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.

Previous Clinical tips: antibiotic resistance
Next Is your profession under threat from automation?

NOTICE: It can sometimes take awhile for comment submissions to go through, please be patient.

4 Comments

  1. Andrew
    03/11/2017

    I’m confused…so has Guild/PSA backed down or are they still lobbying? Medical groups crowing about a back down since last Friday but still no press releases confirming or clarifying?

    I’d heard that most of the state health ministers are on board but Greg Hunt who has the final call has said it will never happen.

    • Jarrod McMaugh
      04/11/2017

      Are you aware of the chess-playing-pigeon analogy?

      Most medical groups have said that the PSA & Guild position is to reverse the TGA decision

      This isn’t true.

      Greg Hunt has a discussion with the Guild, who very simply explain that the position is to create a Prescription Except When (specific circumstances) category. Specific criteria & pharmacist training are both required for this model.

      Greg Hunt can clearly see that this is not a reversal of the TGA decision; it is a proposal for a new system that can be expanded to other medications based on OS practice & evidence.

      Greg Hunt goes to GP17 – the RACGP conference & says that pharmacists aren’t asking to overturn the TGA decision.

      RACGP figureheads celebrate their victory over nothing by claiming they got what they were after, when in fact what happened was they were told that the thing they said was happening wasn’t actually happening at all.

      In other words, they were told that they have it all wrong, and they celebrated like they won something.

      Does that cover it for you?

    • Anthony Tassone
      04/11/2017

      Andrew

      There were recent media reports with regards to the Guild’s position on the up-scheduling of codeine suggesting that the Guild has ‘reversed its position’ and ‘will accept the up-scheduling in full’.

      As has consistently stated, the Guild has never sought to reverse the decision to up-schedule codeine but along with the PSA have put forward a proposal for a confined exception for acute pain only under a strict patient protocol and mandatory real time monitoring.

      The Guild has done this because we believe it is a common sense approach to address the issues of maintaining convenient access where appropriate for legitimate users and identifying at-risk patients given there is no real time monitoring at the prescription level.

      The Guild asked that our proposed approach be considered as part of a COAG Health Ministers discussion involving all State and Territory Health Ministers and the Federal Minister for Health Greg Hunt (which was held earlier this week).

      The Guild understands the complexity of this issue and that it is a matter for the State and Territory Health Ministers to decide the drugs and poisons scheduling in their respective jurisdiction. To date, no State or Territory Health Minister has taken up the Guilds proposal.

      Whilst the Guild has received a good hearing from the State and Territory Health Ministers, achieving collective agreement across all jurisdictions is a difficult task.

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

  2. Ron Batagol
    03/11/2017

    Dr.Weekes of NPS Medicine Wise,in the highlighted published statement in this article, has clearly and unequivocally summarised the KEY FOCUS FOR PHARMACISTS NOW!

Leave a reply