and damaging”, citing statistics that more than 100 Australians die each year as a result of codeine addiction.

“A failure to limit codeine to prescription-only would fly in the face of the unanimous decision of Australia’s state and federal health authorities to act on the weight of evidence – in line with 26 other countries which have already curbed over-the-counter codeine sales – creating a dangerous regulatory mess that will put more Australian lives at risk.”

Independent, not-for-profit medicines information organisation NPS MedicineWise has also come out in support of the upschedule, saying evidence shows paracetamol/ibuprofen combinations offer similar pain relief to that of codeine-based analgesics in acute pain, with generally improved tolerability.

“Paracetamol is an effective pain reliever for mild to moderate pain,” Dr Lynn Weekes, CEO NPS MedicineWise and pharmacist, tells AJP.

“In fact, studies have found that low dose of codeine (below 15mg) does not offer any benefit over paracetamol alone. Often non-pharmacological options are the best way for customers to manage acute pain.

“For pharmacists this change in codeine scheduling is an opportunity to advise about other treatments, such as heat or cold packs or, when appropriate, topical or oral NSAID preparations,” says Dr Weekes.

“Importantly pharmacists should discourage stockpiling of OTC codeine products and assist customers to switch to alternatives as soon as possible.”

Meanwhile the Pharmacy Guild has spoken positively about the upschedule in a recent interview.

“It’s something that’s handed down from clinical experts, and we have to respect that,” Guild spokesperson Greg Turnbull said in a recent radio interview on 2CC Canberra on Thursday morning.

“They’ve come to this decision. It will mean some inconvenience and perhaps some cost for some patients, but as you suggested, the important thing is that patients speak to their doctor or pharmacist about what alternative pain relief medication they might need.

“They might need a script for some of these medicines which they can currently buy over the counter, but it’s also possible that an alternative medicine might be available over the counter and they should talk to their pharmacist.”

The Guild spokesperson says its priority now is highlighting the importance of implementing a real-time monitoring system not only for Schedule 8 medicines, but also inclusive of Schedule 4 medicines.

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