Codeine claims and counter-claims

woman taking pill - vector

Chief Medical Officer Brendan Murphy and the University of Sydney’s Peter Carroll have gone head-to-head on Radio National debating codeine efficacy and implication in overdose

The two spoke to the ABC’s Fran Kelly, with Professor Murphy explaining that the upschedule was happening for two reasons.

“Addition of low dose codeine to simple analgesics really adds very little if any additional benefit in terms of pain management,” Prof Murphy told Ms Kelly.

But the “main reason” is concerns about addiction, he said. Prof Murphy cited a statistic of 100 deaths a year from people misusing OTC codeine – a statistic which has been hotly debated in recent days.

People are dying of “a variety of drug overdoses but in a big study reported in the Australian Medical Journal, with a number of codeine-related deaths were looked at, at least 40% of them were related to over-the-counter codeine products; so sometimes they do take multiple drugs… but the main codeine-containing drug in 40% of the deaths in this paper were due to over-the-counter codeine,” he said.

Prof Murphy also told Ms Kelly that around 600,000 Australians are abusing low-dose codeine.

Peter Carroll countered the claim, saying he disputed the 100 deaths a year statistic and that the “vast majority” of people used low-dose codeine safely and appropriately for acute pain.

Yesterday (23 January) NSW Pharmacy Guild president David Heffernan queried the statistic, telling the AJP that it is “misleading” and defames the pharmacy profession.

Speaking to the AJP today after the Radio National broadcast, Mr Heffernan said that Mr Murphy needed to “set the record straight on the 100 deaths”.

“The public deserve better,” he said. “He said it was 40% deaths from OTC codeine, which is not true and at the end of the day it’s degrading to pharmacists to keep saying it.

“The 40% he quoted was 40% of the 40% they could identify with codeine, from one study which he did not identify. 

“He needs to set the record straight; or if he has other evidence to support his claims, he needs to produce it. Enough is enough on the spin.”


Codeine battle

Prof Carroll and Prof Murphy disagreed on a number of points in today’s broadcast, including who uses OTC codeine and how they use it.

Prof Carroll said that “at least 98% of people” who buy these products in pharmacy use them correctly and are at no risk.

But Prof Murphy countered with a claim that 20% of people who use codeine use it “chronically” and misuse it.

“Other data shows three-quarters of packs bought over-the-counter are used by these chronic abusers.”

Prof Carroll disputed claims that low-dose codeine adds little benefit when combined with other analgesics, and when asked by Ms Kelly why Painaustralia would support the assertion that it has little benefit, said, “they’re wrong”.

He said that MedsASSIST had been highly useful in tracking problem codeine users and warned that abusers would be enabled to doctor shop by the lack of a monitoring system post-1 February.

Prof Murphy told Ms Kelly the fact that a real time monitoring system (MedsASSIST) had been implemented to track OTC codeine sales showed that the drug was not suitable for the Pharmacist Only schedule.

“The definition of an over the counter drug, the S3 schedule, is that the drug is safe and not subject to misuse,” he said.

He also warned that people expecting to be able to receive a prescription for low-dose codeine from their GP post-upschedule may be disappointed.

“Doctors don’t prescribe useless drugs,” he said.

Instead, he expects that people seeking to manage pain will talk to pharmacist about paracetamol, ibuprofen and combinations of the two.

Listen to the full broadcast here.

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